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.

  • Fact Checker

    I'm not sure the 38,000 that DID sign up would agree with your "yet to sign up a single customer" statement.

    In January it was 18,000... Middle of the pack for the states.

  • 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.

  • vashti

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

  • David Kennedy

    I have family in Portland, Oregon. I lived there for 3 years.
    Portland is the place where most of the California Welfare bums go when things get overcrowded.
    Oregon is filled with homeless who will never work because there are no jobs. Three vagrants live in my mother-in-laws yard and give her protection from the meth and crack me, its a model of what this country is becoming.
    Oh, Yeah...Oregon spent 305 million to set up the Obama-care program and has yet to sign up a single customer... I guess it wasn't enough money...

  • 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.

  • Sick&Tired

    I predict you will see a lot more visits to ER.It's all free now they go get pills which become their income.Watch and see it every day.

  • 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.

  • liberty4all


    Look forward to your posts because I can count on a cogent, thoughtful message. I often don't agree with you but know your posts will enlighten me with the reasoned opinions of someone who does not think like me.

    Could not disagree more with single payer unless that single payer is the individual. I favor an approach whereby insurance is removed from the equation as a means to (1) control prices, and (2) create a consumer who makes decisions based on a direct impact which will be felt by them. That is why I have always loved the idea of a health savings account.

    As to #1, there is a reason why some of the only reductions in costs we see in medical services are the areas where health insurance does not cover. The cost of Lasix surgery and breast implants have become much more affordable. Now, it may have a little bit to do with the technology getting better but most of it has to do with the fact that medical providers of these services have to compete for the consumer's dollar.

    As to #2, most insurance is provided through employment (or if single payer, all provided through the government). I believe folks do not have the same appreciation for the consequences of their choices as they would if they were given money, then had to part with it to pay for medical services. At a company I worked for years ago, we had to work until the end of April just to make enough money to pay for the health insurance provided to the employees. Most employees had no concept, and as long as they had $20 for the co-pay in their pocket (or the office accepted Visa), they would run off to the doctor at the slightest sniffle. I think paying them higher wages and forcing them to shop for their own health insurance or medical services on a cash pay basis would have affected some of the decisions that were being made.

    Before I am called heartless, I am not naive enough to think this country does not need a "safety-net" and I think the goal of all citizens getting quality affordable healthcare is a noble one. Despite my preference for a smaller federal government I would gladly support some of my tax dollars going to such a safety net (as it currently does). I would hope that abuses are curbed and realize that no safety net is a perfect system. However, I believe single payer for everyone is an absolute last resort after all other reasonable alternatives have been attempted and failed.

  • Wilt Chamberland

    then why should we pay for preventive healthcare for the masses if we aren't going to follow the "doctors orders"?-- and the rest of worlds healthcare exceeding ours is pure conjecture. Claiming it as being a fact is incredible of you claim.

    I beg your answer though, under your single payer system do I, making 60-80K a year, have the same quality of healthcare as Warren Buffet or do I get the same level of care as the 30 year old that settled to be a lumber loader at Lowe's?

  • Medman

    captain, I agree with your comment, but have to nit-pick your first question, "Can the Federal Government afford...." The question should be, "Can the taxpayers afford it/".

  • Wirerowe

    Mntnman you know good and well I did not criticize anyone. There for the grace of God go you or I. I would disagree with your characterization of our health care system. most of the 85% who had health insurance before the affordable health care act generally received good health care. Clearly we need improvements including expanding accessibility. But I think we would both agree that a system that was repeatedly sold on a mountain of misrepresentations about premiums going down $2500, a person , keeping your own insurance, keeping your own doctors and not costing anything is probably not the best way to achieve that. Also any transparent discussion needs to say with some certainty how any expansion of accessibility is going to be paid and who is going to pay for it. Then this needs to be taken to the voters. I think some universal catastrophic fund is the basis of an improved way to move forward.

  • poca guy

    How do you conclude that people are going to be healthier because they have free insurance. And that this new found health savings will not be overriden by the huge costs associated with people taking advantage of something they don't have to put a dime into? Sounds good but I don't think it is realistic.

  • 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.

  • mntnman

    No more accurate than any estimate made five decades out. That proves what exactly? Our countries GDP was $3.8 trillion in 1960. Now its over $16 trillion. Inflation occurs. Costs rise. So its no surprise that the estimates were wrong. Doesn't make Medicare a failure. Just makes it expensive.

    BTW there are quite a few fixes to Medicare that would improve the costs -- many of which have been rejected by political parties -- one comes to mind -- negotiating drug costs with the pharma industry. Rejected by some in power -- wont' say who, but you probably know who. Can't complain about the costs when there are solutions -- which are blocked by some in power.

