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West Virginia health insurance

State Republicans voice support for prompt Obamacare replacement

In November, Donald J. Trump became president-elect, and this month West Virginia’s Republican congressional and state leaders announced Obamacare replacement as one of its main goals, promising it would happen soon.

Nonetheless, the Affordable Care Act remains in effect, as does 2017 open enrollment. West Virginians who want to begin coverage on January 1, 2017, must enroll by December 15, 2016. Those who want to take advantage of subsidies must purchase coverage through the state’s exchange. 2017 open enrollment ends on January 31.

2017 health plans and rates

Two carriers are selling 2017 plans through West Virginia’s partnership exchange. They are listed below along with their average rate increases:

  • Highmark Blue Cross Blue Shield:1 percent
  • CareSource:8 percent

These steep increases are well above the national average of 25 percent; however, West Virginians who buy health insurance from the exchange may qualify for subsidies based on income. 85 percent of West Virginia exchange enrollees received subsidies in 2016.

West Virginia health ratings

The Commonwealth Fund’s Scorecard on State Health System Performance 2015 ranked West Virginia 39th among the 50 states and District of Columbia – down from 34th in 2014.

While the state improved its uninsured rate and percentage of at-risk adults without a routing doctor visit in the past two years, both to lower-than-average levels, its performance worsened for indicators including adults without a dental visit in the past year, adults age 50 and older who received recommended screening and preventive care, and young children who received key vaccines.

See the state’s 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 — again, a slip in the rankings from 44th in 2014.

High per capita health funding and low disparity in health status remain among its strengths, and its uninsured rate has decreased 20 percent in the past year. However, West Virginia ranks among the bottom two for 10 measures, including childhood immunizations, preventable hospitalizations, and all outcomes (i.e., premature death, poor mental health days, poor physical health days, cancer deaths, cardiovascular deaths, diabetes, infant mortality, and disparity in health status).

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 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. As of late-2015, a Gallup poll showed the state’s uninsured population had dropped 12.1 percentage points to 7.7 percent – the nation’s fourth largest reduction in uninsured since 2013.

The ACA is given most of the credit for the state’s success in reducing its uninsured population.

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.

At the end of the 2016 open enrollment period, there were 37,284 people enrolled in private plans through West Virginia’s exchange – almost 112 percent of the 2015 total (33,421). As of March 31, effectuated enrollment stood at 33,235, and 87.7 percent of those enrollees were receiving premium subsidies that averaged $388 per month.

West Virginia’s exchange gained a second health insurance carrier for 2016. CareSource joins Highmark Blue Cross Blue Shield. CareSource plans to expand its presence in 2017.

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 had 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 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 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 June 2016, West Virginia Medicaid enrollment grew by 218,634 enrollees – a 62 percent increase. Enrollment in Medicaid continues year-round, so that number continues to change, 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.

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 is 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. Twenty-four percent of all West Virginia Medicare recipients selected a Medicare Advantage plan in 2015 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:

  • 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.

Other state-level health reform legislation:

More West Virginia coverage


News, history, and enrollment info for your state marketplace


Your state’s Medicaid expansion, eligibilty, contacts


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