By Tom Lacock
Wyoming Medical Society
Anyone attending a Wyoming House Joint Labor, Health, and Social Services Committee meeting during the 2017 legislative session would be wise to bring a legislative facebook with them, as the cast has made significant changes from a year ago.
Leading the committee will be Rep. Eric Barlow (R-Campbell County), who has been on the committee since 2013. A veterinarian and rancher by trade, Barlow will be herding a committee which returns just one other member – JoAnn Dayton (D-Sweetwater County) – from a year ago. Joining Barlow and Dayton on this year’s House committee include Scott Clem (R-Campbell), Mike Gierau (D-Jackson), Timothy Hallinan, MD (R-Campbell), Marti Halverson (R-Lincon/Sublette/Teton), Kendell Kroeker (R-Casper), Lars Lone and Pat Sweeney (both R-Casper).
Barlow replaces Elaine Harvey (R-Lovell) as the House committee chairman and says he has large shoes to fill.
“It is an honor to get the opportunity, and obviously there is a lot to learn and continue to learn about the issues and complexities of the interests that are out there,” Barlow says. “Following Chairman Harvey is daunting in and of itself. She has been a tremendous mentor on a personal side, but also on a policy side for how to approach challenging issues and hope to give people the best opportunities to advance their causes.”
The Senate’s Labor, Health, and Social Service Committee will be led once again by Charles Scott (R-Casper), who has served in the Senate since 1983. The Senate Health Committee membership returns Brian Boner (R-Converse/Platte), Ray Peterson (R-Cowley), and sees Fred Baldwin, PA-C (R-Kemmerer) move over from the House Health Committee to the Senate Health Committee. The lone rookie on the committee is Anthony Bouchard (R-Laramie/Goshen).
A Holding Pattern for 2017
After two years of debating Medicaid expansion in the Wyoming Legislature, this year’s health committees will probably be void of high-profile bills as the committees wait to see what the change in Presidential administration means to federal health programs such as Medicaid.
“We really were in a holding pattern on a lot of the big issues waiting on the outcome of the election,” Scott says. “With the (Donald) Trump victory, it is becoming increasingly clear to me they will repeal Obamacare because it was collapsing under its own weight. I think next year is going to get interesting, because once you repeal Obamacare, what do you replace it with?”
Scott says he is hearing there is a strong possibility that the new administration will offer the states block grants for Medicaid. That could mean the freedom for the state to design its own benefits and process for distribution of benefits.
“If they give us a Medicaid block grant, which seems like a strong possibility, if it is a real block grant and we have significant freedom in how we can structure the Medicaid program, we can be creative,” Scott says. “Then the question becomes how much money will we get and how many people can we cover? We need to try to provide the essentials they need to have and not some of the frills Obamacare pushed. That will be quite a response to that – getting it right. That is what we are looking forward to.”
Work to be Done This Year
While next year could be full of fireworks, there is work to be done this year as well.
Barlow says he has always been interested in the Title XXV efforts of the legislature, and that item will remain front-and-center for lawmakers this year. Despite shrinking state revenues and nearly $249 million in cuts to state agencies this year, Wyoming Governor Matt Mead has asked for a contingent appropriation up to $21 million for Title XXV services in his 2017 supplemental budget for Title XXV services to the Wyoming Department of Health. This will attempt to address a budget shortfall in the biennial budget for such services.
Barlow sits on the Legislature’s joint subcommittee to review Title XXV Issues. In addition, the legislature has allowed Wyoming courts the ability to make outpatient commitments of Title XXV patients, and instituted a gatekeeper policy over the past two years. The gatekeeper is an organization named by the department of health which oversees and routes patients to different facilities based on the needs of the patient. While the legislature has made progress on the issue, Barlow says there is still room for improvement.
“I have always been interested in this, and it goes back to Senate File 60 from 2013,” Barlow says. “We did a Medicaid reform bill and I think we need to have an interim or two interim type of topic where we look at continuum of mental health care and find how we build that continuum.”
The concept of a multi-payer claims database to house information about physicians, services and their costs was floated last year in a budget footnote that would allow the department of health to study the issue. The department of health released its study this summer along with ideas of how to proceed with such a database if the legislature wished to do so. Scott and Barlow both say they believe the concept is worth examining, but neither foresaw much action being taken on a database this session.
Barlow says he thinks the footnote opened the door to the concept of a database, but he doubts large efforts on implementation takes place before a larger interim discussion. He said there could be smaller steps taken, such as discussion on whether the state employees insurance pool could become a part of a multi-payer claims database. For his part, Scott says a similar database produced years ago by Hank Gardner under the Governor Dave Freudenthal administration offered some helpful information to issues of health care costs, but he said he doesn’t believe joining or developing a database is in the cards this year because of a lack of available state funds.
“With Obamacare we got a decent comparison between jurisdictions and found Wyoming is considerably more expensive than other areas for the cost of healthcare, and we aren’t sure why,” Scott says. “The database would be helpful in trying to figure out what they are, but you have privacy issues in those things, and the fact is we can’t afford it this year.”
A bill to join a licensure compact for emergency medical services will also come out of the Joint Labor, Health and Social Services committee. Scott says this will help those in rural border areas respond to emergencies while addressing legal liability.
Scott says he will also introduce a bill on his own, having been approached to work on a bill that deals with laws on durable powers of attorney which came out of the Governor’s Task Force on Elder Abuse.
“This was (The Task Force’s) first priority so it is clear what the providers know who they are dealing with,” Scott says.
Barlow says he has also been asked to put forth a bill to license providers of acupuncture and oriental medicine. It will be based on a previous year’s draft of a similar bill with the end goal of developing a licensing board for acupuncture and oriental medicine practitioners outside the Board of Medicine. He says around 27 providers in the state are licensed by a national certifying board, and another 12 are in the process.