About 166,000 West Virginians have Medicaid coverage because the Affordable Care Act allowed states to expand their programs to low-income residents. (Getty Images)
More than 200,000 West Virginians get their health insurance through the Affordable Care Act, a 2010 law that President-elect Donald Trump tried to overturn during his first four years as president.
Now with a second Trump presidency on the horizon, residents and health care advocates worry what that will mean for West Virginians’ health care coverage and premiums.
More than 51,000 West Virginians bought their health insurance through the federal government’s health insurance marketplace, a provision of the 2010 Affordable Care Act, also known as Obamacare. Another 166,000 West Virginians have Medicaid coverage because the Affordable Care Act allowed states to expand their programs to low-income residents.
Louise Norris, a health policy analyst for healthinsurance.org, said it’s too soon to say whether Trump and congressional leaders will again attempt to repeal the ACA.
“We just don’t know,” she said. “The ACA did get upheld by the Supreme Court for a third time in 2021 and at that point, the justices on the bench were the same as the ones who are there today. So we have a lot of history, a lot of water under the bridge.”
Along with the presidency, Republicans will have the majority of seats in both the U.S. Senate and House of Representatives. Trump and Republican leaders have sent mixed messages about the future of the law.
During a debate with Democratic opponent Vice President Kamala Harris earlier this year, Trump said he had “concepts of a plan” to replace the Affordable Care Act. House Speaker Mike Johnson told a Pennsylvania crowd in October there would be “massive” health care changes if Trump was elected.
Norris said West Virginia is among the states that have most benefited from the Affordable Care Act.
“If you look at states just based on income, because so much of the Affordable Care Act is income based with the idea of helping to make health insurance affordable for people on sort of a sliding scale, depending on their household income, you get more help if you’re lower income,” she said. “And West Virginia, if you look at it on the spectrum of income across the country, it’s certainly on the lower end.”
West Virginia’s uninsured rate has dropped from 15% in 2013, the year that full provisions of the health care law went into effect, to about 5.9% last year.
The Affordable Care Act also eliminated lifetime limits on health insurance coverage, prohibits health insurance companies from denying coverage to children because of pre-existing conditions and requires that marketplace plans cover adults with pre-existing conditions such as asthma, diabetes or cancer. It also requires health insurance plans to cover preventative health care such as mammograms and colonoscopies without charging a deductible.
Rhonda Rogombe, health and safety net policy analyst for the West Virginia Center on Budget and Policy, said a repeal of the Affordable Care Act would be catastrophic for people in West Virginia and across the country.
“The ACA really shifted our health care landscape in that you didn’t need to have a job that offered health insurance in order to receive health insurance, which bridged the gap of millions and millions of people and hundreds of thousands of people across our state,” she said.
But repealing the law isn’t the only change that could leave West Virginians without access to health coverage. Tax credits through the American Rescue Plan and extended through the Inflation Reduction Act make the plans affordable in West Virginia, which has the highest premiums in the country.
The tax credits are set to expire at the end of 2025 unless Congress and Trump extend them.
“West Virginia is the state that’s probably poised to see the biggest impact if those subsidy enhancements go away, simply because West Virginia has the highest premiums in the individual market of anywhere in the country, by kind of a long shot,” Norris said.
West Virginians pay on average $1,122 per month without subsidies for an Affordable Care Act plan, compared to the national average of $603 per month, she said.
Like the health care premiums, the subsidies for West Virginians are almost double the national average, she said.
Charleston business owner Venu Menon and his family have gotten their health insurance from the health insurance marketplace for the past few years. For he, his wife and their two college-aged daughters, the Menons pay more than $800 a month for “nominal coverage” he said. The tax credits make it more affordable, he said.
Menon said he worries about the prospect of the health care law being repealed not only because he’s a customer of the health insurance exchange, but out of concern for the greater population and the number of people who would lose their health care coverage.
“Since Obamacare was first proposed and then implemented, it seems like the number of people who need medical care, the number of medical issues, and the amount that costs have all gone up,” Menon said. “And so I can’t imagine what kind of crisis would happen if there’s absolutely nothing to replace other than the free market.”
Menon has owned and operated Charleston’s Mea Cuppa Coffee for nearly 10 years, and for six of them, he was uninsured, he said.
“I know that feeling of, ‘Hey, if something major happens, not only is it jeopardizing my ability to work, is also probably jeopardizing my ability to continue to have my business, depending on the severity of it,’ whether that’s catastrophic like a car crash or if it’s something worse, like a heart attack or cancer or whatever,” he said.
Ellen Allen is the executive director of West Virginians for Affordable Health Care, a nonprofit organization whose two-person staff gets their insurance through the marketplace. Without the tax credits, Allen would pay more than $1,700 per month in premiums and a maximum of $9,200 in out of pocket costs for the year, she said.
“I don’t care how much money you make, that’s a lot of money out of pocket,” Allen said.
The monthly tax credits bring her total year cost down from about $30,000 to about $15,000, she said.
Allen said she wants to see the Trump administration and Congress do everything they can to keep the tax credits and continue to support the Affordable Care Act in its current form.
“It is unfathomable that an advanced society would even consider taking action that could jeopardize the access to health care for over 50 million Americans including one third of West Virginians,” she said.
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