The federal government has reduced costs for health insurance plans under the Affordable Care Act. Starting today, West Virginians are eligible to enroll in cheaper plans.
Anyone without employer health insurance or publicly funded plans like Medicare and Medicaid can apply for insurance through the federal marketplace. The federal government subsidizes these plans to keep them affordable.
Starting this month, more subsidies are available, meaning customers can get covered for less.
Jeremy Smith runs WV Navigator, which helps people sign up through the federal health exchange.
“Virtually everybody will be able to qualify for some subsidy that will lower the cost,” he said.
He said higher income earners have not qualified for subsidized plans in the past. That included anyone making 400 percent of the federal poverty guideline.
Starting this month, health insurance plan costs will be capped at 8.5 percentage of someone’s yearly income, regardless of what they make.
For example, a couple making $70,000 a year together would not have qualified for a subsidized plan in the past. Smith says they could have paid roughly $1200 a month for insurance through the marketplace. Now that same couple would end up paying less than $300 a month, due to the price cap and other subsidies.
The open enrollment period was also extended until Aug. 15th Anyone already enrolled in the marketplace can revisit their plan to apply for more affordable options available now, said Smith.
WV Navigator is a federally funded nonprofit that helps West Virignians sign up for plans through the marketplace. Those who need assistance can call the nonprofit at (304) 356-5834.
Since taking office, President Joe Biden has committed to bolstering the Affordable Care Act, best known for expanding who qualifies for Medicaid and banning insurance companies from penalizing those with pre-existing conditions.
Not that the federal legislation ever went away, but during Donald Trump’s term, he and Congress did chip at some provisions originally passed in 2010. One move was to essentially eliminate the individual mandate, which penalized anyone who didn’t buy into some health coverage plan.
West Virginia’s own Attorney General Patrick Morrisey joined a nationwide lawsuit last summer to overturn the Affordable Care Act, largely around this provision. The U.S. Supreme Court is still deciding the outcome.
But with Biden in office, the tide could be shifting in a different direction. Last month, Biden ordered federal departments to suss out any policies that may be creating barriers to affordable coverage. It will take time for the administration to pinpoint and address those policies, but West Virginia has already and will see the impacts.
The Legacy of ACA in West Virginia
West Virginia opted for Medicaid expansion, and the results were obvious. Since the Affordable Care Act passed in 2010, the number of uninsured folks dropped from 17 percent to 6.5 percent.
“Medicaid expansion resulted in about 170,000 individuals getting health care coverage,” said Dr. Jim Becker, medical director for the state’s Medicaid system. “That turned out to be a great benefit for the state, it enabled a lot of people who had chronic health conditions to come in and get health care coverage.”
Another Open Enrollment Period
As for Biden’s first moves, he ordered the reopening of healthcare.gov. That’s a central place where anyone can sign up for federally subsidized health coverage plans offered in their state.
In November and December, 19,000 West Virginians found coverage, according to WV Navigator, which is a federally funded promotion that guides folks through their health insurance options.
Per Biden’s order, many more could also sign up between Feb. 15 and May 15.
Becker says it’s a timely move considering the pandemic.
“With a lot of new people unemployed, they’ve probably lost any employer-based insurance coverage. And so I’m hoping that another push on the ACA, we’ll bring some of those people into Medicaid coverage, or help them get connected to the marketplace,” Becker said.
Dr. Brian Gallagher agrees. He is a professor of pharmacy at Marshall University and chief of government relations at Marshall Health. Thousands of West Virginians who will get their COVID-19 vaccine shots may be prompted to consider their health coverage options.
“Now that they’re going to be going out to get the vaccine, they’re going to be thinking, I might need health care insurance coverage, and it would remind them to enroll,” Gallagher said.
Discussing abortion options in WV
Biden’s administration will reconsider a Trump era “gag” order that has prevented federally funded Title X clinics from discussing abortion options with pateints. These family planning clinics provide birth control, pap smears, STD testing, but not abortions.
Reproduction rights advocates like Margaret Chapman Pomponio of WV Free say rescinding the gag rule woud bridge the gap between West Virginia’s single abortion clinic, in Charleston, and the roughly 130 Title X clinics in the state.
“The Trump administration was forbidding a discussion of comprehensive reproductive health care options. So providers were severely hampered by that,” Chapman Pomponio said.
Work requirements for Medicaid recipients
States have had the option to require Medicaid recipients to work, actively seek employment or volunteer.
