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Health Reform Facts: West Virginia DEMOGRAPHY The Patient Protection and Affordable Care Act (ACA) was

Health Reform Facts: West Virginia

DEMOGRAPHY

The Patient Protection and Affordable Care Act (ACA) was enacted on March 23, 2010. Successful implementation requires cooperation between key stakeholders, federal and state agencies, and reform advocacy organizations. Because the fifty states vary greatly, each state’s implementationprocess will be unique.

In 2009, West Virginia’s population

was

The health care needs of West Virginia’s vast rural population will pose challenges to those implementing health reform in the state.

estimated to be 1,819,777. 1

Percent of Population in West Virginia living in Rural versus Urban areas

2

43 57
43
57

Rural43 57 Urban

Urban43 57 Rural

WEST VIRGINIA AND THE UNINSURED: HOW WILL ACA HELP?

While 85.4% of all West Virginia residents have health insurance, over 262,300 individuals remain uninsured, 3 including about 5.3% of West Virginia’s children 4 and approximately 19.2%of the state’s working population. 5

ACA is designed to address these concerns by providing affordable access to health insurance coverage to those individuals who would otherwise be unable to obtain coverage, and to extend current benefits and services provided by Medicaid (a federal and state funded public insurance program that provides health insurance coverage for low-income and disabled individuals and families).

NEW BENEFITS UNDER ACA: THE EFFECTS IN WEST VIRGNIA

Insurance

Coverage

ACA establishes new requirements for private health insurers in order to make health care plans more accessible to the public. These requirements include the following:

Effective Immediately: Plans must cover certain preventive health services, such as vaccines and screenings, without a co-pay.

Effective September 2010:

Health Care Facts: West Virginia National Coalition on Health Care

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Insurers will not be allowed to drop any insured person because he/she gets sick or develops a chronic health condition. In addition, ACA allows individuals to renew health insurance coverage regardless of their health status.

Individuals up to the age of 26 can choose to be covered under their parents’ insurance plan.

Effective January 2014:

Under the “guaranteed issue” provision, an insurer must accept every employer and individual in the state that applies for coverage.

Insurers cannot exclude people from coverage if they have a pre-existing condition (e.g., asthma, diabetes, or any other long-term condition) or past illness.

All insurers will be required to offer a coverage package that offers essential benefits.

 

Effective Immediately: ACA makes tax credits available to qualifying small businesses to

Small

Business

Assistance

help them afford coverage for their employees. These tax credits could total up to 50% of

business’ health insurance premiums. In 2008, West Virginia had over 24,868 small businesses, 6 which represented almost 72% of the state’s employers. 7

a

 

Effective January 2014: ACA requires that states create an insurance market “exchange”

Health

a marketplace where people will be able to compare and shop for health insurance.

Insurance

This will make access to health plans easier and more efficient. U.S. citizens, legal

Exchanges

immigrants, and small businesses will be able to purchase insurance through these exchanges.

Tax Credits

Effective January 2014: ACA provides a tax credit to qualified individuals so that they may purchase health insurance through the exchanges. Qualification for the tax credit will be based on the individual’s household income and his/her number of dependents. A person who earns between 133% and 400% of the federal poverty level 8 may be eligible for individual tax credits.

for

Individuals

High-Risk

Effective July 2010: High-risk pools are designed to provide health insurance coverage to people who were previously uninsurable due to a pre-existing condition. The Department of Health and Human Services (HHS) may allocate $27 million for West Virginia to implement a high-risk pool that complies with ACA’s requirements. 9 West Virginia will be running its own high-risk pool; residents will be allowed to sign up for the program beginning September 1 st . 10

Insurance

Pools

Expansion

Effective January 2014: ACA contains provisions that would create new eligibility requirements for Medicaid. For example, adults under the age of 65 earning less than 133% of the federal poverty level, may be eligible to apply regardless of whether they have children. It is estimated that approximately 121,635 West Virginians may be eligible to join Medcaid. 11

of

Medicaid

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IMPLEMENTATION CHALLENGES IN WEST VIRGINIA

Successful implementation of ACA will require a joint effort among local, state, and federal agencies, as well as many non-governmental organizations. The State of West Virginia will face several challenges:

Health Care Workforce– With the potential increase of West Virginia’s insured population, it is important that primary care physicians and other necessary health care professionals are engaged in health care reform. ACA provides grants and loan forgiveness to health care professionals; this will help West Virginia ensure that it has an appropriate supply of doctors, nurses, social workers, and other professionals to cover the increased demand.

