As a result of the Affordable Care Act, the uninsured rate in West Virginia has declined from 14 percent in 2013 to just 5.3 percent in 2016, according to US Census data (for perspective, the national average uninsured rate in 2016 was 8.6 percent). A large part of this is due to the ACA’s expansion of Medicaid; more than 200,000 people gained coverage under Medicaid and CHIP in West Virginia between late 2013 and September 2017.
West Virginia residents have until December 15, 2017 to enroll in a plan for 2018 — on or off-exchange. After that, individual market coverage for 2018 will only be available to people who experience a qualifying event during the year (Native Americans can enroll year-round in the exchange, as can anyone eligible for Medicaid or CHIP).
2018 health plans and rates
- Highmark Blue Cross Blue Shield: 28.6 percent (coverage available statewide)
- CareSource: 19 percent (coverage available in 32 counties)
Because the federal government is no longer funding cost-sharing reductions (CSR), insurers have added the cost of CSR to their premiums for 2018, which accounts for a significant chunk of the overall increase. Insurers in most states added the cost of CSR to silver plan premiums, since CSR benefits are only available on silver plans. But West Virginia regulators instructed insurers to add the cost of CSR to premiums at all metal levels.
87 percent of West Virginia exchange enrollees received subsidies in 2017, and those subsidies are increasing in size for 2018 to keep pace with the increasing cost of coverage. But because the cost of CSR was spread across all plans, rather than being added only to silver plan rates for 2018, premium subsidies in West Virginia (which are tied to the cost of a silver plan) aren’t as large as they would have been if the cost of CSR had been added only to silver plan rates.
West Virginia health ratings
The Commonwealth Fund’s Scorecard on State Health System Performance 2017 ranked West Virginia 38th (at the bottom of the third quartile) among the 50 states and DC, up from 41st in 2013.
West Virginia scored poorly in the “avoidable use and cost” and “healthy lives” dimensions (48th and 50th, respectively), but scored better in “prevention and treatment” as well as “access and affordability” (23rd and 24th, respectively). The state’s acceptance of federal funding to expand Medicaid under the ACA has contributed greatly to improving access and affordability, and reducing the uninsured rate in West Virginia.
See the state’s 2017 scorecard for additional details and analysis of its rating.
The 2015 edition of America’s Health Rankings analyzed a variety of factors and ranked West Virginia 47th out of the 50 states. But in the 2016 report, West Virginia moved up four spots, to 43rd place. A four-point jump was among the best improvements in the country — only Iowa improved more than that (five spots, from number 22 to number 17).
Unfortunately, West Virginia had the highest prevalence of deaths from drug overdoses in the country in 2016, by quite a wide margin (32.2 deaths per 100,000 people; the next-closest state was New Mexico, with 24.7 overdose deaths per 100,000 people. West Virginia is also among the worst five states in terms of obesity, and tobacco use.
But West Virginia has the lowest incidence of chlamydia and pertussis in the country, and the third-highest public health funding in the country.
Trust for America’s Health has also put together a summary of public health issues in West Virginia; the details are available in the 2016 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.
How has Obamacare helped West Virginians?
Primarily because of Medicaid expansion, West Virginia was one of the states predicted to see the largest drop in its uninsured rate following implementation of the Affordable Care Act (aka, Obamacare). According to US Census data, the state’s uninsured rate was fairly comparable to the US average in 2013, but was well below the national average by 2016.
West Virginia’s uninsured population at about 14 percent in 2013 (compared with 14.5 percent nationwide), and that number fell to 5.3 percent by 2016.
The ACA is given most of the credit for the state’s success in reducing its uninsured population, as much of it comes from the expansion of Medicaid, which is a provision in the ACA.
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.
But by 2017, effectuated enrollment in West Virginia’s exchange stood at just 29,674 people, 87 percent of whom were receiving premium subsidies.
West Virginia’s exchange gained a second health insurance carrier in 2016, and has continued to have two insurers since then. CareSource and Highmark Blue Cross Blue Shield offer plans in West Virginia’s exchange.
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 terminating its plans to expand into West Virginia.
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.
The makeup of West Virginia’s congressional delegation has changed considerably since 2010. Capito is now a Senator, along with Joe Manchin, a moderate Democrat. Mollohan and Rahall have since been replaced with Republicans in the House. So all of West Virginia’s Representatives are Republicans, and all are opposed to the ACA.
Senator Manchin is the only current member of West Virginia’s Congressional delegation who supports the ACA. Although Capito has taken a more moderate stance than many of her fellow Republican Senators, she ultimately voted in favor of all of the Better Care Reconciliation Act and “skinny repeal” in July 2017, although she voted against the Obamacare Repeal Reconciliation Act. Capito voted in favor of the tax reform bill that passed the Senate in early December 2017, which includes some of the provisions of the “skinny repeal” bill, including repeal of the ACA’s individual mandate.
Governor Jim Justice won the 2016 gubernatorial election in West Virginia. Justice ran as a Democrat (albeit a conservative one, intent on reviving the coal mining industry in West Virginia), and won despite the fact that the state overwhelmingly voted for Donald Trump for president. In August 2017, however, Justice announced that he was switching to the Republican party. While he was a Democrat, Justice had voiced his opposition to the US House legislation that would have repealed the ACA
The previous governor, Democrat Earl Ray Tomblin took office in 2010 (replacing Manchin, who left the Governor’s office for the Senate), and was 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. But Tomblin was term-limited, and could not run again in 2016.
West Virginia operates 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.
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 September 2017, West Virginia Medicaid enrollment grew by 201,555 enrollees – a 57 percent increase (it’s noteworthy, however, that all of the growth happened in the first three years, and enrollment has since declined somewhat; as of June 2016, total Medicaid/CHIP enrollment was up 62 percent over where it had been in last 2013).
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.
Medicare in the state of West Virginia
As of 2015, West Virginia had 416,820 Medicare enrollees – 23 percent of the state’s total population, tied with Maine for the highest percentage of beneficiaries. Nationwide, the average was 17 percent.
The state has a relatively high percentage of individuals who qualify for Medicare due to disability – 23 percent, which is the same as Arkansas. Only three states have a higher percentage of beneficiaries eligible due to disability. The remainder of West Virginia Medicare enrollees are eligible due to age.
Annual per-enrollee Medicare spending in West Virginia is about $8,362, which is slightly below national spending ($8,970). As of 2009, West Virginia’s annual overall Medicare spending equaled $3.5 billion per year and The Mountain State ranked 34th in the nation.
West Virginians can enroll in Medicare Advantage plans instead of Original Medicare. These private plans offer additional benefits. 25 percent of all West Virginia Medicare recipients selected a Medicare Advantage plan in 2016 compared with 31 percent nationwide. About 48 percent enrolled in a Medicare Part D plan to gain prescription drug benefits, and the national average is 45 percent.
State-based health reform legislation
Recent bills in the West Virginia legislature related to health reform include: