In January 2001, in the first month of his administration, Gov. Bob Wise summoned his department heads to his conference room.He told them he wanted to insure everybody in the state. He ordered them to work together to reduce the cost of health care."The strong message from Governor Wise to all the players is: You will work together, and you will make these things happen for the people of West Virginia," said Ann Stottlemeyer, commissioner of the Bureau of Senior Services.They began immediately. Every two weeks, they gather around a big conference table at the Health Care Authority.One person after another lays out a problem. They all have at it."People yell at each other sometimes. And quite frankly, that's why this works," said Susan Small-Plante, Wise's director of constituent services. "These people like each other, but they don't always agree. There's a gut level of honesty that goes on in that room. The meetings often last the entire afternoon. They'll schedule them so they're talking about Subject A from 1 to 2 and Subject B from 2 to 3."They explore a problem from all angles and decide who's going to work on what. When they need extra money, they decide who's going to write the grant application and what will be in it.They call their group the HUG, the Health Umbrella Group.The list of team members reads like a Who's Who in health care in West Virginia government.Soon after they began, they went on a "big picture" retreat, said Sharon Carte, director of the Children's Health Insurance Program. They listed problems they could attack immediately, problems that would take extra money, and hard-core problems."Unfortunately, there weren't many problems on that first list," Carte said."All these people are smart and well-versed in their work, but they can't possibly know everything," said Small-Plante. "Twelve or 15 people are sitting around a table, and somebody says, 'Boy it would be good to have some information about this,' and somebody else says, 'Yeah, I could use that too.' And then they say, 'where do we get that from?' And someone else will say, 'Kellogg is likely to fund something like that.' Or 'Benedum will throw in seed money.' Then Sally Richardson will say, 'Well, my office could administer that.'"It's all these great minds, thinking creatively. All the players who can make the decision are sitting right there at the table."In the past two years, they have set quite a few balls in motion:
They brought the enrollment in the Children's Health Insurance Program up to 36,000 children. Because that effort has added so many children, they now have a significant underfunding problem to solve.
They secured a Robert Wood Johnson grant to explore the possibility of allowing small business owners to buy health insurance through the Public Employees Insurance Agency. At this point, the proposal is limited to businesses that have at least 19 employees. They helped the Health Care Authority put together first-ever state maps that show where doctors practice and where West Virginians go to get health care. HUG was invaluable, said Sonia Chambers, HCA chairwoman. "A lot of people at the HUG meeting said, 'At our agency — PEIA or Medicaid — we know a lot about where our beneficiaries live. We know what a lot of the problems are. We also know where we might have trouble finding enough specialists.'"
The HUG will use the maps to target areas that need access to health care. "This will eliminate guesswork," Small-Plante said. They eliminated much government duplication that had been eating up time and health dollars. For instance, they discovered that medical providers had to fill out different forms at several agencies. So they helped the Insurance Commission create a one-form, one-stop way providers can become state-certified to receive insurance payments. Early in the game, they realized that nobody really knew how many West Virginians have no health insurance. Nobody knew who the uninsured were or where they got their care. The HUG contracted with West Virginia University's Institute for Health Policy Research to produce a three-part survey — "Health Insurance in West Virginia" — that provides the detail they need for planning. They secured a federal grant to study the possibility of insuring all West Virginians. Nationally known health-care expert Sally Richardson now directs a wide-ranging group which intends to come up with a plan by the end of 2003. (Richardson also oversaw the survey.) They are applying for a grant to find ways the state might create a high-risk insurance pool for people who cannot otherwise get insurance, who have pre-existing health problems, for instance. They plan to attack West Virginia lifestyle factors that run up health — and insurance — costs. They aim to stamp out West Virginia's No. 1 status in obesity, discourage pregnant women from smoking, and reduce the number of West Virginia couch potatoes via such efforts as the "biggie fries = biggie thighs" billboards and an upcoming exercise program called West Virginia Moves. "The HUG group helps people maintain a sense of mission," said Stottlemeyer of senior services. "It's so easy to forget that in the flood of daily agency details."Every month they meet with Wise. "He constantly keeps asking, 'What's happening with the big picture?'" Stottlemeyer said. "We meet, and we tell him what's happening, and he turns to me and says, 'What's happening with the big picture? And we get back on track.'"'I have no protection'Almost 300,000 people depend on the HUG group to stay on track. One in four working-age West Virginians was uninsured for all or part of 2002. Those numbers keep shifting upward.In 2001, when Wise gave his department heads their marching orders, Dink Brua had health insurance.He was one of the people who kept the steam boilers going at the FMC plant in South Charleston. But in April 2003, FMC shut down most of its plant.Brua and 55 other union workers lost their jobs and health insurance.At the same time in Charleston, Megan Kozak, 28, was working her way through school, determined to start her own business.High-priced insurance has created a new class system, she said. "I used to be part of the elite group. The elite group is people who have insurance and the security that comes with that. But if you try the American dream of going out and setting up your own business as I have, I lost the insurance that came with my job, and I can't afford it now."Today, as a registered dietician and massage therapist, she has her own health-care business in a doctor's office. She works with people who have severe arthritis, who can't sleep, who hope to avoid surgery. "It's ironic," she said. "My job now is to help other people be secure and healthy, but I have no protection myself."Two years ago, Allura Burger of Institute was one of the people who answered the phone when you called Allegheny Power with a question. Last December, Allegheny Power moved its call center to Fairmont. Now, Burger works part time at West Virginia State College, but has no insurance. Her husband, a full-time student, has no insurance either.He did a paper on African-American women and medical care, she said. "African-American women are two times less likely to be employed with insurance, so we're twice less likely to receive the care," she said.Insurance makes a whale of a difference, she said. "If I have the flu or something now, I'm not going to go to the doctor's office, because that's $60 or $70 I don't have," she said. "As an African-American woman, I was brought up, you keep working unless you can't walk. You just keep going. If you stop, the whole family stops.""This situation is just about everybody's story now," Burger said. "My father, he was with Carbide. My mother, she was with Flexys. The building that she works at is going to be shut down. So she might not have health insurance either."One of my fellow church members has been with AT&T for Lord knows how many years. They're shutting down their center. Another worked for Mountaineer Gas. They shut down, too."The gambleIt's a moving target. The Insurance Commission predicts doubled insurance prices. The Bush administration proposes to limit the Medicaid dollars. Medicaid may be in the hole again this year.It is particularly hard to find ways to offer affordable insurance to self-employed people, small businesses with fewer than 19 people, or people who cannot afford $200 a month. "We keep coming back to this concept that, until we can control health costs, we're never going to be able to expand health care coverage," said Stottlemeyer.Go after health costs, Brua would say. "As I look ahead, I'm concerned," he said. "You're basically just gambling. I enjoy good health. But anything can happen."Staff writer John Heys contributed to this story.To contact staff writer Kate Long, use e-mail or call 348-1798.