"We want to do as much on the state level as we can," Cline said. "We understand our situation and our needs here."

The division has secured funding to hire actuarial staff, "so we can make the technical changes necessary," she said. They have applied for a consumer services grant and money for outreach "so we can let West Virginians know about these changes and what to expect.

"I'm certainly not throwing rocks at the people who are already there on the job," Perdue said.

"They're doing the best they can. But you have to have enough people to manage. The well-being of hundreds of thousands of West Virginians depends on those people."

Reach Kate Long at katel...@wvgazette.com or 304-348-1798.

Parts of health-care reform that kick in September 23:

For more detail: www.commonwealthfund.org

"It's D-Day, and they're hitting the beach, and they just don't have enough troops," House Health and Human Resources Committee Chairman Don Perdue, D-Wayne, said last week. "That's a recipe for failure."

Two weeks from now, major reform provisions kick in. Among other things, insurance companies can no longer drop customers after they get sick or deny coverage to      children with pre-existing conditions.

Other parts of the law don't take effect until January 2014, when hundreds of thousands of West Virginians will be eligible for subsidized insurance under the reform law.

State Insurance Commissioner Jane Cline said Friday that she does not have enough people to handle the "enormously complex" job ahead.

"We need more people," she said. "We're also going to have to replace our people [who retired or resigned] if we're going to do what we need to do for West Virginians.

"We're running as fast as we can," Cline said.

She said her staff is overwhelmed with tasks that must be accomplished to get ready for January 2014. At that point, an estimated 125,000 West Virginians will be able to buy insurance through a new health insurance exchange run by the Insurance Commission.

Another 170,000 will be eligible for Medicaid insurance, state Medicaid Commissioner Nancy Atkins said last week.

Perdue said the need for more health care workers appears to conflict with the longstanding Manchin administration order that agencies not replace employees who retire or hire new people without permission.

"Hundreds of thousands of West Virginians stand to get decent health care, and the state stands to save money, so we don't want to be penny-wise and  pound-foolish," Perdue said.

Jim Pitrolo, Gov. Joe Manchin's policy director, said Friday that health reform jobs must go through the approval process like any other job.

"There's a directive from the governor's office that we are only replacing those people that are essential to the operation of government," he said.

The Division of Insurance may be a special case, Pitrolo said. "They do have quite a bit that's falling on them," he said.

Last week, experts at a statewide health-care summit praised West Virginia's advance planning for health care reform.

"But that edge can evaporate quickly," warned Ken Thorpe, chairman of health policy and management at Emory University. "Things will happen very fast for the next two years, and it's very important that the state be able to keep up."

Thorpe helped West Virginia's Legislature prepare a health reform plan two years ago.

"This is an enormously complex job," Cline said, "and it impacts all segments of the insurance regulatory responsibilities we have. You have rates and forms. You have education and consumer service. We have our compliance people and the accounting staff has to monitor grants and forms. Our finance people will be responsible for medical loss ratio."

"I'm equally concerned about Medicaid," Perdue said. "I don't think they've beefed up their staff to get ready for 170,000 more people."

There is funding for about two dozen more Medicaid administrative positions already in the budget, he said.

"The last time I looked, Medicaid had about 78 people working at the administrative level, and they are budgeted for 109 people," he said.

"Where it can be proven that additional people are needed, it will be considered," Pitrolo said. "However, we would look first to see if there's anybody already employed who can handle those responsibilities."

"The people who are in charge of this task have a right to adequate staff," Perry Bryant, director of West Virginians for Affordable Health Care, said Monday. "Because, without adequate staff, they are doomed to fail. They need skilled people, not just warm bodies."

Cline said her staff takes part in 16 to 20 phone tutorial sessions with their federal counterparts per week.

"The next one on Standard Definitions next week is scheduled for three hours," she said. The Minimum Loss Ratio calls take six hours apiece, she said.

If the federal government finds a state not ready to implement health care reform, the federal government will do it for the state until the state is ready, Thorpe warned.

"Major parts of the health-reform legislation are designed to be implemented at the state level," he said. "So the challenge is: Either you lead or you get led. If you don't do the job, Washington will do it for you, and you may not like what they come up with. This is the opportunity to do it your way."

"We want to do as much on the state level as we can," Cline said. "We understand our situation and our needs here."

The division has secured funding to hire actuarial staff, "so we can make the technical changes necessary," she said. They have applied for a consumer services grant and money for outreach "so we can let West Virginians know about these changes and what to expect.

"I'm certainly not throwing rocks at the people who are already there on the job," Perdue said.

"They're doing the best they can. But you have to have enough people to manage. The well-being of hundreds of thousands of West Virginians depends on those people."

Reach Kate Long at katel...@wvgazette.com or 304-348-1798.

Parts of health-care reform that kick in September 23:

For more detail: www.commonwealthfund.org