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.


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  • Uba

    Obama is crap just like his vision for America I come from Russia and have seen first hand the ills of to much government control. Obama uses racism as a crutch to demonize any group or individual who doesn't agree with him or his policy's how convenient. He is an astute political tyrant.

  • Tom

    Vote red then jump on the blue gravy train. Makes real good sense, people.

  • peleliu

    How much does the Iraq war cost us in money and loved ones?

  • Ricardo

    It will follow the same pattern as all insurance policies: increasing deductibles, co-pays and out of pockets. The failure of ACA is it does not reduce costs. Lawyers, doctors, insurance companies and drug companies are the big winners.

  • WVian4ever

    It seems to me that if people work they should have health insurance. This Medicaid expansion isn't for people not working- it is for the working poor. If they don't have health care for themselves or their kids then the incentive is for them to be completely unproductive in society so they are poor enough for traditional Medicaid.

  • WVian4ever

    It seems to me that if people work they should have health insurance. This Medicaid expansion isn't for people not working- it is for the working poor. If they don't have health care for themselves or their kids then the incentive is for them to be completely unproductive in society so they are poor enough for traditional Medicaid.

  • Michelle

    $5.2 billion coming into the state from taxpayers across the country to subsidize costs that would have otherwise be 100% state dollars is a smart financial investment.

  • DP

    WVU MOM-I highly congratulate you for your independence, persistence and morality!!! EVERYTHING you said is spot on! Sadly, so many in this Country are exact opposites of you. Obummer and Ultra Liberal Dems encourage this behavior and unfortunately it's going to become much, much more of a nanny state in the future!

    I'm tempted to get on a tangent about this disaster (aka. Obamacare) and the MOST deceitful POTUS ever. His chronic lying about this POS legislation will do so much more harm to this Country it's truly incalculable. But, I'll save it for another day.

    WVU MOM, you make MOST (sadly not all) of us VERY, VERY PROUD!!!!!

  • GobblyGook

    Well, well, well. The State has budgeted $3.6 BILLION for Medicaid for 2015. They will need $4.5 BILLION by 2018. Where will the money come from? From the people who work, from their wallets.
    Who's in your wallet? Obama!!


    This trend of a nanny state is frightening, extremely frightening. 1 in 4 is on medicaid. As a college student I had a child out of wedlock. I was able to get medicaid to cover the birth and my child's healthcare. I busted my butt to get away from the food stamps and get my own healthcare. It took about a year to make that goal. I was embarrassed to have public assistance. These days people seem to take it as a matter of course. What happened to pride and independence? Why aren't families helping each other? Why would they rather go to the government?

    • Alum

      Good for you, good for you, good for you!!! And thank you for being an great example of work ethic, something that is sorely lacking in many parts of WV and the US.

  • ole sasquatch

    WHAT YOU ALL DON'T KNOW ABOUT MEDICAID. Previous to Obama Care to receive Medicaid you could only have 5000.00 worth of assets. Now if your income is below the 138% poverty level it's available to anyone. Medicaid law says: states have the option of recovering ALL medicaid benefits including costs for any medical care through ESTATE RECOVERY. Here's the POTENTIAL BOMBSHELL! Since anyone with over 5000.00 of assets at death is subject to REPAY EVERY PENNY of Medicaid received, in reality can those affected really say they have insurance at all? Beneficiaries be forewarned! This weighs over the head of all new medicaid recipients like an anvil. People at the very least, deserve to know FOR SURE if they will have anything to leave their children after passing.

    • vashti

      it is actually 200 in assets and applies only to long term care medicaid. it has been in effect for years.

    • liberty4all


      I think you and I have taken different views on this before. Nonetheless, if the children want something left to them at the time of their parent's passing, let the children pay for the medical care. If the taxpayer is funding the medical care and there are assets of the estate at the time of death, let the taxpayer recoup what it has given. I don't see the problem with this concept.

      • ole sasquatch

        1. Just let the one's who have assets know there is the risk that all medical care expense incurred will come out of their estate. (That equals no insurance - can you understand that - paying full price - copy. Be very clear about that. Most do not have any idea of this law and are conservatives who have responsibly saved for their later years.
        2. Do not automatically throw these responsible individuals into this snake pit - like is being done under Obama Care - just because they've had one bad income year.
        If they know their life's work is at risk - they would rather have regular insurance so at least Obama Care should give them that option, which they would gladly take if they knew the alternative. Right now these conservative responsible people have been given no other choice but medicaid under current Obama law.
        I hope all my fellow conservatives can understand the injustice.

  • Wirerowe

    Nationally the administration says that 7,100,000 more have been insured under the affordable care act.McKinsey the national consulting firm says that 75% of those are paying premiums or 5,400,000 million. McKinsey says that 27 % were previously uninsured . So 27% of 5,400,000 means that there are now 1,458,000 more people paying premiums than were previously insured. Clearly some of this is attributed to a growing population some of who would have bought insurance without the act.

  • Gary R

    It was a disgrace to put all these extra people on Medicaid. As the report says when states did this emergency rooms saw a great increase in non emergency room visits. The liberals say that the federal government is picking up the tab. Where does that money come from ? The people that work and pay taxes for the free loaders. After 2022 how much is the the federal government going to pay I've sent emails to Manchin and Rockefeller asking and they won't answer me. I guess they're still writing that part of Obamacare. What ever happens our taxes are going to go thru the roof. Thanks Tomblin.

    • pc

      Hell, we already know the answer to your question. Rockefeller is gone by 2015 and unless you are a typical naïve WV democrat, you can bet you will see little or nothing of him around these parts after that (i.e., back to NY for Jaybird). As for Gov. Billy Ray, Earl Bob, Jimmy Joe, or whatever, well, when the expanded Medicaid bill comes due in a few years, he, too, will be long gone from the scene of the fiasco. Probably, in Florida with his and his wife's exorbitant state pensions and the millions his family scammed from the state under the racing dog breeding program. Manchin? who knows, perhaps he'll be back in the Governor's mansion by then. Anyway, Hoppy paints a very, very bleak picture for the state in the next decade or so.

  • Pickle Barrel

    Unanswered questions:
    1. How many of the 20,131 had their health insurance cancelled due to Obamacare and signed up as a last refuge?
    2. How many of the 20,131 are receiving premium subsidies from Obamacare?
    3. How many of the 20,131 are in the 18-30 Pajama Boy target group?
    4. How many West Virginians are still without health insurance?

    Meanwhile, Obama takes his little victory lap and crows about signing up 7.1 million nationally. That still leaves about 43 million uninsured, meaning 85% of those without health insurance before Obamacare still don't have it.
    Total enrollees means nothing unless you know what it consists of.

    Hope it was worth screwing up 1/6 of the economy.

    • smalltowndoc

      Our small practice saw 4 patients change from private insurance, to Medicaid. Then 2 patients lost an insurance they loved, and are now on the BCBS plan. Their deductible more than doubled. They were ticked! The result is the 2 BCBS patients rarely come, while the Medicaids are here much more than they have ever were in the past.
      Also,half of the Medicaid patients came in with a very long list of complaints and procedures they wanted. But don't worry, someone else is paying for it.

  • Gary

    Compared to the price of war and the rebuilding of countries we ravage, health care is a relative bargain. We always find a way to fund the killing of people.

    • Wilt Chamberland

      Can't say for sure but I bet you are all for tax payer funds paying for abortions