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Obamacare in West Virginia: Uncertainty runs deep

USA TODAY's Julie Schmit, Rick Jervis and Greg Toppo reported from California, Texas and West Virginia to see what people are seeing, and thinking, as the Affordable Care Act is being rolled out in three very different ways in these three states.

PRINCETON, W.Va. — "What's your sugar?" asks Lawrence Pickering as he walks through his neighbor Catherine Selen's front door. Like Selen, he has diabetes, so whenever the two meet, their blood-sugar levels double as their greeting.

A 31-year-old waitress and West Virginia native, Selen is grateful to have a number that's finally under control, weeks after a life-threatening diabetic event put her in the hospital. The June 2 incident followed nearly six months of having no health insurance, forcing her to scramble to find insulin and supplies.

Like many other West Virginians, she's looking forward to guaranteed health insurance next year under the Affordable Care Act, which will cover her medication, syringes and six daily blood tests.

Many don't share her enthusiasm. In a Gallupsurvey of West Virginia small-business owners in April, 48% said the law would be bad for business and 55% said they believed it would raise their health care costs. About four in 10 (41%) said they had held off hiring new employees or (38%) had pulled back on plans to expandThe Obama administration has delayed until 2015 the requirement for businesses to offer health insurance to employees.

"Employers are working at this from the standpoint of how much this is going to cost," West Virginia Chamber of Commerce President Steve Roberts told the Charleston(W.Va.) Daily Mail. "The (law) regrettably has created an environment of unpredictability that has employers frightened about what might be next."

TEXAS: Resistance in a state where many are uninsured

CALIFORNIA: A key test, and 'people will be watching'

West Virginia will be one of seven states partnering with the federal government in a subsidized health plan that allows consumers who don't qualify for Medicaid or employer-provided insurance to buy private care on a sliding scale. As part of the Affordable Care Act, the state also will expand Medicaid eligibility. A family of four that now earns more than $8,240 is ineligible, but next year the cutoff will rise to $32,499. About 133,500 more people will qualify, according to recent state estimates. One of them is Selen.

Medicaid would cover virtually all her costs. She'll also be eligible for coverage from her employer, but Selen estimates that would cost her about $200 a month in premiums and diabetes care. Should her family income jump over the next few years, she would be eligible for coverage through the state's new private insurance marketplace.

REASSURING FALLBACK

Selen is leaning toward staying on Medicaid — after cutting back on work, she became eligible — but struggles with her decision.

"I don't want to come across as being a welfare flea," she says. She acknowledges that even if she buys insurance through work, Medicaid is "something to fall back to — that's reassuring to me. I don't have to jump through hoops to get it, and I don't have to be desolate to get it. I can just be an American who needs insurance — to me that's comforting."

The state insurance commissioner says as many as 60,000 people will buy insurance through the subsidized exchange. The Kaiser Family Foundation estimates that 260,000 West Virginians don't have insurance — about 14%, or one in seven. So the new law will be "a huge improvement," says Craig Robinson, executive director of Cabin Creek Health Systems, a chain of four health centers in the state. Nationwide, about one in six Americans is uninsured, making West Virginia's rate slightly better than the national average of 16%.

An audit commissioned by Democratic Gov. Earl Ray Tomblin last spring found that West Virginia ranked 48th in overall health and among the worst in the USA for chronic conditions such as heart disease, obesity and diabetes.

Though the new law will help thousands get coverage, Robinson and other health care providers worry that physicians, who can earn higher fees through traditional insurance, may limit the number of low-income patients they see, leaving patients scrambling to find doctors willing to care for them.

Most of West Virginia's uninsured are like Selen — holding down a job or in a family with someone who's working — but unable to afford insurance or working for an employer that doesn't provide coverage.

DESPERATE SITUATION

Selen, a Type 1 diabetic, had been working at a Cracker Barrel restaurant for about nine months when she lost her Medicaid benefits in January because she earned too much. She couldn't immediately tap into the restaurant's insurance plan, because the new enrollment period wouldn't come for months. She was earning too much to qualify for subsidized drugs but not enough to actually afford them. The bill for the two kinds of insulin she needed was more than $300 monthly — and she takes home just $600 to $700 a month.

