West Virginia Senate Rejects PEIA Reimbursement Bill | News, Sports, Jobs
CHARLESTON — A majority in the West Virginia Senate on Friday rejected a bill that would have addressed state health insurance program reimbursement rates for public workers.
Senate Bill 574 on the State Public Employees Insurance Agency was defeated 14 to 20.
The only member of the 11-member Democratic minority to vote for the bill was Sen. Bob Plymale, D-Wayne. Of 23 Republicans, 10 voted against the bill.
SB 574 would create two funds within the PEIA. One would cover administrative costs for state employees and the other would cover administrative costs for non-state employees.
The bill would also require the PEIA to reimburse hospitals for non-state employees at a rate negotiated by the PEIA and the hospital beginning in 2023.
Senate Health and Human Resources Committee Chairman Mike Maroney, R-Marshall, said the PEIA serves between 220,000 and 230,000 members with about 30,000 members in the non-state employee pool. Maroney said many spouses of state employees are leaving their private insurance plans for PEIA and receiving similar coverage, but with much lower premiums.
According to the PEIA, the reimbursement rate for all plan members is nearly 60% of Medicare levels. Current law does not allow PEIA to negotiate separate rates for state and non-state employees.
The bill would likely increase premiums for entities participating in the non-state employee plan and result in more than $11.4 million in expenses if that reimbursement rate were increased to 125% of Medicare.
“They have comparable coverage, but how can their premium drop by $400 a month? It’s because we subsidize their insurance,” Maroney said. “If we as a state and a legislature want to subsidize cities, counties and political subdivisions for non-state employees, that’s a decision we have to make. But we don’t subsidize with state money. We say we’re going to subsidize you, but hospitals and providers pay for it. It is simply wrong.
Sen. Ron Stollings, D-Boone, opposed the bill. A doctor in his hometown of Madison, Stollings said the bill doesn’t go far enough to address issues with hospital PEIA reimbursement rates.
“We talk about kicking the box on the road. We don’t even kick the box to have any real impact,” Stollings said. “Unless you dramatically increase rates on that tiny fraction of policyholders.”
Stollings introduced his own bill Friday, Senate Bill 677, which would top PEIA reimbursements up to the Medicare rate by raising the current soda tax from 1 cent to 5 cents.
“We’re going to have to come to the table with more premium impact than 13% of policyholders,” Stollings said. “We’re going to have to come to the table here and get a better risk pool…we have to be serious here in a multi-faceted approach if we’re going to deal with this.”
Although the bill failed, a successful amendment was made by Senate Majority Leader Tom Takubo, R-Kanawha. A pulmonologist, Takubo’s amendment would have allowed PEIA to negotiate reimbursement rates with emergency medical service providers.
“It just allows EMS providers to align with what we’re trying to do with hospital providers and allow those hospitals to negotiate the exact same thing that we allow Kentucky, Maryland, Ohio, Virginia and Pennsylvania to do.” said Takubo.