Legislature Passes GO HELP Legislation

Most Reform Measures Die

            On the final night of the session, the legislature passed Senate Bill 414, which establishes the Governor's Office of Health Enhancement and Lifestyle Planning, or GO HELP. GO HELP will coordinate health care initiatives across state agencies, plan for future health care reform efforts, take over some of the duties of the Pharmaceutical Cost Management Council, and develop pilot projects for medical homes. The details of GO HELP are spelled out below.

            Virtually, all of the other health care reforms recommended by Select Committee D and Ken Thorpe, a health care economist from Emory University and consultant to the legislature, were rejected or ignored by the legislature. These measures include:

             Imagine 50,000 fewer smokers in West Virginia. No public policy would produce greater benefits in the health status of West Virginians than increasing our cigarette tax to the national average. The failure of the cigarette tax means that West Virginia will continue to have the second highest smoking rate in the country. Even Kentucky, the state with the highest smoking rate, increased their cigarette tax to 60¢ a pack, which is higher than West Virginia's current rate.

             * Despite the tireless efforts of Senator Dan Foster, the Senate first weakened and then the House killed the menu labeling bill. SB 419 would have required fast food restaurants and other chain restaurants to post on their menu and menu board the calorie content of the food they sell.

             Since 1990, the number of obese West Virginians has doubled, going from less than 15 percent to more than 30 percent of the population. And like smoking rates, West Virginia has the second highest rate of both childhood obesity and adults who are overweight or obese.

             The Senate first rejected the menu labeling bill, then reconsidered the bill and added an amendment to exempt the restaurants owned by former Senator Oshel Craigo. When SB 419 got to the House of Delegates, the bill was referred to the Health Committee and then Government Organization Committee. The House Health Committee quickly stripped out the Craigo amendment, and passed a very good menu labeling bill.

             However, in the House Government Organization Committee the bill was in trouble. Delegate Jim Morgan, Chair of the committee, offered a very decent compromise. Fast food chain restaurants could provide caloric information in any manner they preferred - through the Internet, on wrappers of the food, etc. However, by 2012 these restaurants would be required to post the calorie information on their menus and menu boards, where it has the greatest impact on behavior.

             While members of the committee ate donuts and Tudor's biscuits, this compromise was rejected by a majority of committee members, and the bill was dead. Those to be applauded for voting for the compromise menu labeling approach were:

Sam Cann (D-Harrison)

Bobby Hatfield (D-Kanawha)

Jim Morgan (D-Cabell)

Danny Polling (D-Wood)

Margaret Staggers (D-Fayette)

Doug Skaff (D-Kanawha)

Those who voted to kill the compromise menu labeling bill included:

Sam Argento (D-Nicholas)

Tom Azinger (R-Wood)

Greg Butcher (D- Logan)

Daryl Cowles (R-Morgan)

Roy Givens (D-Brooke)

Daniel Hall (D-Wyoming)

Bill Hartman (D-Randolph)

Dale Martin (D-Putnam)

Pat McGeehan (R-Hancock)

Carol Miller (R-Cabell)

Jonathan Miller (R-Berkeley)

Mike Potter (R-Mercer)

Mike Ross (D-Randolph)

Ruth Rowan (R-Hampshire)

Randy Swartzmiller (D-Hancock)

Joe Talbott (D-Webster)

             It is interesting to note that every Republican on the Senate floor and in the House Government Organization Committee voted against the menu labeling bill, as did every legislator from the northern panhandle regardless of whether they were Republicans or Democrats.

            *  In his State of the State address, Governor Manchin directed Medicaid to seek a waiver to cover adults up to 50% of federal poverty level. "This is such an important step toward addressing our state's growing healthcare concerns...that, if necessary in the future, I will propose an increase in our state's cigarette tax to pay for its continuation." When the tobacco tax failed, there was no additional money for Medicaid, and Governor Manchin's proposal to expand Medicaid died.

