Medicaid Expansion Story Archives - Page 2 of 3 - West Virginia Public Broadcasting

Drug Treatment Funding in Question as U.S. Health Secretary Promises Fight Against Opioids

West Virginia’s opioid overdose death rate is two and a half times the national average, the highest in the country. Last year, 864 West Virginians died from an overdose, up by more than 17 percent from the year prior.

West Virginia Department of Health and Human Resources Sec. Bill Crouch shared those statistics at a press conference Tuesday. Crouch hosted U.S. Health and Human Services Sec. Tom Price for a closed-door meeting about the state’s struggle with substance abuse and what the federal government can do to help.

“We are losing a generation of West Virginians,” Crouch said, “and in some cases with an addicted mother and her newborn baby, I worry we are losing two generations.”

Price said President Trump is committed to battling the opioid epidemic, not just in West Virginia, but across the country.

Shortly after taking office, Trump created a bi-partisan commission on drug addiction, led by New Jersey Gov. Chris Christie, and last month announced nearly $500 million in federal grants awarded to states to combat substance abuse.

Counselor to the President Kellyanne Conway says that’s Trump’s plan- to support efforts on the frontlines.

“This will not be solved from Washington, D.C.,” she said during the press conference. “This will be ameliorated and annihilated at the state and local levels.”

Price said the president’s push to support local efforts is why Price traveling the country to meet with state officials, but it’s also why the administration is supporting two essentially budgetary actions that seem to put substance abuse treatment at risk in West Virginia, at least for some populations.

The first is health care: 170,000 West Virginians received Medicaid coverage when former Gov. Earl Ray Tomblin chose to expand the program as a part of the Affordable Care Act. According Crouch, some 50,000 of those West Virginians also suffer with an addiction.

Medicaid does cover substance abuse treatment, but a Trump-backed plan to repeal and replace the Affordable Care Act would also put an end to Medicaid expansion and result in the potential loss of treatment for those 50,000 West Virginians.

“We have serious concerns about what is going to happen with that population,” Crouch told reporters. “Our crisis right now is difficult to deal with. If we have an additional 50,000 individuals with no coverage, no way to get treatment, we think our problem is going to get light years more difficult.

Considering those difficulties, Crouch was asked about his ability to convince federal officials to keep the expanded version of the program, but the secretary said the ACA repeal comes with something that’s good for West Virginia.

“As a state that wants more flexibility in terms of Medicaid and how we utilize Medicaid monies, that’s very welcome to us,” he said.

“We believe it’s wholly possible and the opportunity exists to provide states the flexibility, the appropriate resources,” Price said of the changes he sees as necessary to the Medicaid system, “so that we can have better outcomes and better coverage for individuals in the Medicaid population.”

The repeal and replace bill that allows for state flexibility, but also ends Medicaid expansion coverage, made it through the U.S. House of Representatives last week, with three supporting votes from West Virginia’s delegation. As it heads to the Senate though, both Senators Joe Manchin and Shelley Moore Capito have expressed concerns.

The second action that may put some substance abuse programs at risk comes in the form of a funding proposal for a federal office. Trump’s administration announced a significant cut to the Office of National Drug Control Policy last week—a 95 percent reduction in his proposed 2018 budget.

Price said while the administration has proposed cutting funding to the office, it is committed to increasing spending to combat the opioid epidemic elsewhere, including through the Department of Health and Human Services, but when asked if the cut was a result of failed outcomes from the office, Prices said that was what he was asking state officials.

Protesters wait outside the Secretary of State’s Office, where HHS Sec. Tom Price held his closed door meeting Tuesday.

“That’s exactly what we’re asking and what the commission is going to be asking: what is the federal government actually doing that’s solving the problem, that’s assisting in getting better outcomes and what is it the that the federal government is doing in wasting federal dollars and resources?” Price said.

Under President Obama, the Office of National Drug Control Policy was responsible for coordinating efforts between public health and safety officials to reduce drug use across the country. The office, which is overseen directly by the White House, does not currently have a page on the administration’s website.

The proposals and their effects have some West Virginia advocacy groups speaking out, attempting to sway West Virginia’s leaders to take a different approach.

Members of the group West Virginians for Affordable Health Care stood outside Price’s Charleston meeting in an attempt to speak with him Tuesday, but were denied access to the listening session.

WVU Expert Talks Health Proposal, CBO Report

On Monday, the Congressional Budget Office released an analysis of the U.S. House of Representatives proposal to replace the Affordable Care Act.The CBO estimates that the proposed legislation would reduce federal deficits by $337 billion over the 2017-2026 period. Savings would come primarily from cutting funding to Medicaid and eliminating nongroup subsidies. A third of West Virginians are on Medicaid and such cuts could have big implications for the state. Kara Lofton talked to West Virginia University health policy professor Thomas Bias about the report and what changes West Virginians could expect to see if the proposed legislation becomes law.

On How West Virginia Will Be Impacted

The two most important estimates in there are what impact the new health care reform law could have on the budget and then on the number of uninsured in the United States. I guess the most concerning from the individual standpoint would be that the proposal would increase the number of uninsured by 24 million individuals by 2026. And most of that is expected to come from Medicaid. And so if you look at West Virginia, for instance, we were a Medicaid expansion state. We had a lot of individuals who became covered under the Medicaid expansion and so it’s kind of unknown of what would happen with Medicaid here in West Virginia.

West Virginia is Not Only a Sick, But Old State. What Changes Might We See to Medicare?

Medicare has been the piece of the puzzle that has pretty much been left alone to date. But it’s important to note that in West Virginia a lot of people are dual eligible for Medicaid and Medicare. So you can’t look at just Medicare, but what impact Medicaid changes will have on Medicare patients as well.

On Stability of the Marketplaces Under the Proposed Legislation

The bill is going to see a lot of compromise and change before we see anything that’s passable. Even this CBO report will play into the debates going forward. So at this point we aren’t going to be seeing any certainty at all – here’s the initial plan we’ve been waiting on. What will it look like a month or two from now? Who knows.

Appalachia Health News is a project of West Virginia Public Broadcasting, with support from the Benedum Foundation, Charleston Area Medical Center and WVU Medicine.

Proposed Federal Changes to Medicaid Would Reduce Funding for W.Va.

On Monday night, members of the U.S. House of Representatives released their bill to replace the Affordable Care Act. Possibly the biggest deal for West Virginia is that the new bill proposes changing the way that Medicaid is funded.

Medicaid is the joint state-federal insurance program that covers more than a third of West Virginians. Right now, the federal government matches state spending for Medicaid dollar for dollar. But under the proposed bill, that funding would change to a per-capita cap.

“This would drastically change it, because it would put strict limits, strict ceiling if you will, on how much the federal government is willing to spend,” said Simon Haeder, an assistant professor of political science at West Virginia University.

“This would transfer the Medicaid program from somewhat of an open-ended commitment to improving healthcare for America’s most-poor individuals to putting a specific dollar amount on this,” he said.

Per-capita caps are supported by West Virginia Representative Evan Jenkins and some other Republican politicians, because they may give states more flexibility in how they spend federal dollars while saving tax dollars paid to the federal government.

“Under the per capita, it would be more reflective of the needs of West Virginia and the populations that Medicaid is designed to do,” said Jenkins.

West Virginia Public Broadcasting spoke to Jenkins at an event last week. At the time of the event, he had not seen the House proposal, but did say he believed the ACA was in a “death spiral” and supported plans to repeal and replace it.

“It’s very important to go back and look at traditional Medicaid….it was a safety net program for targeted populations,” he said. “Well, what’s happened is that, under the ACA, Medicaid was used as a vehicle to allow able-bodied people based on income level – up to 138 percent of [Federal Poverty Line] to go in. So that was one of the Obamacare approaches to expanded insurances – just put more people in Medicaid. So … as a result, the Medicaid budget is three times what it was when Bill Clinton was president. The trajectory right now is through the roof and is simply unsustainable.”

But critics of per-capita caps say they don’t adjust for increased healthcare costs.

“The problem is, when they set that amount they usually tie it to CPI, the current [rate of] inflation,” said Ted Boettner, executive director of the West Virginia Center on Budget and Policy.