Selen qualified for coverage at a free clinic but had to wait about six weeks for an appointment at a facility 40 minutes from home. By then, she says, "I'm looking through old suitcases, old purses to see if I have any medicine left over."

Selen finally persuaded a handful of pharmacies and physicians to give her free samples, but she soon ran out of syringes. The "very low point in my life" came last spring when she approached a prostitute downtown to ask where she could find clean needles. The woman said she had a relative with diabetes.

After weeks of on-again, off-again medication, her condition worsened. She cut back on work as a result, and by June 1, she once again qualified for Medicaid. A day later, she awoke early, walked out her front door and collapsed. Selen has no memory of what happened next, but she ended up several yards away, face-down on the sidewalk. A neighbor called 911. Selen spent three days stabilizing in the hospital.

Weeks later, she is on the mend, hoping the new law will help her find an insulin pump, while allowing her to keep her job and support her husband and two young children. "I can still work," she says. "I can still provide for my family and I can still have means to be healthy. When you've been almost dead and dirt-poor, being able to go to work is a privilege."

Tuesday, Selen learned that her Medicaid benefits were suspended again. She plans to cut her hours until January.

"I will have to work less and force my kids to live in poverty so I can survive," she said.

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Obama Policies Hurting State

July 3, 2013
By THE INTELLIGENCER The Intelligencer / Wheeling News-Register

But with Gov. Earl Ray Tomblin signing an executive order that would have allowed for up to $20 million to be pulled from the Medicaid reserve fund, in order to offset the general revenue shortfall, it leaves questions as to how the state will bear the burden of greatly increased Medicaid spending under the "Obamacare" mandate.

Medicaid already puts enormous pressure on West Virginia's budget. Now, acting Revenue Secretary Jason Pizatella will have to ask legislators to find a way to "restore what we've cut the next time they convene." The Legislature will likely find it very difficult to come up with money to fill such a gaping hole.

President Barack Obama's war on coal has just begun to take its toll on West Virginia. Declining coal production means severance taxes on coal and other extracted resources were down nearly 10 percent during the just-ended fiscal year. That is the beginning of a domino effect in which sales and use taxes in West Virginia were down nearly $16 million, and income tax collection stayed out of the red only because of that $45 million transfer from the state's special account.

West Virginians need no longer wonder if Obamacare and the president's war on coal will be devastating one-two punches. Now, the only question is how - or if - we can find a way to get off the ropes onto which we've been knocked.

CURRENT LAWS

Group Health Insurance in West Virginia
  • Coverage may not be denied due to health problems nor may premiums be higher, provided the applicant is eligible.
  • Because of life changes involving family or unemployment, special opportunities for group coverage may be available.
  • Employers may require a waiting period for new employees and new HMOs may also impose affiliation periods.
  • Group insurers may review medical records for the six months previous to coverage.
  • For pre-existing condition, an exclusion period may apply for up to 12 months.
  • If coverage has been maintained continuously, without a break longer than 63 days, creditable coverage is allowed.

Small Business Health Insurance in West Virginia

  • Small businesses may not be denied coverage or have their coverage cancelled due to sickness within the employee group.
  • Based on the characteristics and health of employees, premiums may rise.

Self-Employed Health Insurance in West Virginia

  • The self-employed may purchase small group insurance.
  • Individuals, self-employed, and small businesses considering professional associations for group coverage acquisition should contact the West Virginia Insurance Commissioner.

West Virginia Insurance Commissioner
1124 Smith Street
Charleston, WV 25305
(888) 879-9842
www.wvinsurance.gov

Individual Health Insurance in West Virginia

  • Providers may deny coverage due to health problems unless applicant is HIPAA eligible.
  • HMOs have open enrollment periods in which coverage may only be denied in certain cases.
  • Providers may review medical records for the two years prior to receiving coverage and attach elimination riders to policies.
  • Pregnancy may be considered pre-existing.
  • The cost of premiums and renewals have no limits.
  • Policies may not be cancelled due to illness.

West Virginia Health Care Programs

Medicaid and State Child Health Insurance Plan assist low income residents.

Location Status of State Exchange Decision Medicaid Expansion Decision Executive Activity
West Virginia Planning for Partnership Exchange Supports