Penny Hart is a single mother of two. She works full-time as a receptionist and hygienist in a small, rural dental practice.
Except for during her pregnancies, Hart lacked insurance for her entire adult life, which has made dealing with debilitating migraines particularly difficult. Imitrex – the migraine medication she takes – runs about $39 a 25 mg tablet for the brand name and about $24 for the generic.
“And I get migraines that last three days to the minute,” she said. “So I need a pill every day for those three days. And I can only afford to get one at a time so I’d have to suffer. But now that I’ve got this insurance I can get these pills 9 a month and it doesn’t cost me maybe 50 cents or nothing.”
That’s because two years ago, Hart qualified for Medicaid under the expanded guidelines, which now include adults with incomes up to 138 percent of the federal poverty line. West Virginia is one of 28 states that chose to expand medicaid under the Affordable Care Act.
Almost 180,000 people gained health insurance coverage under the expansion, reducing the uninsured rate in West Virginia by 56 percent from 2013-’15 -- one the biggest uninsured drops in the nation, according to a national independent health insurance resource center.
Now that they’re insured, fewer patients are using charity care. Both candidates for governor -- Republican Bill Cole and Democrat Jim Justice -- say they will uphold the expansion. Despite the Medicaid expansion’s successes, though, some officials still have concerns.
Double the People
“The issue really is that originally 90,000 people would come in,” Delegate Ron Walters, R-Kanawha, said. In reality, almost twice that many newly eligible people have joined Medicaid under the expansion.
“Now. It’s good to have people covered with health insurance, let’s start with that,” he said. “But when we had such a poor projection from the administration it’s caused a substantial strain on our budget and in the future it’s going to cause a substantial strain because we’ve made a commitment to these people and now we’re going to have to keep it, but now we’re going to have to find the revenue to fund it.”
Funding the Program
The federal government covers 100 percent of the expansion’s cost for the first three years. Then, starting in 2017, West Virginia will have to contribute 5 percent of the expansion costs. While 5 percent doesn’t sound like much, it’s about 15 million dollars.
“We have been preparing for the budgetary consequences of that diligently,” Deputy Secretary of Public Insurance Jeremiah Samples said. Samples said that as a result of the expansion, fewer people are accessing free services, including charity care programs, behavioral health, federally qualified health centers and free clinics. Those savings have allowed the health department to move about $20 million of state money into covering West Virginia’s portion of the expansion.
While Samples said the state is in good shape for next year -- at least as far as Medicaid expansion is concerned -- by 2020, West Virginia will have to contribute 10 percent of expansion costs. The state’s contribution will then cap at 10 percent.
“You get out further, 2020, 2021 the state’s going to have $45 million, $50 million responsibility compared to about $600 million from the federal government,” Samples said. “So there is a substantial amount of taxpayer dollars coming from the state for that.”
Despite financial concerns, the long-term cost of not providing care to people who need it are far greater than the cost of covering Medicaid’s expansion, advocates say.
Short Term Costs, Long Term Gains
“We cannot ignore, the people who really need care and who aren’t really getting care and what their impact and influence is on our entire society,” Delegate Don Perdue, D-Wayne, said.
“What kind of caused the whole crisis with health care in the United States was too many people didn’t have the money to be healthy that’s essentially what it amounted to,” he said. “And in West Virginia where a huge percentage of our population is Medicaid eligible by virtue of income, and if you think about the fact that 50 percent of the people who are covered by Medicaid are children, then you can see that our future is very much tied up in our ability to improve our health statistics.”
Perdue lists the benefits of expansion – lowered uninsured rates, lowered uncompensated care costs, lowered health costs of incarcerated populations, increased well visits and increased access to treatment.
For example, soon after qualifying for Medicaid under the expansion, one of Penny Hart’s fallopian tubes burst and she had to have a hysterectomy. She said the surgery was completely covered under Medicaid. If she hadn’t had the coverage, she said, she has no idea how she would have paid emergency medical bills.
But no matter how beneficial the Affordable Care Act has been for West Virginians like Penny Hart, legislators will have to figure out how to balance the cost of expanding Medicaid in the face of shrinking revenue.
Appalachia Health News is a project of West Virginia Public Broadcasting, with support from the Benedum Foundation.