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Appalachia Health News tells the story of our health challenges and how we overcome them throughout the region. 

What Biden’s Take On The Affordable Care Act Would Mean For West Virginia

Democratic presidential candidate Joe Biden departs after speaking about reopening the country during a speech in Darby, Pennsylvania.
Democratic presidential candidate Joe Biden departs after speaking about reopening the country during a speech in Darby, Pennsylvania.

Since taking office, President Joe Biden has committed to bolstering the Affordable Care Act, best known for expanding who qualifies for Medicaid and banning insurance companies from penalizing those with pre-existing conditions.

Not that the federal legislation ever went away, but during Donald Trump’s term, he and Congress did chip at some provisions originally passed in 2010. One move was to essentially eliminate the individual mandate, which penalized anyone who didn’t buy into some health coverage plan.

West Virginia’s own Attorney General Patrick Morrisey joined a nationwide lawsuit last summer to overturn the Affordable Care Act, largely around this provision. The U.S. Supreme Court is still deciding the outcome.

But with Biden in office, the tide could be shifting in a different direction. Last month, Biden ordered federal departments to suss out any policies that may be creating barriers to affordable coverage. It will take time for the administration to pinpoint and address those policies, but West Virginia has already and will see the impacts.

The Legacy of ACA in West Virginia

West Virginia opted for Medicaid expansion, and the results were obvious. Since the Affordable Care Act passed in 2010, the number of uninsured folks dropped from 17 percent to 6.5 percent.

“Medicaid expansion resulted in about 170,000 individuals getting health care coverage,” said Dr. Jim Becker, medical director for the state’s Medicaid system. “That turned out to be a great benefit for the state, it enabled a lot of people who had chronic health conditions to come in and get health care coverage.”

Another Open Enrollment Period

As for Biden’s first moves, he ordered the reopening of healthcare.gov. That’s a central place where anyone can sign up for federally subsidized health coverage plans offered in their state.

In November and December, 19,000 West Virginians found coverage, according to WV Navigator, which is a federally funded promotion that guides folks through their health insurance options.

Per Biden’s order, many more could also sign up between Feb. 15 and May 15.

Becker says it’s a timely move considering the pandemic.

“With a lot of new people unemployed, they've probably lost any employer-based insurance coverage. And so I'm hoping that another push on the ACA, we'll bring some of those people into Medicaid coverage, or help them get connected to the marketplace,” Becker said.

Dr. Brian Gallagher agrees. He is a professor of pharmacy at Marshall University and chief of government relations at Marshall Health. Thousands of West Virginians who will get their COVID-19 vaccine shots may be prompted to consider their health coverage options.

“Now that they're going to be going out to get the vaccine, they're going to be thinking, I might need health care insurance coverage, and it would remind them to enroll,” Gallagher said.

Discussing abortion options in WV

Biden’s administration will reconsider a Trump era “gag” order that has prevented federally funded Title X clinics from discussing abortion options with pateints. These family planning clinics provide birth control, pap smears, STD testing, but not abortions.

Reproduction rights advocates like Margaret Chapman Pomponio of WV Free say rescinding the gag rule woud bridge the gap between West Virginia’s single abortion clinic, in Charleston, and the roughly 130 Title X clinics in the state.

“The Trump administration was forbidding a discussion of comprehensive reproductive health care options. So providers were severely hampered by that,” Chapman Pomponio said.

Work requirements for Medicaid recipients

States have had the option to require Medicaid recipients to work, actively seek employment or volunteer.

West Virginia never got behind that idea, and advocates like Jessica Ice with West Virginians for Affordable Health Care say that’s a good thing. She hopes Biden is putting this issue to rest.

“For years, we have fought against work requirements. And it would be nice to focus on positive progressive policies, rather than fighting these harmful ones every year,” Ice said.

Expanding Medicaid, again

On the flip side, of work requirements, any expansion to Medicaid may allow those that want to work to do so. If the income threshold for Medicaid rises, more folks dealing with substance use disorder can choose to live productive lives, according to Gallagher at Marshall University.

“If we get those people back to work, how do we make sure that they're able to keep their medication-assisted therapy?” Gallagher said. “So one of the things we need to look at is to see what ways that we can use Medicaid expansion to keep people in recovery while they're also getting back to work and back to a normal life.”

Where the buck stops: State funding in balance

Turning from federal politics to the upcoming state legislative session, the real question is funding. Measures to expand Medicaid may be a non-starter if there’s some serious budget cuts. Gallagher says he’ll be watching to see if state legislators do end up eliminating the personal income tax.

“That's going to be a huge hole to try to fill,” he said.

Around $2.1 billion to be exact. Aside from public education, the Department of Health and Human Resources, including funds for Medicaid, has made up the largest chunk of the budget.


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