SOUTH CHARLESTON, W.Va. — As the 2020 election cycle takes shape, one West Virginia advocacy leader says health care will be among voters’ top concerns when they head to the polls next year.

“It’s in the top three. Most West Virginians list it as their first or second most important issue,” said Jessica Ice, the executive director of West Virginians for Affordable Health Care. “Access, affordability, all of that.”

Ice spoke to MetroNews on Tuesday about her organization’s top concerns heading into next year as well as the possible trends with Medicaid.

Ice said West Virginians — regardless of party — think about multiple aspects of health care in their everyday lives.

“We know that there is a lot of challenges to good health care in West Virginia. Geography, the opioid crisis, even just having enough providers is a challenge,” she said. “I don’t think it’s as much as a partisan issue in this state. Even with Medicaid, a lot of folks might think conservatives might not be as in favor as liberal folks, but Medicaid is a very popular program in our state.”

According to the U.S. Centers for Medicare and Medicaid Services, more than 528,000 West Virginians are enrolled in Medicaid or the Children’s Health Insurance Progam. West Virginia expanded Medicaid in 2014, and more than 155,000 people have coverage as a result. The expansion was possible because of former President Barack Obama’s health care law.

“It’s huge,” Ice said of Medicaid’s impact in West Virginia.

During the 2018 midterms elections, health care ranked as the top concern among voters nationwide. Congressional Republicans have tried multiple times to repeal “Obamacare,” but have been unsuccessful.

West Virginia is among the states challenging the constitutionality of the federal health care law. Oral arguments regarding a December ruling — which struck the law and its mandate provision down — took place in July in a New Orleans courtroom.

The 2017 tax law zeroed out the individual mandate penalty.

“What we’ve been doing is trying to educate people on what that would mean for West Virginians if we do lose the protections that came out of the Affordable Care Act,” Ice said.

“We’re trying to be optimistic and not think too hard about a negative decision, but being realistic and know it could fundamentally change how people access health care not just in West Virginia, but across the country.”

Ice said recent policy with the state Legislature has been mixed; during this year’s regular session, lawmakers overwhelmingly approved expanding Medicaid to cover pregnant women in households that make up to 185% of the federal poverty level in addition to coverage through the Children’s Health Insurance program for women in householders that earn between 185% and 300% of the federal poverty level. The changes apply to up to 60 days of postpartum care, yet the CHIP expansion also covers prenatal care and delivery.

The federal poverty level for a family of four is $25,750; the new Medicaid limit is around $47,600 and the CHIP maximum is more than $77,250.

A concern Ice mentioned was a failed measure that would have required “able-bodied” people to work or volunteer for at least 20 hours a week to receive Medicaid benefits. Lawmakers failed to pass the measure, but Ice said legislators could introduce a similar measure in future sessions.

“Our position is Medicaid is a health program, not a jobs program,” she said. “We would like to avoid attaching work requirements to health insurance.”

Ice said going forward, she would like to see the new Medicaid and CHIP limits for mothers being expanded to one year as well as school districts be allowed to bill Medicaid for certain services.

“Healthy kids are out healthy future, and we think this is an area that we could reach people where they are,” she said. “Not just children, but entire family units.”

Ice noted the challenges in expanding Medicaid billing, including likely amendments to the state’s requirements.

“That’s a long-term thing that we want to work on,” she added.

During the next election, Ice said her organization will focus more on educating voters rather than encouraging participation.

“They are already engaged because this is so personable to them. Health care’s personal to everybody,” she said. “What we try to do is provide a variety of things. Education is the biggest, but we also want to provide opportunities to participate, so sending them where they can write their legislator or a petition that they might want to look at.”

The U.S. Census Bureau on Tuesday released a report on the uninsured rate across the country; West Virginia’s rate slightly rose from 6.1% in 2017 to 6.4% in 2018. The state’s uninsured rate decreased from 14% to 5.3% between 2013 and 2016.

The national uninsured rate increased from 7.9% in 2017 to 8.5% in 2018.