Most of the focus on the new health care law has been about problems with the website and the number of people who have signed up on the exchange. In West Virginia, 20,131 individuals used the initial sign up period to choose a health insurance plan on the exchange.
However a more important figure—one that has attracted far less attention—is the number of West Virginians who have signed up for Medicaid, the state health care program for the poor. Under Obamacare, individuals and families in participating states with income of up to 138 percent of the poverty level, qualify for Medicaid.
The state Department of Health and Human Resources (DHHR) reports 104,827 West Virginians have been added to Medicaid under the expansion. That means 461,354 individuals, about one in four West Virginians, are now on Medicaid.
And the number will continue to grow. It is estimated that approximately 28,000 more West Virginians could eventually sign up under the expansion.
Medicaid is expensive. The state has budgeted $3.6 billion ($2.7 billion in federal money and $930 million in state dollars) for 2015. Initially, no additional state dollars will be needed to pay for those newly covered under the expansion.
However, the federal share will scale down from 100 percent to 90 percent by 2020. State contracted actuaries estimated that from 2014 to 2023, the federal government will spend $5.2 billion and the state approximately $375 million on Medicaid expansion in West Virginia.
Obamacare supporters argue that opening Medicaid to thousands more West Virginians is positive; more lower income folks will be able to get health care without going broke and providers shouldn’t get stuck with as many unpaid bills.
But there are still many unknowns.
What happens if Washington’s fiscal problems grow and Congress dumps more of the Medicaid costs on the state? West Virginia’s budget is already tight and it would be difficult to scale back a health care benefit once people have gotten used to it.
Also, there’s no guarantee that providing more people with free health insurance coverage (except for small co-pays) will encourage people to make price-conscious decisions about their care. A study published recently in the journal Science found that when Oregon expanded its Medicaid rolls in 2008, patient use of hospital ERs for non-emergencies increased by 40 percent.
(It should be noted, however, that DHHR is putting in place strategies to encourage Medicaid patients to take more personal responsibility for their health by appropriately using the health care system.)
West Virginia also has a provider issue. DHHR Assistant Secretary Jeremiah Samples believes there is a great need for more providers in West Virginia. “While West Virginia is situated better on primary care than most states, we still have primary care shortfalls,” Samples told me. “Our shortfalls are just not as acute as other jurisdictions because of our robust network of Federally Qualified Health Center and Rural Health Clinic infrastructure. However, we do have significant shortfalls for specialty providers, which could result in folks having to wait longer to see a specialist.”
West Virginia has a high rate of chronic health problems—diabetes, heart disease, smoking-related ailments, obesity. The life expectancy here is three years less than the national average. The hope is that providing another 100,000-plus state residents with insurance will improve our overall health.
But what we don’t know yet is how much this additional care is going to cost and how we’re going to pay for it in the years ahead.