Health insurance prices in West Virginia are significantly higher than any other state — about twice as high as neighboring states. Is this acceptable?
This is a drag on our families, our businesses, our state budget, and our entire economy. As an attorney fighting daily to create health benefits for thousands of uninsured coal miners, I see the painful impact on workers all the time. Unless we address this disparity, all of our efforts to become globally competitive will be severely hindered. A statewide plan to bring down the price of health insurance to a competitive level is long overdue.
In West Virginia, health insurance costs More than $2,000 per month for a typical family with the lowest-cost entry-level health insurance plan (And prices can be much higher, depending on factors like age.) Even after subtracting public subsidies, costs are still high; if employees can’t buy insurance individually, the employer shoulders the burden of purchasing it. See a map of local health insurance prices; West Virginia is notoriously expensive.
The Affordable Care Act (ACA) has made things better by making subsidies and Medicaid available to most working-age West Virginians, increasing access to care through community health centers, and modestly lowering premiums. But West Virginia still has much higher health care costs than neighboring states. It’s an intolerable situation.
The problem is that West Virginia isn’t using all the tools of the ACA to lower prices. Instead, Republicans like Attorney General Patrick Morrisey are actively hurting us by suing to repeal the ACA. Twelve years of failure and favoritism for Big Pharma is Morrissey’s legacy. But failure is no longer an option.
You may be wondering, “Can West Virginia really lower its rates when the state has such poor health care?” Yes, they can. Mississippi, a state with similar problems, pays 25% less for health care than West Virginia, thanks to innovations under the ACA and the Inflation Reduction Act.
Republican and Democratic governors of 19 states have created State Health Innovation Plans under the ACA.Section 1332) implemented the ACA to ensure affordable, high-quality insurance in broad markets (Pennsylvania, Maryland, Kentucky, Virginia, etc.). But extremists in West Virginia’s Republican Party, led by Morrissey, oppose everything the ACA pays for, which means we’re the worst in the country. Predictably, Morrissey is screaming about inflation to distract from the failures with health care, the biggest cost item.
What does a more moderate and responsible health policy look like for West Virginia? It will be determined by relevant stakeholders through a transparent, collaborative process to design a state health innovation plan and affordable Medicaid purchasing program. The Centers for Medicare & Medicaid Services has proposed a six-step process for states to develop customized health innovation plans that lower prices without straining the state budget.
Step 1: Identify policy problems and solutions – Look at issuer participation, plan selection, affordability, and demographics.
Step 2: Build strategy and coalition – Work with all stakeholders (advocates, issuers, legislators, providers, hospitals) to consider the impact on rate setting, plan administration, and healthcare operations.
Step 3: Data Collection and Actuarial Analysis – Evaluate the costs and benefits of states regaining control from the federal government in their health insurance markets, as well as federal pass-through funding options for state innovation and/or buy-in plans.
Step 4: State Legislature Power — Legislation may not necessarily be necessary, but lawmakers can help if they agree to reduce the biggest costs facing families and businesses. Affordable Medicaid Buy-In Bill.
Step 5: Prepare a state application that includes a 10-year budget, implementation plan, actuarial and economic analysis, reporting goals, and public comment.
By following these steps, West Virginia would design a broadly supported, standardized health insurance plan offered by all private insurers (the “West Virginia Option”), combined with a marketwide reinsurance program that would reduce premiums while lowering costs for insurers. There are many success stories: Virginia’s Republican Governor Glenn Youngkin recently created a marketwide reinsurance program. 15% reduction in health insurance premiums in the first yearMinnesota created an affordable Medicaid buy-in plan to allow workers to continue receiving Medicaid even as their income increases.
Unfortunately, short-sighted officials like Morrissey never set us on that path of innovation. The status quo works well for out-of-state Big Pharma bosses. (As former President Ronald Reagan warned, “You know, the status quo is Latin for ‘the mess we’re in.'”) It’s time for West Virginia to use the tools of the ACA to craft a health innovation plan and get back to competing, growing, and prospering.
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