West Virginia never got behind that idea, and advocates like Jessica Ice with West Virginians for Affordable Health Care say that’s a good thing. She hopes Biden is putting this issue to rest.
“For years, we have fought against work requirements. And it would be nice to focus on positive progressive policies, rather than fighting these harmful ones every year,” Ice said.
Expanding Medicaid, again
On the flip side, of work requirements, any expansion to Medicaid may allow those that want to work to do so. If the income threshold for Medicaid rises, more folks dealing with substance use disorder can choose to live productive lives, according to Gallagher at Marshall University.
“If we get those people back to work, how do we make sure that they’re able to keep their medication-assisted therapy?” Gallagher said. “So one of the things we need to look at is to see what ways that we can use Medicaid expansion to keep people in recovery while they’re also getting back to work and back to a normal life.”
Where the buck stops: State funding in balance
Turning from federal politics to the upcoming state legislative session, the real question is funding. Measures to expand Medicaid may be a non-starter if there’s some serious budget cuts. Gallagher says he’ll be watching to see if state legislators do end up eliminating the personal income tax.
“That’s going to be a huge hole to try to fill,” he said.
Around $2.1 billion to be exact. Aside from public education, the Department of Health and Human Resources, including funds for Medicaid, has made up the largest chunk of the budget.
West Virginians have about three weeks left to enroll for health insurance under the Affordable Care Act, also known as Obamacare, and a non-profit in the state has offered socially distanced help to apply.
West Virginians can shop around for health insurance through the ACA Marketplace until Dec. 15. The Marketplace provides insurance options that qualify under ‘Obamacare.’
Those who want or need help applying online for health insurance can use the West Virginia Navigator — a free program run by a non-profit. Because of the pandemic, there is only virtual help this year through telephone or Zoom, as opposed to the program’s regular in-person help.
“This time of year, people are bombarded with ads for health insurance,” said Jeremy Smith, program director for WV Navigator. “Some are legitimate, but some are not. We are grant-funded, so we have no profit motive, and our only goal is to help people find the best, most affordable plan for them.”
Those who need financial help with insurance can also find that through the West Virginia Navigator program. Eight in 10 applicants who applied last year were eligible for aid, the non-profit said.
More than 200,000 West Virginians depend on the Affordable Care Act for health insurance annually.
Anyone needing assistance signing up for health care can click here.
The Affordable Care Act, also known as Obamacare, was back before the U.S. Supreme Court today — the third time in a decade. If the healthcare law is overturned, hundreds of thousands of West Virginians could be impacted.
The lawsuit to overturn the ACA was brought before the high court after challenges by the Trump Administration, as well as 18 Republican attorneys general, including West Virginia Attorney General Patrick Morrisey. The challenge questions the constitutionality of the individual mandate, a provision that requires people to purchase health insurance or pay a penalty.
In 2012, the mandate was contested before the Supreme Court and it was upheld. However, in 2017 a Republican-controlled Congress essentially nullified the penalty by making it zero dollars, which has since prompted the lawsuit. The Republican-led lawsuit is asserting that since the penalty is zero dollars and no revenue is raised, the penalty is no longer a tax, therefore, making it unconstitutional.
More than 200,000 West Virginians depend on the Affordable Care Act for health care coverage. Additionally, multiple studies have found more than 700,000 West Virginians have pre-existing medical conditions.
Many across the health industry, including hospitals and the American Medical Association, are urging the Supreme Court to uphold the ACA. News outlets are reporting that two conservative justices implied at today’s hearing that the ACA could be upheld even if the individual mandate is struck down.
The Supreme Court is expected to announce its ruling on the case at the end of its term in June 2021.
When the Senate Judiciary Committee voted Thursday to move forward with President Donald Trump’s Supreme Court Justice nominee Amy Coney Barrett, Senate Democrats boycotted. In their places stood poster-sized photos of people the senators said would lose health care coverage if the court strikes down the Affordable Care Act.
With just a little more than a week before Election Day and with a challenge to the health care law coming before the high court, health care is on both the ballot and the docket. And for the Ohio Valley — a region with some of the nation’s worst health outcomes — the stakes are high.
“I mean people would lose their lives as a result of it,” said Ben Chandler, CEO of Foundation for a Healthy Kentucky, a nonpartisan research and advocacy group. “I’m personally familiar with a number of people here, right here in Kentucky, who would not be alive today but for the Affordable Care Act.”
One week after the presidential election, the Supreme Court will hear arguments for California v. Texas — a lawsuit led by 21 states suing 18 additional states that attempted to overturn the Affordable Care Act in a lower court.
