Lawmakers, Unions Weigh in on WVU Medicine Wheeling Hospital PEIA Decision
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WHEELING -- West Virginia Senate Majority Whip Ryan Weld said a possible legislative solution to current Public Employee Insurance agency reimbursement issues may be addressed as soon as Wednesday -- the first day of the upcoming regular session of the West Virginia Legislature.
On Thursday, WVU Medicine Wheeling Hospital announced they would no longer accept PEIA patients, citing inadequate reimbursement to that hospital and others around the state.
But Weld, R-Brooke, noted last year the Senate passed out Senate Bill 574, which called for raising the PEIA reimbursement rates for in-state hospitals.
He has asked Senate President Craig Blair, R-Berkeley, if the bill can be brought back the first day of session, and Blair has agreed.
"The Senate had a bill (SB 574) we passed out unanimously last year," Weld continued. "We did it out of recognition that nobody was 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, failed to be addressed in the House.
It called for raising the reimbursement rate to in-state hospitals from 59% to 110% of the federal Medicare reimbursement rate.
"Given what happened (Thursday), I asked Senate President Blair if we could do this bill on Day 1 of the Legislature because of the immensity of the problem, and knowing that it has to be addressed," Weld said. "There could be other solutions as well, but this is the one we are all familiar with.
"PEIA has always had a massive structural imbalance to its program, and it is in constant need of being bailed out. We need to find a permanent solution."
Union leaders representing Ohio County Schools personnel tell members they do presently still have their Public Employees Insurance Agency - at least until July 1, and they should contact their state lawmakers now to make sure the issue is a priority at the start of the upcoming legislative session.
Ohio County School Service Personnel Association President Jerry Ames said he called the central business office for WVU Medicine in Morgantown on two occasions Thursday, and he gave them his name and his title as president of the OCSSPA.
Both times different employees read to him verbatim an email they received telling them "the situation should be resolved soon."
He made an additional call Friday morning and was told the same thing.
"I have had three people tell me that (that the issue will be resolved), and I take them at their word," Ames added.
Messages left by the Sunday News-Register to the same office on Friday were not immediately returned.
Ames hopes there will be a statement released soon indicating that PEIA coverage at Wheeling Hospital will continue after July 1.
"I don't want our people to be scared not knowing whether they are going to be insured. I feel sorry for them," Ames said.
For now all employees with PEIA health coverage do have medical insurance, he continued.
"It's good as gold right now," Ames added. "The date given was July 1."
The move by Wheeling Hospital on Thursday came less than a week before West Virginia lawmakers convene for their regular session in Charleston.
Ames called the pulling of PEIA coverage by Wheeling Hospital "a scare tactic" as they seek a higher rate of reimbursement for procedures. He also isn't certain what will happen at the Legislature this session regarding PEIA funding.
Lawmakers are looking at how best to spend a $1.3 billion budget surplus, and using some of the money to shore up the PEIA system is likely to be discussed.
"Why are they not allowing more reimbursement?" Ames asked. "Then they have a surplus. Maybe it needs to be reallocated a different way.
"They need to quit worrying about a (proposed) 10% tax reduction, or a reduction in inventory tax. It's all a big political game."
Ohio County Education Association President Jenny Craig urges those with PEIA insurance - even if they have selected the Health Plan option as their coverage - to contact their legislators this weekend before the start of the regular session on Wednesday to press the importance of shoring up PEIA.
She has been speaking with legislators herself, as well as with other state officials. One of the questions they all have had is whether public employees who choose the Health Plan option offered them rather than the PEIA option would be affected by WVU Medicine-Wheeling Hospital's decision.
WVU Health System President and CEO Albert Wright confirmed Friday that the Health Plan option would be included in Wheeling Hospital's PEIA edict. Wright said the reimbursements from PEIA and the Health Plan option are about the same.
"We have many concerns," Craig said. "Our hope at the (West Virginia Education Association) is that during the legislative session, there will be a lot of good work to fund PEIA and make it solvent so that both members and hospital systems will be able to afford and accept PEIA coverage. This is a goal the WVEA has fought for since (the teachers' strike of) 2018.
"The pressure will be on the Legislature to intervene and make sure PEIA insurance is solvent and affordable enough not just for members, but for hospitals to accept the coverage."
While Wheeling Hospital is the only hospital to announce they would not be accepting PEIA insurance after July, Craig noted the fear is that others in the WVU Medicine system and other hospitals in the state might soon follow suit.
"The reimbursement rate is low, and work is going to have to be done this session to rectify the differences," she continued. "That is why it is important to make this a priority at the beginning of the session."
Wheeling Hospital's announcement doesn't just affect teachers and school personnel, but state troopers, corrections officers, and city and government workers. And the vast majority of government employees in West Virginia do receive coverage through PEIA, according to Craig.
"Funding PEIA will have to be a renewed top priority at the get-go of the session or there will be a crisis," she said. "We need to have a long-term funding solution."
Craig admits she is not sure what that will look like.
She noted that following the teachers strike in 2018 the Legislature promised to fully fund and have a reliable funding stream for PEIA. A task force was formed to delve into the matter, "but it hasn't met in two years," she continued.
School employees often forgo health screenings, surgeries and doctor's appointments until summer when they have time off, and so often do their families Craig explained.
Another issue is that many local doctors are affiliated with Wheeling Hospital, and it is already hard locally to find a primary care physician, she added.
"July 1 is not a lot of time - only a few months, and that is only if all can act quickly," Craig continued. "Our members need to be contacting legs in the next week so the Legislature makes this a priority when the session starts. Now is the time to do that before the session starts."
Delegate Charlie Reynolds, R-Marshall, released a statement Friday indicating he had sent a letter to Gov. Jim Justice regarding the PEIA issue.
He states in the letter that the PEIA matters "need resolved immediately."
"My constituents, and the residents of the entire Northern Panhandle, are being severely harmed by this decision as an extraordinarily high percentage of my constituents rely on PEIA and WVU Medicine for their health care needs," Reynolds wrote. "The taxpayers of West Virginia 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 are, our mutual constituents are losing substantial access to health care," he continued. "Quite simply, this is government at its worst and my constituents deserve better. These issues need addressed immediately. Accordingly, I am requesting that your office immediately coordinate and participate in a meeting involving all interested parties, and myself to address and resolve these very important issues. I look forward to working with everyone as we resolve these issues as soon as possible."