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.