             * The Senate Finance Committee refused to take up HB 3022, which would allow uninsured individuals and employers who don't currently provide health insurance coverage to their employees to purchase primary care-only coverage. HB 3022 would pay providers a set fee per person per month (called a capitated rate). This is an innovative approach that moves away from paying doctors on a per procedure basis, where the more procedures they perform the more they get paid, to a system where physicians are paid a fix rate. A capitated rate also allows payers to begin to pay doctors based on performance, rather than on the number of procedures they perform. Ironically, the legislature passed a bill allowing PEIA to pay a capitated rated for PEIA-insured individuals, but denied the opportunity for uninsured individuals to participate in a capitated program.

Details of the GO HELP Bill

             The two basic functions of GO HELP are to coordinate the various health care efforts of state government and to plan for future health care reform. It will take a special director of GO HELP to get the leaders of the Department of Health and Human Resources, PEIA, the Health Care Authority, Medicaid, and other state health care agencies to work together.

             It will also be challenging to develop a 5-year strategic plan for health care reform by December 31, 2009. Initiatives to be included in the strategic plan include: focusing on select chronic illnesses; encouraging recess and other physical activities in public schools; promoting bicycle and pedestrian trails and sidewalks; promoting universal wellness and health promotion benefits; support for efforts to decrease tobacco use; and promotion of health information technology, such as electronic health records.

             In addition to these activities, GO HELP will take over the functions of the Pharmaceutical Cost Management Council. These functions include collecting and publishing information on the amount of money that drug manufacturers spend on trying to influence doctors (and other prescribers) to write prescriptions for brand name drugs. This is referred to detailing expenses. GO HELP will also collect and publish the amount of money that drug manufacturers spend on direct to consumer advertising, which is all the ads on TV and the full page ads in magazines that promote brand name drugs.

             GO HELP will only be able to publish aggregate data - not individual physician level data -- on detailing expenditures. So, consumers will not be provided information on whether their physician accepts free meals or other freebies from drug companies.

             GO HELP will also oversee the development of four different pilot projects for patient-centered medical homes (PCMHs). PCMHs are a team approach to treating patients, particularly those with chronic illnesses. Community health centers and private physician offices would be paid to provide improved patient education in a face-to-face, personal manner. Additionally, our health care system is highly fragmented, and the PCMH is designed so that a primary care physician is paid to coordinate a patient's care with various specialists.

            The potential in adopting medical homes is to improve the health status of West Virginians, while decreasing cost. There are mixed reviews of PCMHs in the literature. For example, the Commonwealth Fund projects significant reductions in cost with the adoption of PCMHs, while the Congressional Budget Office has projected modest increases in cost for adopting PCMH for Medicare patients. Adopting different pilot projects to see what works best in West Virginia is an appropriate strategy given this uncertainty.

            SB 414 also establishes an advisory council for GO HELP. The advisory council is composed of agencies (DHHR, PEIA, the Health Care Authority and CHIP); as well as provider associations (Hospital Association, the State Medical Association,  the Nurses Association, etc.) and consumers and purchasers of health care (AFL-CIO, AARP, the Chamber of Commerce and a consumer public interest organization). While the advisory committee has limited authority (the right to offer advice on contracts, legislative rules, etc.), and despite the fact that the advisory council is only required to meet once a year, which has lead some observers to conclude that the advisory council is likely to be more ceremonial than substantive, the composition of the advisory council was the most fought over provision of SB 414.

            GO HELP is not health care reform. It is an opportunity for future health care reform.

            Throughout the year-long process that Select Committee D undertook to study health care reform and develop proposals, they made repeated efforts to engage the Governor and get his support for the process and recommendations. They failed. If Governor Manchin signs SB 414, he will own the process and the results. If the Governor signs SB 414, who he appoints as the director of GO HELP will send a clear message of how serious he is in achieving meaningful health care reform. Stay tuned.

             While this legislative session did not live up to expectations, there are some legislators who worked extremely hard to reform health care and deserve special recognition. The two chairs of the Health Committees, in particular, were outstanding. Senator Roman Prezioso (D-Marion) and Delegate Don Perdue (D-Wayne) provided outstanding leadership and determination in their efforts to achieve health care reform. Please drop each a note of thanks at roman.prezioso@wvsenate.gov and DPerduerx@aol.com. Thanks.