Health Policy, the Social Safety Net, and the 2022 Legislative Session

The COVID-19 pandemic has now been ongoing for two years. Opioid overdose deaths are rising. Maternal and infant mortality rates are alarming. The number of children in the foster care system across our state continues to outpace the rest of the nation. Despite these realities, the West Virginia Legislature did very little to pass proactive health- or safety net-related legislation. In fact, lawmakers did not pass many bills related to these areas at all.

Numerous themes that emerged during the 2022 legislative session have been apparent both on the federal level and in other states. West Virginia legislators prioritized social issues masked as health issues – like curtailing public health related to COVID-19 and abortion access – rather than introducing bills that could expand access to health services for families during these financially and otherwise difficult times.

There were several bills relating to COVID-19 – none that made people safer, like paid sick days or paid leave. Instead, the Legislature turned its attention to undermining proven public health interventions.^[1] The COVID-19 vaccine, mask mandates, and other safety protocols provide safe, effective, and holistic means of addressing the virus. These public health measures have proven vital to reducing outbreaks and mitigating the symptoms of those infected. Ivermectin has never proven effective against COVID-19 or other viral infections.

Access to abortion in West Virginia is already minimal, with just one clinic still operating in the entire state. Despite this, at least a dozen bills were introduced that could further curtail access to abortions in the Mountain State.^[2] Of these, just one passed. SB 468 prohibits abortions if a person indicates that they seek termination of their pregnancy because the fetus has a disability. This bill stands in stark contradiction to COVID-19 related “freedom” bills that asserted that the state could not interfere in one’s medical decision-making. Access to safe and legal abortion services is an economic security issue. People denied abortions are far more likely to live in poverty and face difficulties meeting basic household needs. Passing this legislation while failing to address our maternal and infant mortality crisis, our unacceptable child poverty rates, or our overburdened foster care system simply means that more families will face economic crises when access to abortion becomes even further out of reach. 

Beyond these two themes, several other bills had the potential to positively impact West Virginians. Unfortunately, the following pieces of legislation did not pass this year: 

• Last year, the West Virginia passed legislation extending dental services to adults over 21 enrolled in Medicaid. SB 620, which did not pass, would have increased maximum dental coverage for this population from $1,000 to $1,500 annually. This increase would have helped make dental services more accessible for West Virginians.
• Had SB 700 been taken up, it would have partially reversed the 2018 law prohibiting the Department of Health and Human Resources (DHHR) from applying for flexibilities that address food insecurity via the Supplemental Nutrition Assistance Program (SNAP). Despite overwhelming evidence indicating the existing law’s harm to SNAP-eligible able-bodied adults without dependents and the state economy, legislators canceled the committee hearing for this bill at the last second. Such action significantly reduced the ability for West Virginia to make nuanced food policy decisions outside of the federal government. 
• Rolling over from last year, the bipartisan HB 3001 would have allowed West Virginians just over the Medicaid income limit to pay a small premium to enroll in a Medicaid buy-in program. Such a program could meaningfully address the cliff effect, or the phenomenon wherein a slight change in income or family status makes one ineligible for Medicaid and other safety-net programs. By tapping into an existing network, a Medicaid buy-in program would be cost-effective, making health care accessible to more people. 
• Several bills were introduced that could have addressed paid family, parental, or medical leave.^[3] These bills were limited to specific populations, including a pilot program, several programs for public employees (primarily teachers, police officers, and firefighters), and an additional program for COVID-19 patients. West Virginia families need paid leave; it is critical to the state’s immediate and long-term economic recovery. Two bills – SB 491 and HB 4434 – introduced comprehensive paid leave programs in which families can enroll. However, neither bill was taken up in committee for debate, indicating that paid leave was not a priority this legislative session.
• The sole foster care bill of the session (HB 4344), which sought to increase wages for Child Protective Services (CPS) workers, did not pass despite a 30 percent vacancy rate at the DHHR – the agency that oversees foster care – and overwhelming support in the House of Delegates. Such raises are just one tactic that DHHR aimed to implement to address vacancies and increase retention rates.  

On a positive note, the Legislature did pass a bill addressing behavioral health. SB 181 expands behavioral health services by designating crisis hotline centers, among other provisions. This is great news, as behavioral and mental health have been significant concerns within the state for several years, especially against the backdrop of the ongoing opioid and COVID-19 epidemics. 

Finally, a bill was passed to split DHHR into two separate agencies. This move will create an additional secretary at the executive level, who the governor will appoint. Dividing such a large agency is not inherently disadvantageous for the state. However, concerns about appointments that do not prioritize best public health practices are valid. Further, arguably the most pressing concern associated with this bill is its timing. Set to go into effect by June 2023 – amid a public health crisis wherein several programs must return to pre-pandemic processes – such a policy could create a massive administrative burden within an agency already strife with critical staffing and funding deficits. 

The 2022 West Virginia legislative session was nothing short of a missed opportunity. Overlapping health and economic crises created the need and opportunity for the Legislature to focus on proactive measures that could prioritize the health and wellness of families across the Mountain State. Addressing issue areas such as the foster care system, paid family and medical leave, and health care affordability and accessibility provide just a few examples of proactive legislation that lawmakers could have pursued more robustly. Next year, we urge legislators to focus on introducing evidence-based legislation that aids and uplifts West Virginia families.

^[1] SB 23, HB 4298, HB 4414, SB 37, SB 43, SB 217, SB 599, HB 2881, HB 3197; HB 4620; SB 605, HB 4309, HB 4456, HB 4697.

^[2] SB 158, SB 160, SB 212, SB 601, HB 2239, HB 2954, HB 3024, HB 3265, HB 4004, HB 4049, HB 4255, HB 4328, HB 4337.

^[3] SB 101, SB 421, SB 491, HB 3123, HB 4376, HB 4637, HB 4776.