State employees had the opportunity Monday evening to make their voices heard about proposed rate increases to their health insurance.
About 160 people attended a virtual public hearing held by the West Virginia Public Employees Insurance Agency (PEIA), to hear proposed changes to their health insurance for Plan Year 2026, beginning July 1, 2025.
On Oct. 24, PEIA and the Retiree Health Benefit Trust (RHBT) Finance Board met to discuss proposed changes to rates.
Brian Cunningham, the director of PEIA, presented the Finance Board’s proposed rate increases, then took questions and comments from the audience.
The board’s proposal includes a projected five-year plan to raise member payments and restore PEIA reserves. Those proposals include more than doubling some copays along with premium increases through 2029.
Cunningham said the rate increases can be attributed to the passage of Senate Bill 268.
The 2023 bill mandated a spousal surcharge and formalized the 80/20 rule, which requires insurance companies to spend at least 80 percent of the money they take in from premiums on health care costs and quality improvement activities.
“As it relates to spousal surcharge, the board is proposing a $350 spousal surcharge,” Cunningham said. “Currently, that spousal surcharge is $147.”
The bill also required PEIA to increase reimbursement to healthcare providers.
“The other things that are driving cost increases, (you) may have heard of Senate Bill 268, which resulted in increased reimbursement to healthcare providers,” Cunningham said. “In plan year 2024 PEIA paid out more than $70 million more in healthcare providers and reimbursement to healthcare providers, particularly inpatient hospitals.”
Finally, Cunningham said, rising prescription drug costs are spurring rate increases for employees.
“A significant driver of the cost of prescription drugs are what are known as GLP-1’s,” Cunningham said. “GLP-1’s are prescription drugs like Ozempic and Mounjaro. GLP-1’s were responsible for almost $53 million in cost in plan year 2024 which is approximately 20 percent of the overall net cost, or the overall net drug spend at PEIA.”
In March, PEIA canceled a 1,000-person pilot program that covered weight-loss drugs due in part to the program’s cost to the state. However, advocates of the program say the state will end up paying more for the health complications that will be caused by obesity.
West Virginia state employees from all walks of life voiced their concerns about increasing healthcare costs.
Retirees on the call say they worked their lives for their retirement, and these rate increases will not be feasible on a fixed income.
Teachers on the call say their salaries do not cover their expenses, but they have continued to work their state jobs for the benefits because it outweighed the cost and they care about their work.
Jamie Tallman was one of 165 West Virginians on the virtual call who spoke during Monday’s hearing. He has been teaching in Grant County for almost 40 years.
He says he and his wife will have to consider selling their home and downsizing if the rate increases are implemented. That echoes sentiments from his fellow state educators that affordable health benefits were leveling out the low salaries provided by the state.
“This would be the most severe pay cut, basically, that I would receive as an educator in all my career. And I know somebody said last night, it is a perk,” Tallman said. “The insurance has kind of been a perk, you know. We work right up there, 49th, 50th, you know, in teacher salary.”
Most speakers said if the rates are raised they will have to consider leaving the state entirely or stopping work for the state.
Cunningham encouraged PEIA members to reach out to their lawmakers to let them know their concerns.
PEIA is continuing to hold public hearings throughout the week.
