WHEELING - Health insurance provided through the Affordable Care Act is proving cost effective for those who qualify for Medicaid coverage, but is expensive for those seeking benefits through the federal health insurance marketplace, according to Kathie Brown, executive director of Wheeling Health Right.
Health Right is among a number of health care providers in the Ohio Valley that find themselves on a road where they are registering patients in the health care marketplace. Many of those registered to date by Health Right have qualified for Medicaid through the expansion of that program approved by Gov. Earl Ray Tomblin.
The agency registers those living below 138 percent of poverty level for Medicaid coverage through the state of West Virginia, but those earning more must obtain their benefits through the marketplace if their job provides them no health benefits.
"What we are seeing are employers reducing hours of employees so don't have to provide them health insurance," Brown said. "We're seeing a lot of patients who worked two jobs now working three. Many employers are no longer providing health insurance because it's so costly for small employers."
Brown said Wheeling Health Right is seeing more patients than it did before the implementation of Obamacare, and mostly they are Medicaid recipients who have applied for and received their Medicaid cards through the Affordable Care Act.
Other patients, meanwhile, don't qualify for Medicaid but haven't decided yet what plan they want or can afford under Obamacare. The Affordable Care Acts requires all Americans to have health insurance in place or face a financial penalty.
The Medicaid card "gives them access as long as can find a provider that takes the Medicaid card," she said. "But those going into the health insurance marketplace ... they are finding if they take too much of a plan they will have to pay it back at the end of the year. They are learning about co-pays and deductibles, and it is different for them. That is why some aren't taking it yet."
A family plan through the marketplace, before any subsidies, can run more than $1,000 per month.
But Brown said overall, the Affordable Care Act is a good thing.
"There are always growing pains and struggles with any program, but they probably could have implemented it in a better manner," she said. "If you live under 138 percent of the poverty level (it is an affordable insurance plan). If you are over that amount, it depends on your level of income. It depends on whether you choose the bronze, gold or platinum plans in the health insurance marketplace. People have to decide where they fit in. That's the hardest part of it."
As for the Medicaid expansion, some in West Virginia are concerned over the future cost of the program.
Tomblin in May extended Medicaid coverage to an estimated 91,500 uninsured low-income residents. The decision followed a financial analysis that concluded that more than $5 billion in promised federal funds will cover nearly all of the resulting costs over the next decade. But with Medicaid already squeezing the state budget, the report also calculates that West Virginia's share of the burden during that time will increase by $375 million.
That's prompting Tomblin to pursue several cost controls: Medicaid will cover mental health and substance abuse treatment through managed care, an alternative to the traditional fee-for-service arrangement; and some patients will face copayments based on income.
The goals include avoiding such expenses as unnecessary emergency room visits, the governor said.
"We'll be asking our Medicaid recipients to take control of their lives and think about the health choices that they make," said Tomblin.
He noted that West Virginia can revisit the decision after three years.
Expanding Medicaid is expected to help the state's hospitals by providing coverage to thousands of residents now treated at hospitals without compensation as charity care.
The financial analysis cites studies estimating the annual savings to hospitals at $20 million to $30 million. Welcoming the announcement on behalf of the state's hospitals, United Health System President and CEO Tom Jones cited how hospitals nationwide will lose $155 billion in federal payments over the next 10 years.
"This expansion of Medicaid in West Virginia will replace a significant portion of those cuts, and keep West Virginia hospitals financially healthy to serve our citizens," Jones said.