WHEELING — Only six states have a higher percentage of residents on Medicaid than West Virginia, according to a national nonprofit health policy group.
More than 554,000 Mountain State residents — more than three of every 10 — are enrolled in the program, according to the Henry J. Kaiser Family Foundation. That's well above the national average of 23.4 percent — meaning a potential repeal of the federal Affordable Care Act under which West Virginia's Medicaid program was expanded could have a disproportionate impact on the state's residents.
The percentage of West Virginians on Medicaid comes as little surprise to incoming state Senate Majority Leader Ryan Ferns, R-Ohio.
"What it says about our state is we have the lowest workforce participation rate in the country and the highest number of people on welfare," Ferns said. "Over half our population is receiving financial assistance, and that is not sustainable."
New Mexico has the nation's highest percentage of residents covered by Medicaid, at 40.4 percent. Next is Arkansas, at 39.6 percent, followed by California, 34 percent; New York, 33.7 percent; Vermont, 33.2 percent; Louisiana, 31.2 percent; and West Virginia, 30.2 percent. Rounding out the top 10 are Massachusetts, at 29.9 percent; Kentucky, at 28.9 percent; and Oregon, at 27.2 percent.
The District of Columbia also has a higher rate than West Virginia, with 36.6 percent of residents enrolled in the program.
Under the Affordable Care Act, the federal government currently is paying 95 percent of the cost of the Medicaid expansion. But if the GOP-led Congress is successful in repealing the Affordable Care Act under a Donald Trump presidency, the 32 states — including West Virginia and Ohio — that opted to expand Medicaid under the health care law could be forced to bear the entire cost of the expansion or revert back to pre-Affordable Care Act eligibility requirements for the program.
Jeremiah Samples, deputy secretary for public health and insurance with the West Virginia Department of Health and Human Resources, acknowledged Mountain State residents have seen "significantly varying" impacts from the Affordable Care Act — but he pointed out the state has reduced its uninsured rate from 17 percent to 5 percent due to coverage expansions under the law.
"There are more than 175,000 citizens on the Medicaid expansion and more than 35,000 who have received coverage on the health insurance exchange. The vast majority of these individuals are working or are transitioning between jobs," Samples said. "It would be devastating for families, the state's workforce and the state's economy if these West Virginians lost their health insurance."
Although the Kaiser Family Foundation report points out any loss of Medicaid coverage would "depend on the specifics of the repeal and any replacement plan as well as actions by individual states," Ferns said there's no way West Virginia can afford to pay for all the new enrollees made possible by the 2014 expansion.
"It likely would go back to the way it was before Obamacare," Ferns said of West Virginia's Medicaid program if the Affordable Care Act is repealed.
That's why Wheeling Health Right Executive Director Kathie Brown, even though she believes the Affordable Care Act has serious flaws, doesn't want to see the law repealed without a workable replacement. The free clinic on 29th Street began accepting Medicaid patients in 2014.
"What it will mean for free clinics across the country is we will be slammed with patients who don't have any other access," Brown said of a potential Affordable Care Act repeal. "I pray there's enough intelligent people working on this to see that you can't just completely throw it out without something else in place. … We need to fix it, but I certainly hope we don't throw the baby out with the bath water."
Brown said she's grateful for the support Health Right receives from the community, but with the decline of state funding for free clinics she isn't sure her facility would be able to handle the influx of patients she'd expect to see if the health care law is repealed and not replaced.
"All we can do is the best we can do. … The people who can't get in here or other free clinics in the state will go to the (emergency room), and it will get back to episodic care rather than primary care," she said.
Although the federal government to this point has paid most of the tab for the Medicaid expansion, West Virginia still has seen its costs under the program increase by almost 25 percent since 2012. The state spent $809.7 million on Medicaid in fiscal year 2012; $901.2 million in 2013; $932 million in 2014; $961 million in 2015; and $985.9 million in 2016, according to a joint report from the West Virginia Center on Budget and Policy and West Virginians for Affordable Health Care.
While the total figure continues increasing, Samples said the state has reduced its per-capita Medicaid costs over the last three years, from $8,914 to $7,154.
Still, as the federal share of the Medicaid expansion cost under the health care law decreases each year, Mountain State lawmakers who will grapple with a potential $400 million fiscal 2018 budget deficit during their upcoming session will have to find an estimated $40.8 million in additional funding for Medicaid.
The report from the West Virginia Center on Budget and Policy and West Virginians for Affordable Health Care suggests ways to increase revenue to fund Medicaid, including additional increases to the tobacco tax, or increasing taxes on beer, wine and distilled spirits and "sugar sweetened beverages."
But Governor-elect Jim Justice has said he plans to propose a fiscal 2018 budget with no tax increases, something incoming Senate President Mitch Carmichael said he supports.
"The people of West Virginia are struggling financially and cannot endure additional tax burdens to prop up government. Just as each family is faced with difficult financial choices when money is scarce, our state government must do the same," Carmichael, R-Jackson, said in a press release.
Although the U.S. Department of Health and Human Services says more than 20 million Americans have gained health insurance because of the Affordable Care Act, Ferns said he doesn't believe the health care law accomplished what it was intended to accomplish. That, he said, is because many people who have purchased coverage through the marketplace have annual deductibles as high as $7,000.
"Now you've got all these people who are supposedly insured who have deductibles they can't afford. … They have an insurance card, but do they have access to health care? In my view, they certainly don't," said Ferns, a licensed physical therapist who owns a business in Benwood.
Ferns said the state needs to turn its economy around to reduce the number of people who need Medicaid, and he believes the best way to do that is for lawmakers to create an environment in which businesses can thrive.
Samples agrees that the best solution to reducing the state's Medicaid enrollment is to focus on the economy and "empower individuals to obtain higher paying jobs."
"As the West Virginia economy improves, less citizens will need Medicaid services as they buy insurance on their own or it is provided through their employer. That said, there will always be some individuals who need support from the Medicaid program," Samples said. "The DHHR is committed to ensuring that these individuals are provided quality care in the most efficient manner possible."