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Cabell County commissioners could decide Thursday which of two competing plans to use in providing health insurance for county employees. The decision could have political implications as well as financial ones.

It sounds like a simple business decision, but this being local government and local politics, it gets a lot more complicated. Throw in one of the first public tests of how the consolidation of the two largest hospitals in this part of the state will affect health care costs, and it could get interesting.

Some answers could come Thursday when the three members of the Cabell County Commission — Nancy Cartmill, Jim Morgan and Kelli Sobonya — hear presentations from two entities wanting to provide health insurance for the county’s employees.

Cabell County Sheriff Chuck Zerkle had asked the commissioners to switch the county’s self-insured health coverage to PEIA, the state’s public employee health plan. That is a proposal before the county commission.

Switching from Highmark Blue Cross Blue Shield to the PEIA Health Plan would save the county an estimated $3.7 million a year, which could be passed on to employees as pay raises, Zerkle said.

On the other side is Angie Swearingen, St. Mary’s chief financial officer. Swearingen oversees managed care for Mountain Health Network, the corporate entity that controls Cabell Huntington Hospital and St. Mary’s Medical Center. The two hospitals joined Huntington Internal Medicine Group and Marshall Health to form an accountable care organization (ACO). An ACO is a group of health care providers that come together voluntarily to coordinate care for the patients they serve.

Swearingen has told the commissioners that if the county will agree to work with the ACO, the providers would work to negotiate lower health care costs between the county and Highmark. Let’s hope that Thursday’s presentation from the ACO representative provides some solid evidence of how that would work and what the specific costs to the county would be.

Assuming representatives of both plans present their offers Thursday, the competing proposals would force the commissioners to face several questions.

First, the commissioners have a responsibility to manage public money wisely. This responsibility is not to be taken lightly, as every dollar spent on one insurance plan when another is less expensive is a dollar that does not go directly to providing public services.

But the commissioners must also consider what is best for employees. If PEIA costs them more than Blue Cross when out-of-pocket expenses are included, that could deter people from working for Cabell County and instead find similar jobs with a neighboring county or in a private industry that provides similar services. Employee turnover could increase.

Thursday’s presentation also will give the public an idea of how the consolidation of Cabell Huntington and St. Mary’s will affect health care costs. One selling point for the consolidation was cost savings through elimination of redundant expenses. If Mountain Health Network can provide better service at lower cost than PEIA, the commission’s decision will be easy. If the ACO is more expensive, that does not bode well for the future of that plan.

This also is a test for PEIA. Can the state agency compete against a private insurance plan? If so, would other agencies of local government consider switching?

And there is a more personal point to consider. Sobonya’s daughter works in the administration at Cabell Huntington. Any decision or vote Sobonya makes will necessarily be watched to see if there is a conflict of interest.

Without hearing the presentations, it’s impossible to tell which of the two competing plans is better. The commission could make a decision Thursday, or it may need time to crunch the numbers. There could be a lot of pluses and minuses to consider, but the decision can’t be put off for long, as the current fiscal year ends in less than three weeks.

Welcome to the discussion.

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