By: David Beard, The Dominion Post
MORGANTOWN, W.Va. — The Public Employees Insurance Agency (PEIA) Finance Board came to Morgantown Monday evening for a public hearing. About 75 people turned out; 16 addressed the board, urging a long-term funding fix, fairness for patients seeking out-of-state care, and a severance tax hike.
PEIA plan participant Sue Kelly didn’t have any specific suggestions but offered the board a rhetorical lecture.
“We depend on the PEIA Finance Board to do more than just count pennies,” she said. “We expect you to have a moral and ethical stance of some nature that recognizes the value of the human beings in West Virginia. … We are furious at not having good health care. We’re furious that we have to fight for it every single year. We’re furious that we are disregarded in comparison to corporations. We are the people of West Virginia. We are the people and you owe us care.”
The board meets Thursday to consider proposals for the 2020 plan year. This was the second of four public hearings this week on the proposals. The first was Thursday in Beckley. The next two are Tuesday in Charleston and Wednesday in Martinsburg.
PEIA Director Ted Cheatham walked briefly through the plan proposals. He noted that Medicare retirees will see no benefit or premium changes for 2019 or 2020, barring any federal changes.
For all others, the board is considering two proposals: one from the Gov. Jim Justice to the PEIA Task Force and one from the Task Force to the PEIA board.
Both proposals remove the $25 copay for out-of-state services and add an appeal process for non-preferred prescription drugs.
The major difference between them is coverage for out-of-state services. Right now, all participants a 70-30 coinsurance split, where PEIA covers 70 percent of the care. Justice proposes going to 80-20 for the majority of participants, under Plan A, for care in border counties. The Task Force proposes 80-20 for Plan A participants at all out-of-state locations – such as the Cleveland Clinic or UPMC.
There’s a cost difference between the two. Under the governor’s plan, PEIA will use $49 million of surplus funds in 2020 to cover costs; in 2021 it will seek an additional $98 million from the Legislature and $24.5 million from employees. The Task Force plan will draw $53.4 million from surpluses in 2020 and will call for $106 million from the Legislature and $36.5 million from employees in 2021.
West Virginia Education Association President Dale Lee sits on the Task Force and pointed out that the 2021 projections don’t include the $100 million Justice proposes to put into PEIA during the 2019 session. That could keep costs contained a bit longer and buy more time to find a real solution.
“The topic of cross-border care was one of the most frequent concerns that was heard from plan participants,” he said, and WVEA supports the Task Force plan. “The task force plan is really a fairness issue compared to the governor’s proposal. The difference of the cost is not that great that it can’t be done.”
WVEA supports the appeal process for non-preferred drugs, he said. A doctor should decide what medication is needed. WVEA also supports the wellness program but urges the board to consider an alternate online version for rural participants who live too far from gyms and wellness centers.
John Taylor spoke for the West Virginia Association of Retired School Employees, whose members live on fixed incomes while healthcare costs steadily rise. “We don’t have any pay increases to help us along.”
Like the other speakers, he appreciates the two-year hiatus on changes, but costs have to be contained long term. “We believe the PEIA board should be our advocates,” he said.
He was among those who suggested that the board annually propose two plans: one based on available funds with whatever cuts and cost hikes are needed, and one that keeps benefits and premiums the same while seeking money from the Legislature to make up the difference.
Norma Taylor, president of the Harrison County chapter of West Virginia Association of Retired School Employees, was one of several urging the board to push the Legislature to raise the oil and gas severance tax.
“Our state government has consistently given up many millions of dollars through tax giveaways,” she said. “The lost revenue would have been more than enough to take care of PEIA. The state must invest in its people and this finance board must tell Gov. Justice and the Legislature to do that.”
Delegate Barbara Evans Fleischauer was among the local legislators who attended. She suggested that PEIA look into joining the anti-trust litigation against generic pharmaceuticals manufacturers going on in the U.S. District Court for the Eastern District of Pennsylvania. The most prominent among those suits is one where West Virginia is among 47 states suing 18 drug makers alleging collusion to inflate costs.
“We’re being cheated,” she said. “We know that’s what’s happening.”