Some lawmakers fear the health care advisory group will push for Medicaid expansion

A proposal to create a Wyoming health care authority at the Joint Committee on Health, Labor and Human Services meeting Monday turned into a prolonged back-and-forth with accusations of a hidden agenda to push Medicaid expansion and increased of government regulation.

The Health Authority would serve as an advisory group and monitor changes in the health sector and provide policy recommendations to state legislators. Its focus would be on accessibility, affordability, quality and innovation in healthcare.

“The mission of this group is to engage in collaborative decision-making to improve health outcomes and economic diversification,” said Jen Davis, chief of Health and Human Services for Gov. Mark Gordon, who introduced the proposal. .

Hidden agenda?

Some committee members objected, saying a task force made up primarily of representatives from the health sector would push an agenda.

“There is no agenda outside of this body,” Davis said in response. “This is to improve health care in the state of Wyoming.”

Davis said the purpose of the authority is not to circumvent any legislative oversight and that the health care industry’s relationship with the Legislature and the general public is not working well. While he didn’t provide any specific examples, he said laws have sometimes been passed that may serve a group of people but not all residents.

“I think the voters might come to all of you and hear one side of the issue and not necessarily all sides of an issue,” he said. “And sometimes that results in a policy that doesn’t work for everyone.”

Rep. Sarah Penn, R-Fort Washakie, agreed with Davis that the Legislature’s relationship with the health care industry isn’t working well, but said that’s because of too much government involvement.

“I think this is moving us in the wrong direction,” he said. “This public-private relationship worries me a lot.”

It also questioned why the authority’s objectives could not be achieved through the mechanisms that currently exist.

Some committee members, such as state Rep. Ben Hornok, R-Cheyenne, said creating a 19-member panel would result in a push for Medicaid expansion in Wyoming, something the Legislature has repeatedly rejected .

Hornok asked Davis if when he was talking about past failed efforts he was referring specifically to Medicaid expansion.

Davis said it was not, and rather was taking a broader approach to consider all options for healthcare solutions.

“Continuing the discussion about Medicaid expansion has shown that it’s not something our legislature wants to move forward with,” he said.

While all members of the Labor, Health and Human Services Committee have some kind of knowledge or experience in health care, Davis said not all have in-depth experience.

“When we talk about making complicated decisions, I think it’s imperative that we have the industry, the experts who are doing these things and making the policy and implementing the policy that you’re all making at the table,” he said.

Davis said part of the purpose of the authority would be to iron out differences of opinion among Wyoming’s health industry leaders in their own meetings so that a unified message can be delivered to lawmakers in the future. Davis also made it clear that the Health Authority would not be the deciding factor behind all health care decisions in Wyoming.

It is necessary?

Some of the more conservative members of the committee, such as Hornok, expressed skepticism and outright opposition to the proposal.

Penn said there’s already a lot of communication and coordination between the health care industry and the Legislature, and it’s not the government’s role to foster positive relationships between those groups.

“I don’t think we need an authorized government entity to say, ‘OK, let’s get in the same room and do this,'” he said.

The authority would be considered a quasi-governmental entity and a cabinet member of the executive branch who would serve under the authority of the governor. It includes state health department heads, legislators, members of the general public, and licensed health care professionals.

Rep. Jeanette Ward, R-Casper, asked Davis if it’s better for public transparency to have these stakeholders coordinate far outside the Legislature. Sen. Lynn Hutchings, R-Cheyenne, expanded on that thought, saying the authority would add another layer to a government bureaucracy full of members many in the public allegedly don’t trust.

Many far-right lawmakers like Hutchings have expressed their lack of trust or support for Wyoming’s health care leaders.

“This bothers me because you’re trying to alleviate a process that seems to be working very well and insert a layer that we’re concerned about into the process,” he said.

Sen. Anthony Bouchard, R-Cheyenne, went even further, saying the Legislature’s purpose is to protect residents from the personal agendas of the health care industry. He cited the Affordable Health Care Act and the initial response to the COVID-19 pandemic as examples and asked how personal agendas could be avoided.

Bouchard also floated some conspiracy theories about COVID and where the push from the Health Authority may be coming from. In 2023, New Mexico created its own health authority.

“I’m frankly horrified to think that we’re going to get experts in a room and they’re going to come and tell us what it’s going to be like because they have the best views,” he said.

Davis did not deny that his staff has looked at what other states have done, but said there was no outside influence in the push to establish the group, noting how there have already been two health authorities in Wyoming in the past and that each physician member of the group should be a resident of Wyoming.

Under the leadership of former Governor Mike Sullivan, a health reform commission operated from 1993 to 1994. This effort resumed in 2003 to generate solutions for liability for medical malpractice, medical errors, health care rural, provider supply, health information technology, Wyoming’s uninsured population, Medicaid, and expanded access to health care.

In the final report issued by the second commission in 2009, the council made recommendations for the establishment of a non-profit patient safety organization, a permanent health policy entity and the continuation of the foundation of health professions data.

Davis said very few of the recommendations that came out of those commissions became law, many of which are some of the same recommendations being considered today.

“After that there was no ongoing conversation to make sure those recommendations continued to move forward,” he said. “They have fallen flat.”

All voices

He also said that the creation of appropriate health policies derives from a comprehensive approach that includes experts from as many parties as possible to spend as much time as possible studying an issue.

“If we don’t have all the right people at the table who know what the impacts are, we can’t make good, informed decisions,” he said. “Good, informed decisions are what lead to good policy.”

Penn found fault with that position, as she and Bouchard believe those who disagreed with what local governments and health leaders were saying about COVID had their voices silenced during the pandemic.

Ward said significant public trust in the health industry had been lost since the pandemic and criticized the fact that only one member of the authority would be a general resident, but one would also be a business owner and another Wind River tribal. member

Although the authority would be non-partisan, many of its members would be appointed by the governor.

What exists now

In 2020, Gordon started a health task force during the height of the pandemic to address the immediate needs of the health sector and develop implementation strategies to prevent serious complications and deaths.

Once the pandemic began to subside, the health task force continued, but changed its trajectory to focus on health care issues relevant to Wyoming. Gordon’s directive to the group was to develop recommendations to reduce costs for Wyoming residents while ensuring adequate access to care for all Wyoming residents.

Some of this group’s legislative accomplishments include expanding the state’s 2-1-1 capacity and funding the Family Resource Network.

Davis said the Health Authority, which would be enshrined in state law and made permanent, would be the evolution of the task force, which could expire at the end of the Gordon administration. Like the task force, the authority would not have the power to enact laws.

“This authority has no real authority other than to make recommendations,” said Rep. Mike Yin, D-Jackson.

But Davis said not every recommendation that could come out of the Health Authority would require legislative action, as some recommendations could fall within the governor’s rulemaking authority.

He compared it to the Wyoming Power Authority, which uses a public/private partnership for its work. This group operates with a budget of approximately $300 million, most of which is disbursed for various energy projects.

The Health Authority would operate on a much smaller budget, mainly contained in the salary of a full-time chief executive.

“The habit of government is to get bigger and bigger,” Penn warned. “And in the end, we may still get nothing.”

Davis and some other health care representatives who also defended the authority referred to legislation passed in the 2024 session that requires health insurers and contracted utilization review entities to follow and waive certain prior authorization regulations.

Sheila Bush, executive director of the Wyoming Medical Society, said the authority will follow the sometimes contentious discussions that took place within the task force on the issue.

“How do we codify it and recreate it so that people beyond us in the future can continue to benefit from it and the people of Wyoming can benefit from these policies?” Bush said.

The creation of the authority would have to be approved by the legislature. A bill that would create the authority and specify who its members could be will be considered at the committee’s next meeting in June.

Leo Wolfson can be reached leo@cowboystatedaily.com.