More than 200,000 West Virginia residents get their health insurance through the Affordable Care Act, a 2010 law that President-elect Donald Trump tried to overturn during his first four years as president.
Now, with a second Trump presidency on the horizon, residents and health care advocates are worried about what it will mean for West Virginians’ health insurance and premiums.
More than 51,000 West Virginia residents get their health insurance through the federal government’s Health Insurance Marketplace, a provision of the Affordable Care Act of 2010, also known as Obamacare. An additional 166,000 West Virginia residents have Medicaid coverage as the Affordable Care Act allows states to expand their programs to low-income residents.
Louise Norris, health policy analyst for healthinsurance.orgsaid it is too early to say whether Trump and congressional leaders will try again to repeal the ACA.
“We just don’t know,” she said. “The ACA was upheld by the Supreme Court for the third time in 2021, and at that point the justices on the bench were the same as those there today. So we have a lot of history, a lot of water under the bridge.”
In addition to the presidency, Republicans will also hold the majority of seats both the US Senate and the House of Representatives. Trump and Republican leaders have sent mixed messages about the law’s future.
During a debate with Democratic opponent Vice President Kamala Harris earlier this year, Trump said he did so “Concepts of a Plan” to Replace the Affordable Care Act. House Speaker Mike Johnson told a crowd in Pennsylvania in October that this would be the case “Massive” changes to healthcare if Trump were elected.
Norris said West Virginia is among the states that have benefited the most from the Affordable Care Act.
“If you look at states just based on income, because a lot of the Affordable Care Act is income-based and is designed to help make health insurance affordable for people on a sort of sliding scale depending on their household income, you get more . “Help if you have a lower income,” she said. “And West Virginia is certainly at the lower end when you look at the income spectrum across the country.”
The share of uninsured people in West Virginia has fallen from 15% in 2013, the year all provisions of the health law took effect, to about 5.9% last year.
The Affordable Care Act also eliminated lifetime limits on health insurance coverage, prohibited health insurers from denying coverage to children based on pre-existing conditions, and required market plans to cover adults with pre-existing conditions such as asthma, diabetes or cancer. It also requires health insurance plans to cover preventative health care, such as mammograms and colonoscopies, without charging a deductible.
Rhonda Rogombe, health and safety net policy analyst at the West Virginia Center on Budget and Policy, said a repeal of the Affordable Care Act would be disastrous for people in West Virginia and across the country.
“The ACA really changed our healthcare landscape because you didn’t have to have a job that offered health insurance to get health insurance, bridging the gap for millions and millions of people and hundreds of thousands of people across our state,” she said.
But repealing the law isn’t the only change that could leave West Virginia residents without access to health insurance. Tax credits under the American Rescue Plan and expanded by the Inflation Reduction Act make the plans affordable in West Virginia, which has the highest premiums in the country.
The tax credits are is scheduled to expire at the end of 2025 unless Congress and Trump extend it.
“West Virginia is the state that will likely see the greatest impact if these subsidy increases go away, simply because West Virginia has by far the highest single market premiums in the country,” Norris said.
West Virginians pay an average of $1,122 per month without subsidies for an Affordable Care Act plan, compared to the national average of $603 per month, she said.
Like health care premiums, subsidies for West Virginians are nearly twice the national average, she said.
Charleston business owner Venu Menon and his family have purchased their health insurance on the health insurance market for the past few years. For him, his wife and their two college-age daughters, the Menons pay more than $800 a month for “nominal coverage,” he said. The tax credits make it more affordable, he said.
Menon said he is worried about the prospect of a repeal of the health care law, not only because he is a customer of the health insurance exchange, but also out of concern for the larger population and the number of people who would lose their health insurance coverage.
“Since Obamacare was first proposed and then implemented, it appears that the number of people needing health care, the number of medical problems, and the level of costs have increased,” Menon said. “And that’s why I can’t imagine what kind of crisis would happen if there was absolutely nothing to replace it other than the free market.”
Menon has owned and operated Charleston’s Mea Cuppa Coffee for nearly 10 years and was uninsured for six years, he said.
“I know that feeling: ‘Hey, if something big happens, it’s going to jeopardize not only my ability to work, but probably my ability to continue to run my business, depending on how serious it is,’ whether that’s a catastrophic car accident or if.” “It’s something worse, like a heart attack or cancer or whatever,” he said.
Ellen Allen is executive director of West Virginians for Affordable Health Care, a nonprofit whose two-person staff buys their insurance through the marketplace. Without the tax credits, Allen would pay more than $1,700 a month in premiums and a maximum of $9,200 in out-of-pocket costs for the year, she said.
“I don’t care how much money you make, that’s a lot of money out of pocket,” Allen said.
The monthly tax credits reduce her total annual costs from about $30,000 to about $15,000, she said.
Allen said she wants the Trump administration and Congress to do everything they can to preserve the tax credits and continue to support the Affordable Care Act in its current form.
“It is unimaginable that a progressive society would even consider taking actions that could jeopardize access to health care for over 50 million Americans, including a third of West Virginians,” she said.
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