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West Virginia health insurance

The Mountain State gains second carrier, navigators

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. The state has successfully implemented Obamacare and Medicaid expansion, but its population faces some significant health challenges. 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 2014 edition of America’s Health Rankings analyzed a variety of factors and ranked West Virginia 44th out of the 50 states — up two places from 46th in 2013. West Virginia’s rating is dragged down by high prevalence of obesity, drug deaths 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 2015 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 Mollohan has since been replaced by David McKinley in the House; McKinley’s position is that the ACA should be repealed.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.

West Virginia operates a partnership exchange with the federal government, using 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 Obamacare help West Virginians?

Primarily because of Medicaid expansion, West Virginia was one of two states predicted to see its uninsured rate drop 10 percentage points following ACA implementation. In 2012, more than 17 percent of non-elderly West Virginia residents were uninsured.

U.S. census data showed West Virginia’s uninsured population at about 14 percent in 2013, and that number fell to 8.6 percent by 2014. A Gallup poll showed the state’s percentage of uninsured had dropped to 8.3 percent in the first half of 2015. A Wallet Hub study put West Virginia’s post-Obamacare uninsured rate at 6.59 percent.

The ACA is given most of the credit for the state’s success in reducing its uninsured population. West Virginia 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 qualified health plans

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.

As of February 22, 2015, the number of West Virginians who had enrollment in qualified health plans through the exchange was 33,421, and HHS reported that 86 percent of them had received premium subsidies. However, as of June 30, some had cancelled coverage or failed to make their premium payments, and the total effectuated enrollment for West Virginia dropped to 31,106 and the percentage receiving federal tax credits remained at about 86 percent.

West Virginia’s exchange gained a second health insurance carrier for 2016. CareSource joins Highmark Blue Cross Blue Shield. Kentucky Health Cooperative was set to expand into West Virginia for 2016; however, in Oct. 2015, the Obamacare CO-OP announced its closure, thereby ceasing operations in Kentucky and West Virginia.

More West Virginians will gain access to in-person assistance from navigators during the 2016 open enrollment period. An additional 42 counties gained navigator presence, and CMS awarded nearly $607,000 in grants to three West Virginia agencies.

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.

Between the fall of 2013 and July 2015, West Virginia Medicaid enrollment grew by 187,533 enrollees – a 53 percent increase. 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.

State-based health reform legislation

Here’s a summary of recent bills in the West Virginia legislature related to healthcare reform:

West Virginia lawmakers introduced a pair of anti-ACA bills in 2015. The House Health and Human Resources Committee voted yes for HB 2216, which would have prevented the state’s governor from creating an exchange without legislative approval, but it did not advance further. HB 2509 would have invalidated Obamacare in West Virginia bud did not advance to the House floor.

Medicare in the state of West Virginia

West Virginia is among the states with the highest percentage of Medicare beneficiaries – 21.1 percent of the state’s total population compared with 16 percent of the U.S. population. The state has a relatively high percentage of individuals who qualify for Medicare due to disability – 27 percent; only three states have a higher percentage.

Medicare spending in West Virginia is about $9,332 annually per enrollee and spends $3.5 billion per year overall. As such, the Mountain state ranks 34th in the nation for total Medicare spending.

West Virginians can enroll in Medicare Advantage plans instead of Original Medicare. These private plans offer additional benefits. Twenty-four percent of all West Virginia Medicare recipients selected a Medicare Advantage plan in 2014. About 51 percent enrolled in a Medicare Part D plan to gain prescription drug benefits; the national average is 47 percent.