  • mntnman

    Appreciate your point of view, just don't agree with it. Right now our health care system is strained to the max, overpriced, over-utilized, way too much charity care, way too expensive and in spite of what many say and think, our outcomes are not even in the top 10 nations. So, we can keep what we've got, or we can work to make it better. Single payer may not be the answer, but what we've got is poor, and those you criticize still get medical care anyway. Its just the most expensive, least efficient medical care we can offer them.

    Its not wishful thinking to conclude that we can develop a system where medical care is wisely used, more efficient adn cheaper. Other do it. You think we can't? I don't beleiv that and wont accept the defeatist attitude..

  • 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.

  • 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.

  • pc

    Tell you what, mntnman, go back and read when medicare was created in the mid 1960s what Lyndon Johnson, house speaker Sam Rayburn and other Congressional Democrats said what Medicare would cost in 40-50 years. Then look at reality: they were hundreds of billions of dollars low in the estimate of what medicare would cost in 2000-2010. Now look at the BS/lies about the cost of Obammycare coming from the lips of Barry boy, Reed, Pelosie, Boxer, et. al., and tell me you believe that they are any more true/accurate than the statements of Johnson, Rayburn and company!!

  • The bookman


  • 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.

  • 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.

  • 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!!!!!

  • bulldog95

    Everyone has the chance to get healthcare now but they arent doing it. So the number said 30 million didnt have insurance, or maybe it was closer to 40 million. If they WANTED it so badly then the number would be much better than 7 million that have signed up for it. Lets assume that all of those 7 million didnt have insurance before, but thats a stretch.

    You and I have went back and forth about abuse and people wanting something for nothing and now the numbers are showing it, if you actually want to look at them. 7 million people, thats it. I would love to know how many of those 7 million lost insurance and ended up on Obamacare as a result.

    Again, those numbers scream an entitlement society that wants medical care as long as they dont have to pay for it. So yea, lets do your plan and give everyone medicare, that 7 mil would turn into 30 mil in a week. In the meantime those of us with a job are paying for a system that will crash.

  • Wirerowe

    I am opposed because I do not believe it would be the best way to provide health care for all Americans. We don't give those in need monthly checks with no strings because we are afraid they will make bad decisions ( buy alcohol, drugs, or gamble the money away) Instead we give them food stamps, housing vouchers, cell phones and free health care. What incentive is for them to learn to make informed decisions when there is no incentive to. Like you I would like that to happen.Won't happen with all the wishful thinking and platitudes in the world. Look at your own children . They take ownership when they have to work for it. Not being judgmental just realistic about human behavior when someone gets something for nothing.

  • mntnman

    My point stands -- the comments are the same as what people said about medicare many decades ago -- and it is generally consider a success, warts and all.

    And its not free. The retired pay a premium every month. Some pay a good percentage of their monthly income.

    Wow. Lots of "let them eat cake" people out here today. Poverty is now a character flaw...

  • mntnman

    We don't force people now, why would we then. As for utopia, it is not such a thing. It exists in much of the rest of the world and their healthcare outcomes often exceed ours. Not an opinion, fact.

  • mntnman

    Opposed because??? As for Oregon, I've seen the study. People have to learn how to use healthcare. Even those with insurance oftentimes overuse their healthcare. Don't shop around for the best deals. Its something we need to teach, at all levels.

  • 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!!

  • Barb

    DWM, I admire people like you that are so smart that you can tell everyone exactly what's going on. Thanks so much!!


    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?

  • 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.

  • 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.

  • zero tolerance

    I really don't think you can change the poverty mindset to take personal responsibility about their personal health. It is ingrained as their impoverished lifestyle is to them. Some know no other lifestyle and as sad as it may be, I don't realistically think you can change that mindset.

    Generational poverty is as much a part of WV history as is coal mining.

  • Wilt Chamberland

    In your utopia of single payer universal healthcare,--- where I suppose I receive the same healthcare as the President and all the beautiful people in Hollywood,,,, or should I say, they receive the same healthcare as I,-- Do we force people into a annual physical and not "following the Doctor's orders" isn't an option?

  • Wirerowe

    There is some evidence from Oregon that those that go on Mediciad continue to use emergency rooms for primary care. There may be reasons for this but your hypothesis if we give people free health care they will quit using emergency rooms for primary care is not substantiated at least by some evidence. I am opposed to a single payer system in America.

  • Charleston

    While your at it, ask a military vet how there treatment at the VA has been of recent?

  • Wilt Chamberland

    mtnman knows that. It's the red herring they always draw on when they have nothing worthwhile to contribute.

  • Wilt Chamberland

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

  • fed up

    let's not get Medicare confused with Medicaid- Medicare is health insurance for someone who worked and paid into the system and is either retired or disabled. Medicaid is free and you don't have to work a day in your life to get it, and it is passed down from generation to generation, and the more babies you have the more money you get....

  • 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.

  • NCWV62

    The thing that doesn't get much airplay is that the extra advertising encouraging people to sign up also increased the numbers that are on 'regular' medicaid that IS paid for, in part, by the state. That little fact seems to be forgotten. How many of the 104k+ new medicaid enrollees are expanded medicaid vs regular medicaid that we'll pay for as a state?

