Earlier this month, a US District Court Judge issued a ruling in the Texas v. Azar lawsuit brought by 20 state attorneys general, including West Virginia’s Patrick Morrisey. If upheld, this ruling would invalidate the entire Affordable Care Act (ACA), which includes many important provisions beyond the ACA’s marketplaces and pre-existing condition protections. It is almost unthinkable that West Virginia is a party to this lawsuit since its effects would devastate our state, where 36 percent of residents under 65 have pre-existing conditions and Medicaid covers 29 percent of the state.
For now, there are a few important things to know:
1. Nothing changes now. The Trump administration’s Centers for Medicare and Medicaid Services (CMS) has affirmed that the ACA remains the law of the land pending appeal. Nothing changes for anyone who gets coverage through the Medicaid expansion or the ACA’s marketplaces on healthcare.gov. You will continue to have coverage.
3.Despite that likelihood, if the decision is upheld, the entire ACA would be invalidated; and the results would be catastrophic, both for individuals and families who rely upon the ACA’s health programs and patient protections and for our state’s economy.
Eliminating the ACA would affect people who rely on the marketplaces, Medicaid expansion, Medicare, and their employers for healthcare. In West Virginia, it could have the following impacts:
-The loss of Medicaid expansion would threaten coverage for over 180,000 West Virginians and the nearly 16,000 jobs it created in the state. Without the ACA, West Virginia would lose $14 billion in federal funds over 10 years, according to the Urban Institute’s estimates.
-Over 30,000 West Virginians, who are not eligible for employer-sponsored coverage and purchased comprehensive health insurance, would risk losing the premium assistance that made their coverage affordable.
–Nearly 800,000 West Virginians with pre-existing conditions would be at risk of being charged higher premiums or losing their coverage.
-Insurers could again impose annual or lifetime limits on care.
-Young adults would no longer be able to remain covered on their parents’ insurance through age 26
-Insurers would no longer be required to cover essential benefits, including maternity care, substance use treatment, mental health care and prescription drugs.
-Seniors on Medicaid would see their prescription drug costs increase due to the Medicare donut hole
West Virginia has arguably benefited more than any other state from the Affordable Care Act. We have the highest percentage of adults with pre-existing conditions of any state in the country. We also saw the largest drop in the uninsured rate among all states following the implementation of the ACA, primarily thanks to the Medicaid expansion. Additionally, West Virginia was recently approved for a Medicaid waiver to provide substance-use treatment services, including medication-assisted treatment (MAT), that were previously not allowable with federal Medicaid dollars such as substance use disorder treatment.
The state would also suffer economically if the ACA’s provisions were eliminated. Because nearly 200,000 West Virginians would lose their health coverage, uncompensated care at hospitals would skyrocket. Spending on uncompensated care could swell to $5.8 billion over ten years, according to estimates from the Urban Institute. West Virginia could also lose 16,000 jobs and $16 billion in economic output, according to a George Washington University model of the ACA’s the economic impact. Reduced economic activity could also cause West Virginia to forfeit nearly $350 million in state and local tax revenues over five years.
These extraordinary economic effects demonstrate why it is so important that West Virginia’s lawmakers move quickly to protect the health care gains we’ve achieved under the ACA. First, West Virginia’s Attorney General Patrick Morrisey should pull our state out of the Texas v. Azar lawsuit that puts so many of his constituents’ health in jeopardy. Second, state lawmakers should enshrine the ACA’s patient protections into West Virginia law. Elected officials on both sides of the aisle have stated a commitment to preserving pre-existing condition protections.
To put their commitments into action, these leaders should adopt policies in the next session that several states have already enacted to incorporate the ACA’s guaranteed issue, pre-existing condition protections, and community rating standards into law. State lawmakers could and should ensure that West Virginians cannot be charged more or denied coverage for their pre-existing conditions.
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