West Virginia will expand Medicaid under the federal health care overhaul through a plan announced Thursday by Gov. Earl Ray Tomblin, which would extend coverage to an estimated 91,500 uninsured low-income residents.
The decision follows a financial analysis that concluded that more than $5 billion in promised federal funds will cover nearly all of the resulting costs over the next decade. But with Medicaid already squeezing the state budget, the report also calculates that West Virginia’s share of the burden during that time will increase by $375 million.
That’s prompting Tomblin to pursue several cost controls: Medicaid will cover mental health and substance abuse treatment through managed care, an alternative to the traditional fee-for-service arrangement; and some patients will face copayments based on income.
The goals include avoiding such expenses as unnecessary emergency room visits, the governor told the crowd gathered outside Charleston’s St. Francis Hospital for Thursday’s announcement.
“We’ll be asking our Medicaid recipients to take control of their lives and think about the health choices that they make,” said Tomblin.
He noted that West Virginia can revisit the decision after three years.
The federal law calls on states to extend Medicaid benefits to people who make less than 138 percent of the federal poverty line. That’s about $32,499 for a family of four. With one of the strictest limits among states, West Virginia now bars adults from enrolling if their household earns just one-fourth of that — $8,240 for a family of four.
Celena Roby believes she would qualify. The Wood County single mother of two said she requires physical therapy and regular hospital visits for injuries inflicted by her then-husband. Roby said she receives temporary Medicaid benefits that expire after six months each year, leaving her with medical debts now exceeding $20,000. She said she finds herself delaying needed treatment while working to keep food on the table.
“A lot of time, the reasons that people stay in domestic violence situations are economic,” Roby said. “You add health care to that, and that makes it an even greater burden ...This would allow me to take care of myself, making it easier for me to take care of my children.”
Expanded coverage would begin Jan. 1, 2014, while enrollment would open Oct. 1.
Tomblin was one of just two Democratic governors who had yet to choose whether to expand Medicaid, leaving Gov. Steve Beshear of neighboring Kentucky as their party’s last holdout. President Barack Obama is deeply unpopular in West Virginia, and state Republicans attacked Tomblin over his decision even before he announced it.
“I am deeply concerned that Obamacare and this expansion will have a very negative impact on economic growth in our state and nation,” said state Attorney General Patrick Morrisey, a former Capitol Hill GOP staff lawyer and lobbyist elected in November.
But seven Republican governors have pushed to expand Medicaid, including Ohio’s John Kasich. Among GOP governors in other border states, Pennsylvania’s Gov. Tom Corbett does not support expansion while Virginia’s Gov. Bob McDonnell is requiring several benchmarks before any expansion can proceed. All told, 21 other states and the District of Columbia are moving to expand Medicaid while 14 have decided against it.
U.S. Sen. Jay Rockefeller, D-W.Va., joined several hospital executives at Tomblin’s side Thursday. Other supporters include Sen. Joe Manchin, also D-W.Va.
Expanding Medicaid is expected to help the state’s hospitals by providing coverage to thousands of residents now treated at hospitals without compensation as charity care.
The financial analysis cites studies estimating the annual savings to hospitals at $20 million to $30 million. Welcoming the announcement on behalf of the state’s hospitals, United Health System President and CEO Tom Jones cited how hospitals nationwide will lose $155 billion in federal payments over the next 10 years.
“This expansion of Medicaid in West Virginia will replace a significant portion of those cuts, and keep West Virginia hospitals financially healthy to serve our citizens,” Jones said at Thursday’s event.
CCRC Actuaries conducted the analysis with the help of specialists. It found that expanding Medicaid should help both employer-based health plans and private insurance premiums. State employers face penalties, estimated at between $6 million to $18 million per year, if they drop health coverage and send employees to the federal law’s insurance exchange. That marketplace aims to offer private insurance coverage by allowing participants to pool their buying power.
The analysis concludes that expanding Medicaid while following other provisions of the federal health care law eventually will reduce the ranks of the state’s uninsured from 246,000 West Virginians to around 76,000.
“The whole reason we fought so hard for health care reform was to finally find a way for every one of our fellow West Virginians, and especially those who struggle to get by day by day, to be able to see a doctor or nurse when they are sick,” said Rockefeller, West Virginia’s senior senator.
Thursday’s announcement follows another audit commissioned by Tomblin that found West Virginia ranked 48th among states for overall health care outcomes, and rated among the worst for obesity, diabetes, adult smoking and heart disease deaths. That report contrasted West Virginia’s glaring health problems with massive spending and problems at the Department of Health and Human Resources, which oversees Medicaid.