Current and future residents of West Virginia will be interested in learning about the issues that play a role in the state’s overall public health. Factors such as legislative positions, public health funding, disease management and socioeconomic indicators all play a role in the overall “healthiness” of a state. We’ve put together a partial list about West Virginia for your consideration.
West Virginia health ratings
The Commonwealth Fund’s Scorecard on State Health System Performance 2014 ranked West Virginia 34th among the 50 states and District of Columbia – the same rating it received in 2009. West Virginia’s Scorecard includes details on how the states are scored.
The 2013 edition of America’s Health Rankings analyzed a variety of factors and ranked West Virginia 46th out of the 50 states. West Virginia’s rating is dragged down by high prevalence of obesity, inactivity, diabetes, and tobacco use, as well as a high rate of preventable hospitalizations. There are some positives though: The state has a low incidence of binge drinking and infectious diseases, and there is a high rate of per capita public health spending.
Trust for America’s Health has also put together a summary of public health issues in West Virginia; the details are available in the 2014 listing of Key Health Data About West Virginia. And you can see West Virginia health data on a county-by-county level in this report from the Robert Wood Johnson Foundation.
West Virginia and the Affordable Care Act
In 2010, both of West Virginia’s U.S. Senators – Robert Byrd and John Rockefeller – voted yes on the health reform law. In the House, the two Democratic Representatives voted yes: Alan Mollohan and Nick Rahall. Republican Representative Shelley Capito voted against the ACA. Mollohan has since been replaced by David McKinley in the House; McKinley’s position is that the ACA should be repealed.
The current congressional delegation from West Virginia is split on Obamacare: two Senators and one Representative that support the law, and two Representatives that oppose it.
Democratic Governor Earl Ray Tomblin took office in 2010 (replacing Joe Manchin, who left the Governor’s office for the Senate), and is generally supportive of the ACA. He opted to expand Medicaid, which has had a huge impact on the uninsured rate in West Virginia in 2014.
The state is operating a partnership exchange with the federal government, using Healthcare.gov as their portal for residents to select plans. They opted for this route instead of running their own exchange, because they felt that they would get more bang for their buck by expanding Medicaid and letting HHS handle the operational aspect of the exchange. The state has frequently been held up as an example of how successful Medicaid expansion can be when implemented well.
How did the ACA help West Virginians?
Primarily because of Medicaid expansion, West Virginia is only of only two states predicted to have a drop of more than ten percentage points in the uninsured rate following ACA implementation. In 2012, more than 17 percent of non-elderly West Virginia residents were uninsured.
Several studies have projected an average uninsured rate of under 7 percent as a result of the ACA. The state has taken a very proactive approach to Medicaid expansion, using an auto-enrollment process to seek out eligible individuals by cross-referencing lists of residents who are utilizing other state benefit programs.
West Virginia enrollment in QHPs
In late 2013, the Kaiser Family Foundation estimated the potential exchange market in West Virginia to be 117,000 residents, and that 71,000 of them would likely qualify for premium subsidies to reduce the price of their coverage. By mid-April 2014, at the end of the first open enrollment period, 19,856 people had completed their enrollment in the West Virginia exchange, and HHS reported that 85 percent of them had received premium subsidies.
West Virginia Medicaid/CHIP enrollment
Using federal funds to expand Medicaid eligibility to 138 percent of poverty has been a major component of Obamacare success in West Virginia. As of early 2014, it was estimated that 53 percent of the uninsured population in West Virginia would be eligible for expanded Medicaid or CHIP, and another 23 percent would be eligible for tax credit subsidies to purchase coverage in the exchange.
As of mid-April, 21,019 people had enrolled in Medicaid through the West Virginia exchange. Enrollment in Medicaid continues year-round, so that number is continuing to increase, further lowering the uninsured rate in West Virginia.
Does West Virginia have a high-risk pool?
Prior to Obamacare, in nearly every state, applicants’ medical history could prevent them from obtaining coverage in the private market, or could result in significantly higher premiums or pre-existing condition exclusions. Thirty-five states – including West Virginia – took it upon themselves to create their own high-risk pools (not to be confused with the PICP risk pools created by the ACA in 2010).
AccessWV was created in 2005 to give people an alternative coverage option if they could not get individual health insurance because of their medical history.
Now that all health insurance plans are guaranteed issue – thanks to the ACA – high risk pools are largely obsolete. AccessWV stopped accepting new members in November 2013, but continued to cover existing members until March 31, 2014.
At that point, the program ceased operation; insureds were able to switch to a new ACA-compliant plan prior to that date, but if they were still enrolled in AccessWV as of the end of March, they had a 60-day special enrollment period (triggered by loss of coverage, which is a qualifying event) during which they could enroll in a new plan.
State-based health reform legislation
Here’s a summary of recent bills in the West Virginia legislature related to healthcare reform: