West Virginia Public Broadcasting
Telling West Virginia's Story
This week, Republicans in Congress will try to rally votes behind a bill that proposes major changes to the way Americans get health care and how much they pay. In West Virginia, many thousands could be affected. Use this Q&A to explore how the bill would affect you.
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All three West Virginia Congressmen voted for the American Health Care Act – the bill to repeal Obamacare.
Critics say it would hurt low-income and older people, both of which are found in abundance in West Virginia. Supporters say Obamacare has failed to offer affordable health care options to many. We debate who’s right.
Also, should pets be allowed in the workplace? And if so, under what conditions?
“The Front Porch” is where we tackle the tough issues facing Appalachia the same way you talk with your friends on the porch.
“The Front Porch” is hosted by conservative lawyer and columnist Laurie Lin, WVPB CEO Scott Finn, and our liberal, goat-herding, Greek-loving, Hillbilly-philosophizing, American-Friends-Service-Committee working co-host, Rick Wilson.
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 at wvpublic.org and as a podcast as well.
Share your opinions with us about these issues, and let us know what you’d like us to discuss in the future. Send a tweet to @radiofinn or @wvpublicnews, or e-mail S cott at sfinn @ wvpublic.org
The Front Porch is sponsored by the Charleston Gazette-Mail, using its C-G-M App to deliver the latest news, traffic and weather alerts. Download the C-G-M app at iTunes or Google Play.
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 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.
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.
Today is the last day to enroll in or change a 2017 insurance plan through the federal healthcare marketplace. But if the Affordable Care Act is repealed,…
Today is the last day to enroll in or change a 2017 insurance plan through the federal healthcare marketplace. But if the Affordable Care Act is repealed, this may be the last time people can sign up for insurance through the marketplace.
In 2016, more than 37,000 West Virginians signed up for health insurance through the ACA marketplaces. Nationwide, enrollment numbers for 2017 are up slightly from 2016 numbers – despite promises from President Trump to repeal the healthcare law.
Last week, the White House ordered federal health officials to stop advertising that the final days to sign up for 2017 coverage are approaching. Critics fear this move will suppress the enrollment of young, healthy people who research has shown tend to buy insurance at last minute. Those healthy individuals help pay into the system, but make fewer claims, helping control insurance costs.
As of January 14, 8.8 million Americans had signed up for insurance through the health care marketplace. Enrollment numbers have not been updated since Trump took the White House on January 20.
Appalachia Health News is a project of West Virginia Public Broadcasting, with support from the Benedum Foundation, Charleston Area Medical Center and WVU Medicine.
