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

Affordable Health Care Not so Affordable for Many West Virginians

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Bob Bailey runs a catering and event planning business in Wheeling. He was insured for 21 years through Mountain State Blue Cross Blue Shield. He had a $250 deductible and paid a monthly rate or premium, of about $500 a month.


“Two years ago, when the affordable health care came into existence, mine stopped on my birthday and by January first I had to have new insurance,” he said.

That’s probably because his old plan didn’t meet the new requirements set by the Affordable Care Act. Unfortunately for Bailey, he used to have a great insurance plan. The Act did not make his insurance more affordable.

“The deductible that was $250, it is now 10 times that much. It’s $2,500,” he said.

The people who were required to buy private insurance through the Affordable Care Act are an admittedly small portion of the West Virginia population - about 2 percent. But high deductibles also affect those with insurance through employers. A 2015 Kaiser Family Foundation survey of employers found that deductibles have increased 67 percent since 2010.

“Affordable Care Act is somewhat of a misnomer,” said Simon Haeder – a political science professor specializing in healthcare policy at West Virginia University. Haeder said the Affordable Care Act does increase coverage, but it does very little to make coverage affordable.

The idea behind the Affordable Care Act was to first help the maximum number of people get insurance, he explained. That was the biggest and most politically challenging step. Then, the politicians hoped to figure out how to make it more affordable.

But here’s the thing with increasing coverage – the money to cover all those new people has got to come from somewhere.

“Clearly one way to contain costs is to reduce access, and reducing access works by increasing payments to individuals,” said Haeder.

Wait. Back up. Reducing access?  I thought more people were covered under the Affordable Care Act. Well, they are, but previously insured people, now tend to pay more to go to the doctor. More cost, less likely to go. More cost and more people delaying services equals more money to pay for the flood of sick people who have entered the insurance pool because insurance companies can’t refuse them.  

“There’s a difference between having insurance and then being able to use insurance right?” said Haeder. “And access issues are certainly a big concern. And access issues have to do with the finances of being able to access those.”

Take Bob Bailey in Wheeling for example. Under his old plan, he never had a copay – that’s the part you pay upfront when you go into a doctor’s office. But now, he does. That’s not a huge deal for him, but a change nonetheless. The biggest shift is that his old insurance plan kicked in after he had contributed $250 to his medical costs. Now? He has to pay $2,500 before it does.

“I’ve never had any operations, I don’t go to the doctor a lot, so basically it’s just me paying out almost $600 a month for a premium and then paying for everything out of pocket,” said Bailey. “So I’m not getting a whole lot of bang for my buck.”.

The idea behind high deductible plans is that if going to the doctor costs the consumer more, you are more likely to shop around for the most cost effective services, so health care costs will drop. But studies have shown that’s not actually the case. Instead of shopping around, which is time consuming and often confusing, people like Bailey just wait to go to the doctor, or don’t go at all, which may affect long-term health.

For instance, Bailey’s father had colon cancer. So Bailey has been getting screened for it every two years since he was 39 – the year his father was diagnosed – and has actually had precancerous polyps removed. Before, his health insurance covered the screening. But now “I’m looking at a large bill because I’ve seen my insurance bills in the past two years that I have it [care under the Act] you’re looking at like $4,000...so that’s a big bill.”.

So who does this really affect? Well, the middle class. It’s those who make enough to be  ineligible for Medicaid under the expansion, but are not comfortable  enough to have excellent private insurance, substantial savings, or the kind of income that makes you not have to worry about bills at all.

A several thousand dollar medical bill can be enough to send the vast majority of West Virginia families into debt or even medical bankruptcy. As a result, some people are choosing to skip or delay lifesaving screenings or treatments.

Until those policies change to make insurance more affordable, many West Virginians are left with increased health care coverage and decreased access to actual care.


Appalachia Helth News

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