Don't let the feds run the show.
A Wyoming group spent more than a year studying options for a health insurance exchange. They weren’t certain how an exchange would work in a lightly populated state, or how much the operation might cost. But the Wyoming Health Benefits Exchange Steering Committee did agree on one thing: The state shouldn't cede control to the federal government.
But nine months after the group last met, that's exactly what's happening. Along with 24 other states, Wyoming failed to submit a plan for an exchange by the Dec. 14 deadline. Now, the federal government is expected to operate a program on Wyoming’s behalf.
Exchanges, virtual marketplaces where consumers can shop for insurance, are a key part of the federal health reform law. States are required to have one running by 2014. Federal officials promise to operate programs for states that fail to comply.
Some Wyoming leaders, including Gov. Matt Mead, say the state's attempt to study an exchange was hampered by a lack of information from federal counterparts.
But even more critical was a bill passed by state’s own Legislature, which halted the exchange group's work until after the U.S. Supreme Court ruled on the Affordable Care Act. The bill also prohibits Wyoming leaders from committing to an exchange until next April.
“We played a lot of politics with the (Affordable Care Act),” said Anne Ladd, chief executive of the Wyoming Business Coalition on Health. “We tried to pretend it wasn't the law of the land. We hoped it would get overturned. When it wasn't overturned, we hoped we would get someone else in office.”
Before the 2012 legislation session, Wyoming appeared on track to meet the federal timeline for exchanges, said Sen. Bill Landen, a Casper Republican who served on the committee. The group recommended accepting federal grant money and conducting more study of exchange options.
After lawmakers enacted the prohibition, the committee met in March and essentially stood down, Landen said. Some lawmakers on the committee continued to gather information, but the prohibition limited their work.
“We kind of put the car in neutral, to be honest,” he said.
In June, the Supreme Court upheld most of the Affordable Care Act, including parts related to health exchanges. By September, lawmakers were publicly acknowledging that Wyoming wouldn't meet the deadline, setting the stage for a federal exchange.
There’s no guarantee Wyoming would have avoided a federal takeover if the committee had been allowed to continue its work. But the state would have been farther along in the process, Landen said.
Still, he and other lawmakers aren’t ready to call the prohibition a mistake. Sen. Charles Scott, co-chairman of the Legislature’s health committee, said taking federal planning money would have committed the state to an exchange. The prohibition, he maintains, was a good idea.
Others aren't so sure. Barb Rea of the pro-health-reform group Consumer Advocates: Project Healthcare noted the exchange group invested considerable time and effort to study the issue.
“To have the Legislature come in and say, 'We don't want to hear what you say anyway,' it's so defeating,” she said.
But allowing the federal government to take first crack at the exchange isn't a bad thing, Rea continued. It gives the state time to decide which parts of the program it would like to control.
“As we gradually learn what the difficult jobs are, we can gradually take it over,” she said. “That seems to me to be not threatening, very logical and something that is going to pay off for Wyoming citizens.”
Some lawmakers want to create a new group that could help with that process. The group would be tasked with monitoring the federal exchange and recommending whether Wyoming should partner with the federal government or run its own program.
A key legislative committee rejected legislation earlier this month that would have formed such a group. But Landen and other lawmakers plan to still sponsor the bill in next months' general session.
Wyoming is not necessarily in a bad situation, given that it can opt back in down the road, Landen said.
“It is going to give us the time to observe and evaluate and still have a couple of years to decide if we want to do something differently,” he said.