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Tomblin query postpones state’s health care decision

CHARLESTON, W.Va. - Gov. Earl Ray Tomblin's administration was expected to make a key decision on health care reform by Sunday. Instead, he punted and asked seven questions.

State officials were expected to tell the federal government what kind of insurance plans companies would be required to offer in the state for years to come.

In 2014, the federal government will provide subsidies to currently uninsured middle income Americans so they can buy insurance.

The federal government doesn't want to pay for bare-bones or unhelpful insurance plans, so it's requiring people to receive "essential" benefits. States were supposed to come up with a set of minimum requirements by Sept. 30 or be assigned a default standard.

Tomblin spokeswoman Amy Shuler Goodwin said a week ago that the state was "researching our options and are in the process of finalizing our decisions before Sept. 30."

Instead, Tomblin sent federal regulators a list of questions this past Friday and made no decision.

The governor appears to have wiggle room, however. While the federal government set a deadline for a decision, a spokesman for the U.S. Department of Health and Human Services said Monday the dates were flexible.

Fred Earley, president of Highmark Blue Cross Blue Shield, West Virginia's largest private health insurance provider, said a lot of questions remain unanswered.

The unanswered questions are "very significant" and the federal government is "markedly behind schedule" in providing answers that are important to states and to insurance companies, he said.

West Virginia is now one of 17 states that have had no public activity on deciding their so-called "essential health benefits," according to Avalere Health, a national firm that monitors health policy.

All told, it's an indication Democrat Gov. Earl Ray Tomblin may not want to ruffle feathers ahead of the Nov. 6 election. Health care reform remains controversial.

Tomblin has, for instance, refused to appoint members to a health care-related board that was created by a 2011 law he signed as governor.

An advocate of health care reform, West Virginians for Affordable Health Care executive director Perry Bryant, said Tomblin's Friday sought answers to "very valid" but also "relatively minor" questions in the two-page letter.

"I don't think he'll get a response until after the election, and I don't think he'll make any decision on Obamacare until after the election," Bryant said.

A few of the questions are identical to ones Tomblin asked the federal government in a July 19 letter. That letter was never answered, Tomblin said.

In another looming deadline for Tomblin - though one that comes after the election - states are supposed to tell the federal government by Nov. 16 how they want to run their health insurance exchanges. The exchanges are basically a government-created marketplace for insurance.

A third decision, which officials may need to make next year, is whether the state will expand its Medicaid program to allow 130,000 or so West Virginians to receive the government-funded health care coverage.

But, so far, health care reform discussions - which will decide how or even if tens of thousands of West Virginians receive health insurance for the first time in their lives - are proceeding quietly. That's despite several high-price consultants the state has hired.

In other states, it is not so.

According to Avalere's analysis, 33 other states have made more progress on coming up with essential benefit plans than West Virginia, which has nearly a quarter million uninsured people. One of them is Texas, which is led by Republican Gov. Rick Perry, a public opponent of the national health care reform law.

The slow pace is also visible at the federal level. The state has previously asked federal officials for clarifications on several questions. The head of the state's Medicaid program told lawmakers recently the state did not expect an answer from the Obama administration until after the election.

Tomblin's questioning letter is his second this year to U.S. Secretary of Health and Human Services Kathleen Sebelius.

"We take very seriously the potential implications of the essential health benefit decision for West Virginia," Tomblin said in the letter.

"While we continue to analyze the essential health benefit benchmark options, we are constrained by the lack of answers to several questions we have posed related to the process, including questions asked in correspondence dated July 19, 2012."

Asked if the governor had punted and could have made a decision with the help of the health care board to which he has failed to appoint members, Goodwin said, "No.  First and foremost Gov. Tomblin needs answers to the critical questions he has asked of Secretary Sebelius.

"We have put together a team of experts who are working on cost projections so West Virginia can be well informed as the process moves forward," she said.

The U.S. health department is apparently sympathetic to states.

An official at the department said the department had sought to get states to make a decision by Oct. 1 so insurance companies would have ample time to design benefit packages. But the federal government is willing to work with states that file their plans belatedly.

Bryant said consumers would not be affected by any of the current delays but insurance companies might be. Without the essential benefit standards in place, the companies don't know what kinds of plans they can offer for customers who will be buying insurance through the insurance exchange.

"For insurance companies it begins to make it more difficult for them to make a realistic projection if they want to enter the exchange or not," Bryant said. "I think that's where you'll see this uncertainty have its greatest consequence."

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



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