Health insurance premiums in West Virginia are much higher than in any other state. About twice as high as our neighboring states. How can that be even remotely acceptable?
It is a dead weight that hampers our households, businesses, the state budget, and the entire economy. As an attorney who fights daily to provide health benefits for thousands of underinsured miners, I see the painful impact on our workforce all the time. All of our efforts to become globally competitive will remain severely compromised unless we eliminate this inequality. It is long past time to develop a nationwide plan to reduce health insurance prices to competitive levels.
In West Virginia, health insurance prices are over $2,000 per month for a typical family with the cheapest entry-level health insurance plan (and prices rise much more depending on factors such as age). Even after government subsidies, costs remain substantial. Companies are burdened by the burden of purchasing insurance when employees cannot afford individual coverage. Check out the map of regional health insurance prices. West Virginia is an eyesore.
The Affordable Care Act (ACA) has improved the situation by ensuring subsidies or Medicaid benefits for most working-age West Virginians, improving access to health care through community health centers, modestly reducing premiums, and more. But West Virginia still faces much higher health care costs than neighboring states. Absolutely unbearable.
The problem is that West Virginia failed to employ all of the ACA’s tools to bring down prices. Instead, Republicans like Attorney General Patrick Morrisey actively harmed us by filing lawsuits to repeal the ACA. Failure and favors for the pharmaceutical industry are Morrisey’s legacy after 12 years. But failure is no longer an option.
You may be wondering, “Given West Virginia’s poor health, can we really lower prices?” Yes, we can. The similarly disadvantaged state of Mississippi pays 25% less than West Virginia, thanks to changes in the ACA and the Inflation Reduction Act.
Republican and Democratic governors in 19 states have created state health care innovation plans under the ACA (§ 1332 Code of Civil Procedure) to secure affordable, quality insurance in a wide variety of markets (Pennsylvania, Maryland, Kentucky, Virginia, and many others). Yet an extreme faction in the West Virginia Republican Party – led by Morrisey – has waged a crusade against anything funded by the ACA. So we’re the worst in the country. Predictably, Morrisey is now yelling about inflation to distract from his failures on our largest cost category: health care.
What might a more moderate and responsible health policy look like for West Virginia? That should be left to relevant stakeholders to design a state health innovation plan and/or affordable Medicaid buy-in program through a limpid, collaborative process. The Centers for Medicare and Medicaid Services proposes a six-step process that states can employ to develop a customized health innovation plan that lowers prices without straining state budgets.
Step One: Identify the policy problem and solutions – Examine issuer participation, plan selection, affordability and demographics.
Step Two: Strategy and Coalition Building – Work with all stakeholders (advocates, issuers, legislators, providers, hospitals) to consider the impacts on rate setting, plan administration, and health care operations.
Step Three: Data Collection and Actuarial Analysis – Evaluate the costs and benefits of the state resuming control of the health insurance market from the federal government, as well as the opportunities for federal pass-through funding for state innovation and/or buy-in plans.
Step Four: State Legislative Power – Legislation may not be necessary, but the Legislature could cooperate if it supports reducing the largest category of costs facing our households and businesses. A good place to start is Del. Kayla Young’s Affordable Medicaid Buy-In Bill.
Step Five: Prepare a state proposal, including a 10-year budget, implementation plan, actuarial and economic analysis, reporting objectives, and public comments.
By following these steps, West Virginia could develop a widely supported standardized health insurance plan – a “West Virginia Option” – that all private insurers would offer, coupled with a market-wide reinsurance program to lower premiums while saving costs for insurers. Successful examples abound. Virginia Republican Governor Glenn Youngkin recently created a market-wide reinsurance program that Reduced health insurance contributions by 15% in the first year. Minnesota has developed an affordable Medicaid buy-in plan that allows workers to keep Medicaid as their income increases.
Unfortunately, short-sighted politicians like Morrisey never put us on that path of innovation. The status quo works just fine for their out-of-state pharmaceutical bosses. (As former President Ronald Reagan once admonished, “Status quo is Latin for ‘the mess we’re in.'”) It’s high time West Virginia used the tools of the ACA to create a health care innovation plan that puts us back on the map to compete, grow and thrive.
