The Public Employees Insurance Agency provides health insurance to employees of the state of West Virginia. (Photo by Lori Kersey/West Virginia Watch)
Public employees in West Virginia are being disadvantaged when it comes to health care after a decade of neglect by lawmakers. If you know how insurance works, you can see that we need to bring more people into the insurance pool to raise revenue and secure our public services. It’s time to embrace “PEIA for All.” (#PEIAforAll!)
The Public Employees Insurance Agency (PEIA) is a participant in the health insurance market. It should behave like one. Allow private employers and individuals to obtain coverage under the PEIA. Charge appropriate premiums. Manage claims carefully. Watch the balance sheet brighten.
There is a saying in the private sector: “Grow or die.” Tragically, the Republican Party is on the side of eliminating public benefits. But nothing could be worse for public employees or the private sector in the Mountain State.
PEIA for All would raise revenue to improve public services while providing more affordable coverage to the tens of thousands who will suffer from the threatened loss of health care tax credits and improving access to health care generally. Talk about killing several birds with one stone. PEIA could require affordable premiums for up-to-date nongovernmental employers, which would generate critical cash flow to support public services.
Sensible Republicans have taken this route for PEIA in the past, sometimes referred to as “PEIA Plus.” Just run the program like a company with some public values. It is not privatization (you cannot privatize because you need public assurance of affordability and benefit to the plan’s ultimate beneficiaries). It’s not rocket science. It’s a good government. And it’s a lifeline for our businesses, which need robust employees but often can’t afford retail insurance prices.
Health insurance premiums will skyrocket for tens of thousands of West Virginians due to the expiration of the increased premium tax credit. The unsubsidized portion of these premiums will raise more in West Virginia than in any other state. So PEIA has the opportunity to command significant premiums while outperforming the private market next year. Employers could make a modest contribution to cover some of the premiums. The state could further reduce premiums by offering state-funded benefits Reinsurance plan This lowers premiums by paying high claims.
All of this would allow PEIA to charge a commercially reasonable amount of premiums to operate at reasonable margins while providing coverage to public and private employers and individuals. Because PEIA does not have to pay shareholders, any surplus could be used to pay for further premium increases for plan beneficiaries or to improve coverage. PEIA could structure these as parallel plans for public, private and individual participants.
You may be asking yourself, “Why would anyone oppose PEIA for all?” The only reason that comes to mind is that they simply resist any public participation in solving public challenges. Fortunately, because of the broad and long-standing public support for PEIA, the expansive majority of West Virginians do not hold this view. We already run a public health insurance program through PEIA, so it’s not a large jump. It’s very doable.
In fact, both the state’s recently commissioned Independent Analysts (BDO) and the PEIA Board appear to recognize the value of PEIA for all. First, the youngest BDO report (p. 31) suggested that plan finances would improve by increasing the cost share for non-governmental participants (which is exactly what is happening, but with a larger population, with PEIA for all).
Secondly, the current proposal from the PEIA board The idea is to require out-of-state employers to enroll all of their employees in the plan to promote solvency (another example of the principle that the more people who pay reasonable premiums, the more solvable the insurance pool will be). These stakeholders already agree on the obvious structural solution to ensure the long-term solvency of this insurance pool: its expansion to cover a younger, larger and healthier population.
West Virginia simply cannot afford to continue wasting all of its income on overpriced, unsubsidized, necessary services like health care, child care and utilities. PEIA for All is part of a broader strategy to boost our economy by enabling households and businesses to focus on their core goals. Step one: PEIA for everyone. Step two: Provide child care so people can afford jobs and businesses can thrive. Step three: Limit utility costs (investments in efficiency, etc.) so that high bills do not put us at a competitive disadvantage. These steps will assist more workers earn a living wage.
This is how we thrive. This is the way forward. In 2026, West Virginians can vote for this change or face crippling costs and economic pain.
