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HUNTINGTON - As state delegates converge on the Capitol in an attempt to pass an operating budget during the legislative special session, Congress is considering rolling back Medicaid expansion, which could add millions to West Virginia's budget woes.

Through eliminating the enhanced matching rate the federal government pays states to cover Medicaid expansion, West Virginia's share of the cost of the expansion would double, reaching $88.1 million by 2021, according to new estimates from the Center on Budget Policy and Priorities, a nonpartisan research and policy institute based out of Washington that focuses on budget and policy matters related to low-income people.

The American Health Care Act (AHCA), which the House passed May 4, would cut federal Medicaid spending by $834 billion over 10 years by both restructuring federal Medicaid financing and ending enhanced federal funding for the Affordable Care Act's (ACA) Medicaid expansion, Congressional Budget Office estimates show.

The ACA gave states the option, starting in 2014, to extend Medicaid coverage to low-income adults with income under 138 percent of the federal poverty line ($24,600 for a family of four in 2017). West Virginia, Ohio and Kentucky all chose to participate in Medicaid expansion, giving 1,259,500 people access to health insurance for the first time, according to the Kaiser Family Foundation.

The House bill would eliminate the enhanced matching rate paid by the federal government, which was at least 90 percent of expansion costs, instead paying the regular Medicaid matching rate, which averages 57 percent, starting Jan. 1, 2020.

West Virginia would have to find a way to make up the difference in order to maintain Medicaid coverage for the 180,500 West Virginians insured by the Medicaid expansion. By 2023, the center estimates the state would need $155.1 million to cover the expansion - a 157 percent increase.

In the larger states, Ohio would see a $735.5 million loss and Kentucky a $404.9 million loss by 2021.

The center estimates this increase would result in many states eliminating Medicaid expansion coverage.

Some Republican members of Congress have claimed that people losing Medicaid expansion coverage could purchase insurance in the individual market, with assistance from the House bill's refundable tax credit, but the center estimates premiums would still be too costly for low-income adults, particularly seniors.

West Virginia seniors would be particularly hard hit, with the center estimating a low-income person 60 years old or older would see a premium increase greater than their total yearly income.

The Senate is working on its version of the bill, and some Senate Republicans, including Ohio Sen. Rob Portman, have suggested phasing out the federal matching rate for Medicaid expansion enrollees or delaying the reduction for a few years.

Edwin Park, Center on Budget Policy and Priorities' vice president for health policy, said a delay would not affect the outcome, and only 1 percent of expansion enrollees would be insured by 2027.

As the Senate works on its bill, which Senate Majority Leader Mitch McConnell, R-Ky., told the media he hopes to vote on in June, West Virginia Sen. Shelley Moore Capito, R-W.Va., said she is keeping access to health care at the top of her list of priorities.

"Senator Capito is working with her colleagues to craft legislation that improves our health care system," a spokesman for Capito said Tuesday. "Senator Capito has made clear that any legislation the Senate considers must provide affordable access to health care for West Virginians, including those who currently receive coverage through the Medicaid expansion."

Sen. Joe Manchin, D-W.Va., was not available for comment Tuesday but said last week at the Regional Health Summit in Huntington that he was committed to fixing the health care bill, but he has significant concerns about the Republican plan.

Follow reporter Taylor Stuck on Twitter and Facebook



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