Photo from: file image
WELLING — West Virginia’s Senate Majority Webb Ryan Weld said a potential legislative solution to the General Employees Insurance Agency’s current reimbursement issues could be addressed as soon as Wednesday — the first day of the next regular session of the West Virginia legislature.
On Thursday, WVU Medicine Wheeling Hospital announced that they would no longer accept PEIA patients, citing insufficient reimbursement to that hospital and others across the state.
But Weld, R-Brooke, noted last year that the Senate passed Senate Bill 574, which called for raising PEIA reimbursement rates for in-state hospitals.
Senate President Craig Blair, Berkeley, asked if the bill could be returned on the first day of session, and Blair agreed.
“The Senate had a bill (SB 574) that we passed unanimously last year,” Weld continued. “We did this in recognition that nobody is doing anything to improve reimbursement rates, and we wanted to avoid such an announcement that came (Thursday).”
The legislation, introduced by Sen. Mike Maroney, R-Marshall, has not been processed in the House of Representatives.
She called for raising the state hospital reimbursement rate from 59% to 110% of the federal reimbursement rate for Medicare.
“Looking back at what happened (Thursday), I asked Senate Speaker Blair if we could have this bill implemented on the first day of the legislature because of the enormity of the problem, and the knowledge that it had to be addressed,” Weld said. “There could be other solutions as well, but this is the one we all know about.
“PEIA has always had a major structural flaw in its program, and it is in perpetual need of rescue. We need to find a permanent solution.”
Union leaders representing Ohio School District employees are telling members they currently still have the Public Employees Insurance Agency in place — at least until July 1, and they should contact state lawmakers now to ensure the issue is a priority at the start of the next legislative session.
Ohio County School Service Personnel Association president Jerry Ames said he contacted the central business office of WVU Medicine in Morgantown on two occasions Thursday, giving them his name and title as president of OCSSPA.
Both times different employees read him an email they received verbatim telling him “the situation should be resolved soon”.
Made an additional call Friday morning and was told the same thing.
Ames added, “Three people told me ‘the problem will be solved’, and I deal with them.”
Letters left by the Sunday News-Register to the same office on Friday were not immediately returned.
Ames hopes that a statement will be issued soon indicating that PEIA coverage at Wheeling Hospital will continue after July 1.
“I don’t want our employees to be afraid of not knowing whether or not they will have insurance. I feel sorry for them,” Ames said.
Currently, he continued, all employees with PEIA health coverage have medical insurance.
“It’s as good as gold now,” Ames added. The specified date is July 1.
Wheeling’s move Thursday came less than a week before West Virginia lawmakers meet for their regular session in Charleston.
Ames called Wheeling Hospital’s withdrawal of PEIA coverage a “scare tactic” as they seek a higher rate of reimbursement for the procedures. He is also not sure what will happen in the legislative session of this session regarding PEIA funding.
Lawmakers are looking at how best to spend the $1.3 billion in budget surplus, and using some of the money to prop up the PEIA is likely to be discussed.
“Why don’t they allow more payment?” Ames asked. Then they have an excess. Maybe it needs to be reallocated in a different way.
“They need to stop worrying about a (proposed) 10% tax cut, or an inventory tax cut. It’s a big political game.”
Jenny Craig, president of the Ohio County Education Association, is urging those with PEIA insurance — even if they choose a health plan option as their coverage — to contact lawmakers this weekend before the regular session begins on Wednesday to press the importance of supporting PEIA.
She has been speaking with lawmakers herself, as well as other state officials. One question they were all asked was whether public servants who chose the health plan option that was offered to them instead of the PEIA option would be affected by the WVU Medicine-Wheeling decision.
WVU Health System President and CEO Albert Wright confirmed Friday that the health plan option will be included in Wheeling Hospital’s PEIA ordinance. The PEIA and health plan option reimbursements are about the same, Wright said.
“We have a lot of concerns,” Craig said. “Our (WVEA Education Association) hope is that during the legislative session there will be so much good work done to fund and make payable PEIA that both members and hospital systems will be able to afford and accept PEIA coverage. This is the goal that WVEA has fought for Since the (teachers’ strike) of 2018.
“The pressure will be on the legislature to step in and make sure that PEIA insurance is affordable and affordable enough for not only members, but for hospitals to accept coverage.”
While Wheeling is the only hospital to announce that they will not accept PEIA insurance after July, Craig noted that the fear is that others in the WVU medicine system and other hospitals in the state may soon follow suit.
“The reimbursement rate is low, and work will need to be done this session to correct the discrepancies,” she continued. “That’s why it’s important to make this a priority at the beginning of the session.”
The Wheeling Hospital announcement affects not only teachers and school personnel, but also state troopers, corrections officers, and city and government employees. According to Craig, the vast majority of government employees in West Virginia receive coverage through PEIA.
“PEIA funding should be a renewed top priority at the start of the session or there will be a crisis,” she said. “We need a long-term financing solution.”
Craig admits she’s not sure what that looks like.
She noted that in the aftermath of the teachers’ strike in 2018, the legislature promised full funding and access to a reliable funding stream for PEIA. And she continued: A task force was formed to delve into the matter, “but it has not met for two years.”
The school staff often skips health checks, surgeries, and doctor’s appointments until the summer when they have time off, and Craig often explains to their family.
Another problem, she added, is that many local doctors are from Wheeling Hospital, and it is already difficult to find a primary care doctor locally.
“July 1 is not a long time – just a few months, and that’s only if everyone can move quickly,” Craig continued. “Our members need to call the legs next week, so the legislature is making that a priority when the session begins. Now is the time to do it before the session begins.”
Delegate Charlie Reynolds, R-Marshall, issued a statement Friday indicating that he sent a letter to Gov. Jim Justice regarding the PEIA issue.
In the letter, he states that PEIA issues “must be resolved immediately.”
“My constituents, and the people of the entire Northern Panhandle, are deeply hurt by this decision as an unusually high percentage of my constituents rely on PEIA and WVU Medicine for their health care needs,” Reynolds wrote. West Virginia taxpayers are getting the short end of the stick because two state-funded entities are at odds with each other.
Gov. Justice, at the end of the day, no matter how complex the issues, our common constituents lose significant access to health care,” Quite simply, this is government at its worst and my electorate deserves better. These issues must be addressed immediately. Accordingly, I demand that “Your office immediately coordinates and participates in a meeting involving all interested parties. I am asking your office to address and resolve these very important issues. I look forward to working with everyone as we resolve these issues as soon as possible.”