“And we all know that medical inflation grows 5, 6, 7 percent a year – much higher than GDP, much higher than other inflation – so that amount of money is really going to decline over time, and that means less benefits.”

Haeder said since West Virginians are sicker, older and more disabled than the national average, Medicaid costs here have similarly been rising at a greater rate.

“And so once you put a ceiling on expenditures, it’s either going to be more state spending or cuts to eligible enrollees or eligible benefits,” he explained.

More state spending would likely be difficult for West Virginia, considering the current budget crisis. The Department of Health and Human Resources did not respond to a request for an interview, but said in an emailed statement that the “DHHR will be exploring the impact of any changes. It will take some time.”

West Virginia is one of 19 states that expanded Medicaid. For now, the more than one hundred thousand people covered by this expansion are protected. In 2020 under the proposed plan, enrollment for expansion would freeze and states would no longer be able to enroll new participants in the program. As of late 2016, more than 170,000 West Virginians had gained coverage through the expansion of Medicaid. Some legislators say, ideally, they hope the number of people covered by this expansion will slowly decline as enrollees’ incomes improve.

Appalachia Health News is a project of West Virginia Public Broadcasting, with support from the Benedum Foundation, Charleston Area Medical Center and WVU Medicine.

More than 25K People in W.Va. With Substance Use Disorders Gained Coverage Under ACA

More than 22,000 West Virginians with substance use disorders have gained health coverage through Medicaid Expansion, according to a report released earlier this month in National Health Law Program. Medicaid Expansion was a voluntary provision of the Affordable Care Act.

The report outlined the impact both Medicaid and the ACA marketplaces have on fighting the opioid epidemic. Medicaid currently pays almost 50 percent of the cost of Buprenorphine in West Virginia – a medication used to treat opioid dependency – as well as for inpatient treatment when necessary. West Virginia has one of the highest rates of opioid overdoses in the country.

As Republican Congressional leaders consider repealing the ACA, including changing funding for Medicaid to a block grant or per capita cap program, ACA supporters say they are concerned the move will reduce access to substance disorder treatment for the expansion population. Cuts or changes to Medicaid funding could also inhibit current efforts to expand substance disorder treatment programs throughout the state.

Appalachia Health News is a project of West Virginia Public Broadcasting, with support from the Benedum Foundation, Charleston Area Medical Center and WVU Medicine.

Questions Surrounding Fate of ACA Repeal Continue

Although Congress hasn’t presented the American public with a clear replacement plan for the Affordable Care Act – the ideas proposed so far are unlikely to make coverage more affordable or allow everyone who has coverage now to keep it. Uncertainty surrounding the ACA is also making it difficult for health plans to stay in the marketplace because they don’t know how to price their plans for next year.

But as members of Congress left Washington today for their February recess, Republicans made it clear they still intend to repeal the ACA.

When it comes to Medicaid – Congressional leaders have proposed replacing Medicaid funding with a block grant or per capita cap program. Under a block grant, states would receive a pre-set amount of funding for Medicaid. Under the per capita payment proposal, federal funding per enrollee would be capped.

Both of these options would likely cut funding to Medicaid and may even eliminate Medicaid expansion – something West Virginia Congressional leaders have spoken strongly against. More than 165,000 West Virginians received healthcare coverage because of the program’s expansion.

Appalachia Health News is a project of West Virginia Public Broadcasting, with support from the Benedum Foundation, Charleston Area Medical Center and WVU Medicine.

Who's to Blame for the $600 EpiPen?

It seems like everyone is angry about the huge price increase of Mylan’s EpiPen. But what’s the real cause?

On “The Front Porch” podcast, Laurie Lin blames federal regulations which inhibit market competition.

We also discuss the future of the Affordable Care Act. Both Bill Cole and Jim Justice, the two leading candidates in West Virginia’s 2016 gubernatorial election, have said they will maintain the state’s expansion of Medicaid under the Affordable Care Act.

In the second segment of the program, we discuss the pros and cons of this expansion, and what it means for the future of health care in the state.

Subscribe to “The Front Porch” podcast on iTunes or however you listen to podcasts.

An edited version of “The Front Porch” airs Fridays at 4:50 p.m. on West Virginia Public Broadcasting’s radio network, and the full version is available above.

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