Over the last decade, at least 20 million people in the U.S have acquired access to health insurance. The Affordable Care Act, often called Obamacare, laid out rules insurance companies had to abide by and a host of new protections for consumers.
Kaiser Family Foundation
After its passage, people with pre-existing conditions could no longer be denied insurance. The ACA reduced out-of-pocket maximums and guaranteed maternity care. A majority of states expanded Medicaid, including Kentucky, Ohio and West Virginia, which gave more than 1.3 million residents in the Ohio Valley access to health care — some of the greatest improvements in health care access in the country.
Although a decision isn’t expected until 2021, if the law is suddenly overturned, millions would lose health insurance. That would cause massive disruptions to health care access, especially in the Ohio Valley, as the country grapples with the coronavirus pandemic.
What’s At Stake
States that expanded Medicaid saw a significant decline in uninsured rates from 2010 to 2015, according to an Urban Institute report. West Virginia’s uninsured rate was reduced by 58.6%, the greatest improvement of any state in the country. Kentucky improved by 57.1%; and Ohio by 44.7%.
A 2018 Kaiser Family Foundation analysis calculated that 54 million people under the age of 65, or “non-elderly adults,” had at least one pre-existing condition that would bar them from obtaining health insurance prior to the ACA. West Virginia tops the list with the highest rate of pre-existing conditions — 37% of the state’s non-elderly population compared to the national rate of 27%. Kentucky and Mississippi tied for the second highest rate of pre-existing conditions among non-elderly adults at 34%, and 29% of Ohio’s nonelderly population has at least one pre-existing condition.
Julie DiRossi-King, Chief Operating Officer of the Ohio Association of Community Health Centers, said one of the organization’s goals is to make sure every Ohioan, regardless of insurance status, has access to primary care.
“When more of our patients have coverage, that brings more operating revenue into the health center to reinvest, to expand access and further our mission,” DiRossi-King said. “We do get federal funding from the federal government to help offset the cost of providing care to the uninsured.”
Medicaid recipients make up more than half of the patients that seek care at community health centers in Ohio. If the health care law is struck down, many enrolled in Medicaid would lose health insurance.
“Pre-COVID we saw the evidence that Medicaid expansion was working as it was intended. It’s getting people through a tough time in their lives when they have a gap in health care coverage,” DiRossi-King said.
Courtesy Ben Chandler
Ben Chandler is the CEO of Foundation for a Healthy Kentucky.
The Foundation for a Healthy Kentucky advocates for policies that aim to improve health care access, health disparities and inequities. CEO Ben Chandler said there would be a number of consequences for Kentucky if the law is overturned.
“Number one is that the expansion of Medicaid would go away, which means that a half-million or so people here in Kentucky would lose their health coverage, and that would not help the overall health of Kentucky,” Chandler said.
Without the ACA, Chandler said Kentucky hospitals and doctors would lose funding.
“I think you’d see a lot of small rural hospitals go out of business if the Affordable Care Act went away,” he said. “You just had a lot of trouble across the board here in Kentucky if that happened.”
Simon Haeder, a professor of public policy at Penn State University, published research showing that 718,942 people below the age of 64 in West Virginia have pre-existing conditions. West Virginians covered by Medicaid would suffer without certain provisions found in the ACA.
“Coal miners, they had a hard time, when they got black lung, to claim benefits,” Haeder said. “There’s a line in the ACA, it’s just a single line that changes everything and makes it much, much easier for them and their families to claim benefits for black lung.”
The Supreme Court Case
The health care law first landed before the Supreme Court in 2012. The court ruled the individual mandate was a tax making the law valid. Prior to 2019, the fee for not purchasing insurance was as much as $695 per person or 2.5% of household income and $347.50 for anyone under 18.
But that penalty was quashed when Congress passed the Tax Cuts and Jobs Act in 2017.
WVU University Relations Video
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Simon Haeder is a professor of public policy at Penn State University
In 2018, 20 states — including West Virginia — sued the federal government over the law’s individual mandate. In what a Kaiser Family Foundation article called an “unusual” move, the federal government agreed with plaintiff states. After courts permitted states to defend the ACA, a total of 21 states are challenging the original plaintiff states in California v. Texas.
Haeder said it’s likely the Supreme Court will rule the individual mandate unconstitutional, but uphold the rest of the law.
