A proposal to create a Wyoming Healthcare Authority at the Joint Health, Labor and Social Services Committee meeting Monday devolved into a protracted back-and-forth with accusations of a hidden agenda to push Medicaid expansion and increased government regulation.
The Healthcare Authority would serve as an advisory group and monitor changes in the health care industry and offer policy recommendations to state legislators. Its focus would be health care accessibility, affordability, quality and innovation.
“The mission of this group is to engage in collaborative decision-making for improved health outcomes and economic diversification,” said Jen Davis, head of Health and Human Services for Gov. Mark Gordon, who presented the proposal.
Hidden Agenda?
Some members of the committee objected, saying that a task force predominantly made up of health care industry representatives would push an agenda.
“There is not an agenda out of this body,” Davis said in response. “This is to make health care better in the state of Wyoming.”
Davis said the purpose of the authority isn’t meant to circumvent any legislative oversight, and that the health care industry’s relationship with the Legislature and general public isn’t working well. Although she didn’t provide any specific examples, she said at times laws have been passed that may serve a group of people but not all residents.
“I think constituents maybe come forward to all of you and you hear one side of the issue and not necessarily all the sides of an issue,” she said. “And sometimes that results in policy that doesn’t work for everybody.”
Rep. Sarah Penn, R-Fort Washakie, agreed with Davis that the Legislature’s relationship with the health care industry isn’t working well, but said that’s because of too much government involvement.
“I think this has us going in the wrong direction,” she said. “This public-private relationship is pretty concerning to me.”
She also questioned why the goals of the authority couldn’t be achieved through the mechanisms that currently exist.
Some on the committee like state Rep. Ben Hornok, R-Cheyenne, said creating the 19-member panel would result in a backend push for Medicaid expansion in Wyoming, something the Legislature has repeatedly rejected.
Hornok questioned Davis if when she was talking about past failed efforts she was specifically referring to Medicaid expansion.
Davis said she was not, and was rather following a broader approach to consider all options for health care solutions.
“Continuing to have the discussion about Medicaid expansion has proven not to be something that our legislative body wants to move forward with,” she said.
Although every member of the Labor, Health and Social Services Committee has some form of health care knowledge or experience, Davis said they do not all possess in-depth expertise.
“When we’re talking about making complicated decisions, I think it’s imperative that we have industry, the experts that are doing these things and making the policy and implementing the policy that you all make at the table,” she said.
Davis said part of the purpose of the authority would be to iron out differences of opinion between leaders of Wyoming’s health care industry in its own meetings so that a unified message can be delivered to legislators down the road. Davis also made it clear that the Healthcare Authority would not be the deciding factor behind all health care decisions in Wyoming.
Is It Needed?
A few of the more conservative members of the committee like Hornok expressed skepticism and outright opposition to the proposal.
Penn said plenty of communication and coordination already exists between the health care industry and the Legislature, and that it’s not the government’s role to foster positive relationships between these groups.
“I don’t think that we need an authorized government entity to say, ‘OK, let’s get in the same room and hash this out,’” she said.
The authority would be considered a quasi-governmental entity and an executive branch cabinet member serving under the governor’s authority. It would include state health department heads, legislators, members of the general public and licensed practitioners in the health care sector.
Rep. Jeanette Ward, R-Casper, asked Davis if it’s best for public transparency to have these stakeholders coordinating much outside of the Legislature. Sen. Lynn Hutchings, R-Cheyenne, expanded on that thought, saying the authority would add another layer of government bureaucracy filled by members many from the public allegedly don’t trust.
Many farther right legislators like Hutchings have expressed a lack of trust or support for Wyoming’s health care leaders.
“This kind of bothers me in that you're trying to alleviate a process that seems to be working really well and insert a layer that we are concerned about to the process,” she said.
Sen. Anthony Bouchard, R-Cheyenne, went even further and said the purpose of the Legislature is to protect residents from the personal agendas of the health care industry. He cited the Affordable Health Care Act and initial response to the COVID-19 pandemic as examples and asked how personal agendas could be avoided.