Insurance Oversight – West Virginia’s government will need to work alongside HHS and other federal agencies to establish procedures and reporting requirements to oversee insurance companies’ compliance with ACA regulations.

Rural Population –In West Virginia, 92% of community health centers’ – non-profit, community- directed providers – patients live in rural settings. 12 ACA allocated $11 billion to improve community health centers nation-wide. Thus, West Virginians may have improved access to community health centers with an increased number of health providers and greater training capacity.

1 U.S. CENSUS BUREAU. STATE AND COUNTY QUICKFACTS (2010), available at http://quickfacts.census.gov/qfd/states/54000.html (last accessed June 2010). These figures are from 2009.

2 THE KAISER FAMILY FOUNDATION, statehealthfacts.org. Demographics and the Economy, Data Source: Urban Institute and Kaiser Commission on Medicaid and the Uninsured estimates based on the Census Bureau's March 2008 and 2009 Current Population Survey (CPS: Annual Social and Economic Supplements), available at http://www.statehealthfacts.org:/comparecat.jsp?cat=1&rgn=50&rgn=1 (last accessed June 2010).

3 THE KAISER FAMILY FOUNDATION, statehealthfacts.org. Data Source: Urban Institute and Kaiser Commission on Medicaid and the Uninsured estimates based on the Census Bureau's March 2008 and 2009 Current Population Survey (CPS: Annual Social and Economic Supplements), available at http://www.statehealthfacts.org:/comparetable.jsp?ind=125&cat=3 (last accessed June 2010).

4 THE KAISER FAMILY FOUNDATION, statehealthfacts.org. Data Source: Urban Institute and Kaiser Commission on Medicaid and the Uninsured estimates based on the Census Bureau's March 2008 and 2009 Current Population Survey (CPS: Annual Social and Economic Supplements), available at http://www.statehealthfacts.org:/comparetable.jsp?ind=127&cat=3 (last accessed June 2010).

5 COVER THE UNINSURED, ROBERT WOOD JOHNSON FOUNDATION, U.S. UNINSURED WORKERS, available at

http://covertheuninsured.org/uninsured_workers#map (last accessed June 2010). These figures are from 2006-2007.

6 Small businesses include employers with fewer than 50 employees.

7 U.S. DEPT OF HEALTH & HUMAN SVCS. MEDICAL EXPENDITURE PANEL SURVEY (2008), available at

8 The federal poverty level for the 48 contiguous states is $10,830 for a single individual. ASSISTANT SEC'Y FOR PLANNING AND EVALUATION, U.S. DEPT OF HEALTH & HUMAN SVCS. THE 2009 HHS POVERTY GUIDELINES (2010), available at http://aspe.hhs.gov/poverty/09poverty.shtml (last accessed June 2010).

9 U.S. DEPT OF HEALTH & HUMAN SVCS. FACT SHEET – TEMPORARY HIGH-RISK POOL PROGRAM, available at

10 Lea Winnerman, HHS Starts Accepting Applicants for High-Risk Pools for the Uninsured, July 1, 2010, available at http://www.pbs.org/newshour/rundown/2010/07/hhs-begins-accepting-applicants-for-high-risk-pools-for-the-uninsured.html (last accessed July 2010).

11 JOHN HOLAHAN & IRENE HEADEN, KAISER COMMISSION ON MEDICAID AND THE UNINSURED, MEDICAID COVERAGE AND SPENDING IN HEALTH REFORM: NATIONAL

2010).

12 NATL ASSOC. OF CMTY. HEALTH CTRS., WEST VIRGINIA HEALTH CENTER FACT SHEET, available at

Health Care Facts: West Virginia National Coalition on Health Care

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