“Congress had a chance in 2017, when they undid the penalty payment, to change the rest of the law. It did not,” Haeder said. “The will of Congress clearly says the rest should stand. We’ve seen that the ACA is functioning without the individual mandate.”
But Haeder said this case is like a “wild card” and the outcome is uncertain. “So, you know, it’s hard to predict where they’re going to go with this one, because there’s so many surprises coming out of it.”
During Barrett’s hearing Democratic Senators introduced constituents with pre-existing conditions who would no longer be covered if the law is repealed. Republicans argued that policy isn’t decided by the court.
The Missing Replacement
President Trump has promised to replace the ACA since his 2016 campaign, so have Republicans in Congress, but neither the party nor the president have delivered a plan.
Recently, President Trump issued an executive order that details actions he’s taken against the health care law. The order promises “to ensure that Americans with pre-existing conditions can obtain the insurance of their choice at affordable rates.”
But Haeder said the order can’t be enforced. “That’s not a legal statement,” he said. “There’s no enforcement powers. There’s no way to implement it. There’s no money behind it. It just says ‘I want to protect people with pre-existing conditions.’”
Few people would be shielded from the effects of a repeal. Haeder says premiums might go down initially. But without the ACA copays and out-of-pocket costs for things like vaccines and contraceptives, those costs would likely go up again.
So-called alternative, cheaper health care plans that have been marketed as “Trumpcare” were recently the subject of a Propublica investigation. Reporters found that many plans are merely supplemental insurance and don’t have to meet ACA coverage requirements. Marketers make commission when they sell these “limited plans.” They have also deceived consumers — who are directed to the cheaper plans via Facebook and Google ads — about what the plans will cover.
Already massive job losses from the pandemic have resulted in thousands of people losing their health insurance. “Why is it that hundreds of thousands of people lose their health care at a time when they need it most, when we’ve got a pandemic upon us, just because they’ve lost their jobs?” Chandler said. “It’s unfair, it’s nonsensical, but it’s the way our system has developed over a period of time.”
Chandler said even more jobs would be lost if the ACA falls without a replacement plan.
“If this Medicaid expansion went away under the Affordable Care Act, you’d have a lot of hospitals going out of business, you’d have a lot of people losing their jobs as a result of it,” Chandler said.
Voters in Southern West Virginia likely will support President Donald Trump as they did in the 2016 election. But some register concern over big-ticket issues like health care and they say the Affordable Care Act may have helped people who are poor but it hurt small businesses and the working class.
Henry Hornsby Jr. has never been what you would say, “big on politics” or elections. He’s not proud to admit that he wasn’t even registered to vote until the last presidential election in 2016.
“You know, I just, I’ve always felt like you … worried about yourself and your own,” Hornsby said as he sat at his desk surrounded by family photos and pictures of vintage race cars. “Sometimes you hear who’s won the presidency before West Virginia, even votes.”
“I just really never felt like West Virginia even mattered towards the presidency and stuff. And secondly, I got to say that I really didn’t think that the President of the United States would have much bearing on my success or failure in Beckley, West Virginia.”
Hornsby says he was proved wrong during the Obama Administration.
Jessica Lilly
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Henry Hornsby Jr. stands in front of his family business, Henry’s Radiator Shop.
Holding Onto Hope for Small/Family Business
He owns a small businessjust across from Robert C. Byrd Drive in Beckley. The shop has been around for almost 50 years.
It’s a family business Hornsby inherited from his parents. He spent a lot of time in the shop with his dad and the workers while growing up.
“Yeah, he always tried to, you know, treat everybody fair,” Henry Jr. remembered about his father. “He really took a lot of pride in his name, both by business and both just by moral conduct. You know, he told me, he spent 50 years making his name, and instructed me that I can ruin that in a day. And be sure not to do that. And I’ve never forgot that.”
Before his father, Henry Hornsby Sr. passed away in December 2001, his dad diversified the family business and opened a car wash, and some rental properties. Hornsby tries to honor his dad’s legacy by staying in business, working hard, and being fair.
“I have one guy that’s been here for 35 years,” Hornsby said as he got choked up. “And so, they’re a little more than just your average employee. I mean, they’re our second family. You know, I know their wives or kids. And when you have to think about them not getting paid. That’s tough.”
Jessica Lilly
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Employees at Henry’s Radiator Shop in Beckley hoist a radiator during the work day.
Henry is especially proud that he has never laid off anyone from the shop. Back in 2010, Henry says business dropped so much under the while Barack Obama was president, that he had to consider layoffs.