  • NCWV62

    Of course they like Medicare! Who wouldn't? People who didn't need a doctor in 20 years are suddenly seeing specialists every week for every little ache and pain because it's free.

  • 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.

  • 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.

  • mntnman

    So said many when medicare was created. Ask an 80 year old if they like medicare.

  • mntnman

    More to the point, can we not afford to leave the uninsured uninsured. We pay when they go to the ER for a cold or headache. We pay when the diabetic goes years without treatment, develops feet problems and has an amputation. We pay over and over -- so lets try a different way and see how it works. The more people who are insured and learn how to utilize medical care, the better we all will be. What we have works poorly for far too many.

    No, I do not think having health care is a right -- but I think it is smart for a society to chose to insure all in order to control costs better, keep kids (d adults) healthier and reduce the amount of poor use of medical resources. (Going to the ER for a headache is nuts!) It will take time.

    My view is we need single payer. Put us all on Medicare. Premiums paid on a sliding scale. Determine rates much like the private sector does. Decide what medical services are worth; one price for particular treatments. (That is a major problem today. Price an MRI study all over the country -- the price variance is ridiculous, given it is the same technology everywhere.) It could be successful if we approached it like a private insurance company. Perhaps we could even use the insurance market and let the private companies vie for our business -- much like Medicare Advantage does. Use the combined market place and the public sector to resolve the issue once and for all. Or not.

    Just one mans opinion.

  • DWM

    You give someone something free that they have done nothing to earn and think they are entitled to, then expect them to make price conscious decisions??

    If they were making good decisions with their lives all along they wouldn't be getting free health care to begin with.

    If anyone sees this as something than an unmitigated disaster in a few years, they aren't paying attention.

  • CaptainQ

    Hoppy, while getting previously uninsured people health insurance coverage is a good thing and a noble goal, the overall looming question must be addressed: Can the Federal Government AFFORD it? All of the money to cover all of the subsidies individuals and families are getting to help pay their premiums has to come from SOMEWHERE.

    In the case of the expanded Medicaid, eventually all of the added cost of coverage for all the new enrollees will fall squarely on the shoulders of the individual state governments. At this moment, West Virginia has already had to dip into it's Rainy Day Fund to balance its budget. And this is BEFORE the brunt of the new ObamaCare related expenses have kicked it. If the state's treasury's hurting now, just wait until all those extra costs of ObamaCare/Expanded Medicaid come due.

    The bottom line is, though the goal of ObamaCare is a just one, how will this nation (and in the years to come, this state) be able to fund it? Where will all that additional money come from? Take a good look in the mirror and smile. THAT'S who'll be paying for it, in one form or another, in the years and decades to come.

  • David

    I agree that the cost to WV for Medicaid is likely to increase, however I believe that most of the people eligible for coverage under expanded Medicaid contribute back far more to society, by being even incrementally healthier, than the cost to society. I don't have numbers to back that up, and it may be my admitted progressive bias which leads me to believe this way. I think healthier people work more, and buy more, which is a plus for everyone.

  • Silas Lynch


    Don’t worry, by 2020 there will be just a scant few of the baby-boomers left to make this eventual single payer system financially top heavy. I think most reasonable people that are willing to honestly and objectively look at the health-care system being assembled before us can see it is being assembled to “cull the herd” and control the expansion of population—Today the liberals already scream “Mother Earth can’t support our human population” According to a 2009 report, The Lancet reports because of our health-care system, Americans born after 2000 can expect to live well into triple digits-- -- The Georgia Guidestone horde won’t stand for the common masses living that long so the best way to control our lifespan is to control our healthcare.

    Hoppy, Obamacare’s implementation isn’t to make sure the poorest among us have healthcare as good as you and I currently enjoy, it’s intent is to make sure you and I don’t never have better healthcare than they do.

  • The bookman

    Medman, the disconnect between cost of programs and revenue to support them permeates every issue we face. Anyone who raises the question of how we manage to pay for the ever expanding safety net is labelled a right wing tea party extremist who wants to starve children. At some point, in the absence of a complete change in our fiscal approach, the weight of our creation will collapse this great country. Thanks for the reality check.

  • Wirerowe

    Agree with Medman . Except new Mediciad recipients are getting the ultimate subsidies. It is free. The President of the state senate is almost giddy that so many people are signing up for Medicaid and state taxpayers are not on the hook for it. Those West Virginia taxpayers who are not on the hook for it are the same federal taxpayers that are on the hook for it. One way or the other West Virginians will have more coming out of their pockets to pay for new Mediciad recipients.

  • Medman

    I find it amazing that people actually believe that getting Federal subsidies for Medicaid does not cost WV taxpayers anything. It is "free" money that spontaneously appears our of the blue and is the logic that created more than $17T in debt that is growing exponentially by the hour.