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W.Va. to tackle health reform

Sep. 04, 2013 @ 12:00 AM

HUNTINGTON -- West Virginia has its work cut out for it, said Renate Pore with West Virginians for Affordable Health Care.

Right now, there are 250,000 uninsured West Virginians in the state, she said. The state expects 133,500 more West Virginians to be eligible for Medicaid under the Affordable Care Act, and 99,000 of them to be eligible for subsidies. All are among those the state aims to enroll in health care plans over the next six months, she said.

Enrollment begins Oct. 1, and much work is to be done when it comes to hiring and training workers and volunteers to help make this legislation, which initially passed in March 2010 and also is known as Obamacare, become a reality in the state, Pore said. That includes 270 new short-term jobs and thousands of new government jobs as Medicaid expands, she said.

It involves comprehensive, controversial changes that she believes will be beneficial in the long run, similar to the birth of Medicare in 1965.

"It's going to have huge consequences in the country, and I think that's why it's so controversial," Pore said as she spoke Tuesday at a coalition meeting of the Financial $tability Partnership of the River Cities.

"The public even today is divided 50-50 on it," she said. "I think it's going to be great for West Virginia but, yeah, people still hate it."

As described by Pore, the four goals of the Act are: Emphasizing preventative health, stronger regulation of the health insurance industry to benefit the consumer, cost containment in health care, and expanding access to health care to most Americans.

In the area of prevention, there will be 62 screenings and similar preventative services covered by health insurance under the act, including blood pressure screenings, mammograms, birth control and others, she said.

In terms of containing costs, the act limits insurance companies' medical loss ratio to 80-20 or 85-15, with the rest being required to go to the health care provider. And it eliminates exclusions for pre-existing conditions, gender ratings and lifetime limits on coverage as well as phasing out annual limits. It also will reduce payments to Medicare Advantage Plans, eliminate the DSH (Disproportionate Share Hospital) payment requirement, reduce payments for hospital readmissions, change payment to doctors and hospitals from fee-for-service and tax "Cadillac plans."

One way the Mountain State has chosen to increase access to health care is by becoming one of 25 states thus far that is undergoing a Medicaid expansion. Kentucky did as well, and Ohio is considering it, she said.

There are now 400,000 residents in West Virginia under Medicaid or CHIP (Children's Health Insurance Program). The Affordable Care Act increases the access to individuals and families within a broader range -- or 138 percent -- of the federal poverty level, which will affect 133,500 more West Virginians, she said.

Those who don't have an employer plan (or if their employer plan costs more than 9.5 percent of their family income) and are ineligible for a government plan, can purchase private plans offered in a Health Insurance Marketplace, a new agency operated jointly by the state and federal governments. The Health Insurance Marketplace will include some familiar names, such as Blue Cross and CareLink, she said, but these new available insurance policies probably won't be seen until Oct. 1.

Also, subsidized private insurance plans will be available in the Health Insurance Marketplace. The subsidies for these insurance plans are available on a sliding scale to individuals and families earning between 100 percent and 400 percent of the poverty level. An online calculator can be found at www.kff.org, she said.

The policies become effective as early as Jan. 1, 2014.

Other than for reasons of poverty or religious beliefs, those who don't get insurance -- either through an employer, the government or a private plan in the new Health Insurance Marketplace -- will be fined anywhere from $95 to $695 yearly. The uninsured now includes mostly young and healthy West Virginians (48 percent), as well as those who are sick, active and worried, and those who are passive and unengaged, Pore said. Many have jobs but don't have coverage.

Businesses will be affected by the program based on their size. Small businesses of 49 or fewer employees -- which number 42,000 in West Virginia and employ 280,000 people -- aren't required to offer coverage but can turn to the Small Business Health Options Program (SHOP). Larger employers (50 or more employees) must provide coverage to full-time equivalent employees (working 30 hours or more weekly) or face penalties beginning in January 2015.

Pore said 95 percent of the state's large employers already offer coverage.

Signing up for a plan will be a paperless process, Pore said, and West Virginians will be able to do so either online, by calling an 800 number or with the help of a "navigator" or "in-person assister." Also, Jennifer Thacker with the WV Alliance for Sustainable Families said it got a grant to train volunteers to help with Medicaid applications. They will be available in each county as well, she said.

Over the next six months, the state will have 270 new jobs that pay $20 an hour, or $29 an hour for management positions, Pore said.

"We have a lot of work to do," Pore said. "It's an enormous opportunity, and we need all hands on deck."

Those representing local agencies who would like to learn more about the enrollment process can hear Pore speak at an upcoming Affordable Care Act training, which is planned for 10 a.m. to 2:30 p.m. Friday, Sept. 20, at the Cabell-Huntington Health Department. Learn more at www.enrollwv.org.

To learn more about how the Affordable Care Act affects West Virginians and other Americans, visit www.wvahc.org or healthcare.gov.