Health Care Made Things Tough
“When you have to choose between paying the insurance premium, or buying groceries, that’s a pretty tough choice, too,” Henry explained.
On top of this, Henry says new regulations on health care as part of the Affordable Care Act or Obamacare increased the price of insurance. Before the Affordable Care Act was passed, most private insurance rates were based on risk factors such as if someone was a smoker, their age, etc. Now, income is a factor in the cost. While Hornsby says he does believe the Affordable Care Act has helped people, it’s been hard on small businesses and the working class.
“It’s just one way that I see the government taking that reward for hard work and trying to make everybody equal,” he said. “I definitely believe in equality, and things like race, sex, all that, you know, but everybody don’t put forth the same effort and I don’t think everybody deserves the same reward without the same effort.”
Hornsby says business has increased since Donald Trump took office and loosened environmental regulations. While that might mean more radiators to hoist in the shop, so far, things are about the same in terms of health care.
“Honestly, right now we’re in pretty much the same boat as we was four years ago with health care,” Hornsby said. “I know it’s tough. It’s hard to make a law that’s good for everybody. There’s always that group that gets crapped on and Obamacare really crapped on small business owners.”
He’s concerned that Joe Biden would just be more of what they saw under former President Obama.
The Hornsby’s aren’t the only ones voting based on health care.
Brianna Wade says it’s her No. 1 issue that’s influenced her vote.
“There’s a lot of people in southern West Virginia, that need health care,” Wade said. “And, you know, that may not have proper access to it, especially kids who (are) in between the ages of 18 and 26, who are going to need to be on their parents health care for a little while until they can get established, or get, you know, health care of their own.”
Diversity Across County-Lines
Brianna Wade is a 28-year-old Black woman. She spent her young childhood growing up in Welch, in McDowell County.
“If somebody didn’t like you, it wasn’t because of the color of your skin,” she remembered about Welch, “It’s just because of your attitude.”
Courtesy
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Brianna Wade with Former Presidential Candidate in 2016, Bernie Sanders.
She often longs for the community pride and support she found in Welch.
“I wish there were more jobs in McDowell County, because I would prefer my kids to grow up down there, kind of like I did,” Wade said, “… playing with their relatives and kids in the neighborhood, that type of thing.”
She moved with her family to Mercer County when she was about 14 or 15 years old.
“I’ve always heard that Mercer County was more racist than McDowell County and I saw that first hand,” Wade explained her experience. “It was also different with the coal camps, because I always learned that with coal camps, everybody’s granddad like or dad worked in the coal mine, so everybody had to have each other’s back. So there was more sense of community and mentality versus Mercer County.”
In neighboring Wyoming County, folks are concerned about health care, too.
“It affected our family personally, because my sister had Obamacare and it was so expensive, it was really hard for her to make the payments,” said Terri Smith, a lifelong resident of Mullens. “So it helped some of the poor people, but it didn’t always help the working class.”
Jessica Lilly
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Terri Smith is a registered Democrat but will be voting for Donald Trump in the 2020 election.
Health care cost is not the only reason why Smith is voting for Trump.Like Hornsby, for her, part of it comes down to work ethic.
“I think you need to work for what you get,” Smith said. “No one’s supposed to hand you anything.”
Smith’s No. 1 one reason why she’s voting for Trump? Border patrol.
“I really think that we could allow anyone into our country, but they need to come in legally,” Smith said. “We protect our own homes at night by locking doors and we need to do the same thing for our country.”
Smith also says her emotions pull her to the Republican party based on their stance on abortion.
“I don’t believe in abortion,” Smith said. “An innocent child has a right to live.”
Not everyone has made up their minds in the county.Amanda Sesco is a registered Republican but says her views are more Libertarian. Last time, she didn’t vote for Trump, but for Green Party nominee, Jill Stein.
“Well, in hindsight, I just feel like I just wasted that vote on the last election,” Sesco said. And I just threw it away.”
Voting Against President Trump
For Kent McBride, a registered Democrat, he knows who he won’t be voting for.
“I will not be voting for Donald Trump,” McBride said.
He’s not as worried about the national economy, because he says there are more important things to focus on.
“I don’t want my son to grow up in a world, my two sons to grow up in a world that gets worse than it is today,” McBride said. “We’re all going to die one day, and it’s not going to be about how big or a 401k’s you have. It’s going to be about, do you live a life that cares about other people? Do you take care of people around you, and I’m worried that the direction this country is going, we’re going to be no better than the people that we’ve fought for years, because we’re going to become that country with that divide.”
