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State signs up rock star health reform consultant

CHARLESTON, W.Va. - Facing tough decisions over health care reform, West Virginia is turning to one of the nation's top health policy experts.

The state will pay MIT professor Jonathan Gruber $121,500 to understand the state's health insurance landscape and "revisit key assumptions" about state health care policy.

Gruber is a policy rock star of sorts. He's advised more than a half dozen states on health care reform. He was a key architect of Massachusetts' reforms when Republican Mitt Romney was governor.

During the 2008 election, Gruber advised three Democratic presidential campaigns. Afterward, he helped crafted President Barack Obama's health care reform law.

The New York Times called Gruber "Mr. Mandate" for his work focused on the individual mandate, the provision in the national law that requires most Americans to buy insurance or pay a penalty.

But Gruber is only one part of an $861,000 multi-part contract the Offices of the Insurance Commissioner signed on Aug. 28.

The state is also hiring Maryland-based CCRC Actuaries and Pennsylvania-based consultant Mike Madalena, a computer database expert.

Their mission is to provide the state with a "clear and comprehensive understanding of the current state of health insurance coverage." 

That understanding could play a key role in two major decisions.

First, the insurance commissioner's office is trying to decide how to set up a health insurance exchange in the state. The exchange is essentially a virtual marketplace for insurance. If the state doesn't establish its own exchange, the federal government will run an exchange for the state.

Second, Gov. Earl Ray Tomblin is trying to decide whether to spend millions to expand the state's Medicaid program.

Earlier this year, the U.S. Supreme Court preserved much of the national health care reform law. But it ruled states could opt out of a federal plan to expand Medicaid, the state and federally funded health care program for the poor.

Before he opts in or decides to stay out, Tomblin wants to know more about what it will take to use the program to provide health insurance to 130,000 low-income West Virginians.

The decision is one of the most important issues facing the Legislature and the governor next year.

So far, several Republican governors have said they will not expand their Medicaid programs, citing immediate costs. Several Democrats have said they certainly will, citing benefits. And many governors are like Tomblin, divided between the costs and the benefits.

Tomblin has a number of questions about the expansion. In July, he put them in a letter to U.S. Secretary of Health and Human Services Kathleen Sebelius.

The state has received no reply.

Earlier this week, a legislator asked when the state would get a reply.

"I can predict it will be after the election," state Medicaid director Nancy Adkins said during a legislative committee meeting.

Hiring Gruber and CCRC seems to be an indication Tomblin intends to take the decision seriously, but administration officials are doing little to take credit for doing their homework.

Perhaps that's because Republicans are attacking Tomblin ahead of the Nov. 6 election for his support for "Obamacare."

Questions for the Offices of the Insurance Commissioner were directed to the Governor's Office.

Tomblin's spokeswoman said in an email, "the consulting group will evaluate our options only."

Perry Bryant, the executive director of West Virginians for Affordable Health Care, said he was excited to have Gruber and CCRC in the state.

The state Public Employees Insurance Agency has used CCRC for years. The firm's managing partner, David Bond, is respected both for his work and his clear explanations to lawmakers.

While there's a cloud of political dust over health care reform in West Virginia, it's been a challenge for officials to have an honest policy debate.

That's, in part, because there's disagreement on basic facts, including how many uninsured West Virginians would be covered by the Medicaid expansion. The 130,000 number is basically an educated guess.

In the first years of the expansion, the federal government would pay, but there may be hidden costs to the states.

There are also uncertain long-term costs. Tomblin has expressed concern over the deeply indebted federal government's ability to keep its promises to pay a large share of the expansion costs.

In 2009, CCRC did a study to estimate a Medicaid expansion scenario. The basic assumptions were different than what ended up in Obama's law, but the model found the state could save $288 million on charity care in 2014 and more in later years.

"It's not like they're going to start from fresh," Bryant said of CCRC.

CCRC may be able to come up with estimates officials can agree on. The firm has previously helped with that.

In 2009, there was a calculation dispute over non-pension benefits promised to teachers and other public employees in retirement.

PEIA estimated the costs to the state at $7.8 billion.

The state chapter of the American Federation of Teachers commissioned its own study that came back with a far smaller number. The estimate set off a brief skirmish over the size of the problem the state was fighting to solve. Eventually, CCRC's numbers became the gospel for lawmakers.

The state has a number of other health care consultants. Several weeks ago Tomblin hired Pennsylvania-based Public Works for a $390,000 audit of the state Medicaid program and eight other state health care agencies.

Contact writer Ry Rivard at or 304-348-1796. Follow him at



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