West Virginia must innovate on health care to become economically competitive

Health insurance prices in West Virginia are roughly twice as high as our neighboring states. (Getty Images)

Health insurance prices are higher in West Virginia than any other state — by a lot. Roughly twice as high as our neighboring states. How is that remotely acceptable?

It is a dead weight holding back our households, businesses, state budget and entire economy. As a lawyer fighting daily to create medical benefits for thousands of underinsured coal miners, I constantly see the painful impact on our workforce. All our efforts to become globally competitive will remain heavily handicapped until we solve this disparity. The time is long overdue for a statewide plan that reduces health insurance prices to competitive levels.

In West Virginia, health insurance prices are over $2,000 per month for a typical family on the lowest-cost, entry-level health insurance plan (and prices get much higher depending on factors like age). Even after public subsidies, costs remain significant. Businesses are burdened by purchasing insurance when workers cannot afford individual coverage. Look at the map of regional health insurance prices. West Virginia is a black eye.

The Affordable Care Act (ACA) improved things by ensuring most working-age West Virginians received subsidies or Medicaid, increasing access to care through community health centers, moderately reducing premiums, and more. But West Virginia still faces much greater health care prices than neighboring states. Totally intolerable. 

The problem is that West Virginia has failed to use all the tools in the ACA to reduce prices. Instead, Republicans like Attorney General Patrick Morrisey have actively hurt us by suing to repeal the ACA. Failure and favors for Big Pharma have been Morrisey’s legacy after 12 years. But failure is no longer an option.

You might ask: “Given West Virginia’s poor health, can we really reduce prices?” Yes, we can. The similarly challenged state of Mississippi pays 25% less than West Virginia thanks to innovations under the ACA and Inflation Reduction Act.

Republican and Democratic governors in 19 states have created State Healthcare Innovation Plans under the ACA (Section 1332) to secure affordable, high quality insurance in a wide variety of markets (Pennsylvania, Maryland, Kentucky, Virginia and many more). Yet, an extreme faction in the West Virginia Republican Party — led by Morrisey — has crusaded against anything paid for by the ACA. So, we’re the worst in the nation. Predictably, Morrisey is now hollering about inflation to distract from his failures on our biggest category of costs: health care. 

What would a more moderate and responsible health care policy look like for West Virginia? That should be up to the relevant stakeholders to decide through a transparent, collaborative process that designs a State Healthcare Innovation Plan and/or an Affordable Medicaid Buy-In Program. The Centers for Medicare and Medicaid Services suggest a six-step process for states to develop a customized health care innovation plan that brings down prices without stressing state budgets. 

Step one: Identifying the policy problem and solutions — Examine issuer participation, plan choices, affordability and demographics. 

Step two: Strategy and coalition building — Work with all stakeholders (advocates, issuers, legislators, providers, hospitals) to consider impacts on rate-setting, plan administration, and healthcare operations.

Step three: Data gathering and actuarial analysis — Evaluate costs and benefits of the state taking back management from the feds in the health insurance marketplace, and federal pass-through funding options for State Innovation and/or Buy-In Plans. 

Step four: State legislative authority — Legislation might not be necessary, but the legislature could cooperate if they supported reducing the largest category of costs faced by our households and businesses. One great place to start is Del. Kayla Young’s Affordable Medicaid Buy-In Bill. 

Step five: Prepare a state application, including a ten-year budget, implementation plan, actuarial and economic analysis, reporting targets, and public comment.

 By following these steps, West Virginia would design a broadly supported standardized health plan — a “West Virginia Option” — that all private insurance carriers would offer, coupled with a market-wide reinsurance program to reduce premiums while saving costs for insurers. Successful examples abound. Republican Gov. Glenn Youngkin of Virginia recently created a market-wide reinsurance program that reduced health insurance premiums by 15% in the first year. Minnesota created an Affordable Medicaid Buy-In Plan to let workers keep Medicaid as their incomes rise.

Sadly, short-sighted officials like Morrisey have never put us on such a path to innovation. The status quo works just fine for their out-of-state Big Pharma bosses. (As former President Ronald Reagan admonished: “Status quo, you know, is Latin for ‘the mess we’re in.’”) It is high time that West Virginia use the tools in the ACA to create a health care innovation plan that puts us back on the map to compete, grow and thrive.