Bouchard also floated a few conspiracy theories about COVID and where the push for the Healthcare Authority may be coming from. In 2023, New Mexico set up its own health care authority.
“I’m quite frankly appalled thinking that we’re going to get experts together in a room and come tell us how it’s going to be because they have the better views,” he said.
Davis didn’t deny that her staff has looked at what other states have done, but said there has been no outside influence in the push to establish the group, mentioning how there have already been two health care authorities in Wyoming in the past and that every physician member of the group would have to be a Wyoming resident.
Under the direction of former Gov. Mike Sullivan, a health reform commission ran from 1993-1994. This effort was resumed in 2003 to generate solutions for medical malpractice liability, medical errors, rural health care, provider supply, health information technology, Wyoming’s uninsured population, Medicaid and expanded access to health care.
In the final report issued by the second commission in 2009, the board made recommendations for the establishment of a nonprofit patient safety organization, a permanent health policy entity, and the continuation of the health professions database.
Davis said very few of the recommendations that came out of these commissions were developed into law, many of which are some of the same recommendations being considered today.
“There was no continued conversation after that to make sure that those recommendations continued to move forward,” she said. “They just kind of fell flat.”
All Voices
She also said that creating the right health policies stems from a comprehensive approach that includes experts on as many sides as possible spending as much time as possible studying an issue.
“If we don’t have all the right people at the table knowing what the impacts are, we can’t make good, informed decisions,” she said. “Good, informed decisions is what leads to good policy.”
Penn found fault with this position as she and Bouchard believe those who didn’t agree with what local governments and health care leaders were saying about COVID had their voices silenced during the pandemic.
Ward said significant public trust in the health care industry has been lost since the pandemic and criticized the fact that only one member of the authority would be a resident at-large, however one would also be a business owner, and another a Wind River tribal member.
Although the authority would be nonpartisan, many of its members would be appointed by the governor.
What Exists Now
In 2020, Gordon initiated a Health Task Force during the height of the pandemic to address immediate needs of the health care industry and develop strategies for implementation to avoid serious complications and death.
Once the pandemic started to wane, the Health Task Force continued, but changed its trajectory to focus on health care issues relevant to Wyoming. Gordon’s directive to the group was to develop recommendations to decrease costs for Wyoming residents while still ensuring adequate access to care for all Wyoming residents.
Some of this group’s legislative achievements include expanding the state’s 2-1-1 capacity, and funding the Family Resource Network.
Davis said the Health Authority, which would be written into state law and made permanent, would be the evolution of the task force, which could expire at the end of the Gordon administration. Like the task force, the authority would have no power to enact laws.
“This authority doesn’t have any real authority besides making recommendations,” said Rep. Mike Yin, D-Jackson.
But Davis said not every recommendation that could come out of the Healthcare Authority would require legislative action as some recommendations could fall within the governor’s rulemaking authority.
She compared it to the Wyoming Energy Authority, which uses a public/private partnership for its work. That group operates on a roughly $300 million budget, most of which is disbursed for various energy projects.
The Healthcare Authority would operate on a much slimmer budget, mostly contained to the salary of one full-time executive director.
“The habit of government is that it gets bigger and gets bigger,” Penn warned. “And ultimately, we may not still accomplish anything.”
Davis and a few other health care representatives who also advocated for the authority, referenced legislation passed during the 2024 session that requires health insurers and contracted utilization review entities to follow and forgo certain prior authorization regulations.
Sheila Bush, executive director for the Wyoming Medical Society, said the authority would follow the sometimes contentious discussions that took place within the task force on that issue.
“How do we codify that and recreate it so people beyond us into the future can continue to benefit from the same thing and the people of Wyoming can benefit from those policies?” Bush said.
The creation of the authority would have to be approved by the Legislature. A bill draft that would create the authority and specify who its members could be will be considered at the committee’s next meeting in June.
Leo Wolfson can be reached at leo@cowboystatedaily.com.
