If federal officials cut the amount West Virginia is reimbursed for the healthcare expenses of its Medicaid expansion population, delegates are preparing a refusal to fill the gap.
On the line is about $160 million in West Virginia dollars.
Also on the line is the health insurance for about 165,000 West Virginians.
Medicaid is a joint federal and state program for health insurance and medical services, traditionally for low-income people but more recently also for the working class.
The 2010 Affordable Care Act encouraged states to expand Medicaid to cover more low-income Americans lacking employer-provided insurance. Forty states participated, insuring about 21 million people since 2014 and reducing the national uninsured rate.
The federal government covers 90% of the expansion cost, significantly more than the average reimbursement rate for other Medicaid beneficiaries.
If the federal assistance for that expansion program is reduced, the West Virginia bill would disenroll and eliminate state coverage for Medicaid expansion.
“The purpose of this originating bill would to be say, ‘No, that’s not the situation. We’re going to have to rethink financially, where this state’s at and what we can afford,” said Delegate Matthew Rohrbach, R-Cabell, who is both the deputy speaker and a doctor.
The bill was not circulating at the Legislature until it hit the House Finance Committee’s agenda on Thursday morning, as lawmakers approach a deadline to move bills from one chamber to the other.
Next the bill would be considered by the full House of Delegates. If it passes there, it would be up in the Senate. The regular legislative session concludes in just over two weeks, midnight April 12.
Delegates who supported the bill emphasized that nothing would change in West Virginia if there is no change by the federal government.
Some other states already have such a trigger law: Arizona, Arkansas, Illinois, Indiana, Montana, New Hampshire, North Carolina, Utah, and Virginia.
The U.S. House of Representatives narrowly passed a budget resolution that could open the door to $880 billion in cuts to spending with Medicaid as a big possibility for those dollars.
Overall, the resolution mandates $2 trillion in spending cuts over 10 years. The Republican majorities in Congress are looking for the big budget savings to meet their goal of fully extending President Donald Trump’s 2017 tax cuts.
The budget plan assigns the U.S. House Energy and Commerce Committee to find $880 million in savings, and one of the biggest programs under its authority is Medicaid.
Rohrbach’s concern is that one option by the federal government could be to significantly lower that match rate. “Now the problem is, if we would have to take that match instead of the 90%, the cost to our program of state general fund dollars is going to be about an additional $160 million,” he said.
He continued, “Then we’re going to have to rethink this, or we’ll have to have a special session to come up with $160 million.”
This year’s process for House of Delegates committees has been to discuss bills and allow for public comment one day and then vote on advancing the bill another day. But on Thursday morning, the Finance Committee moved directly to a vote after discussing the bill that few knew was being introduced.
On Thursday afternoon, the committee convened again, pulled the bill back, allowed for discussion — and advanced it yet again.
“This is an important bill. I think this is probably the most consequential bill that we’ll have all session, and I just don’t like the way it was rolled out,” said Delegate John Williams, D-Monongalia.
Williams added, “I think we ought to see what the federal government says before we take action. In the meantime, maybe we could pressure some of our friends i the federal government to not cut our people’s lifeline.”
Delegate Sean Hornbuckle, D-Cabell, said he is troubled by the potential action.
“We cannot put a dollar amount on lives, and we know in West Virginia what our population has gone through, is going through. We need to do everything we can do to protect our neighbors,” Hornbuckle said.
“We also know from a business standpoint that it’s going to hurt the hospitals.”
Delegate Marty Gearheart, R-Mercer, countered that the bill would not yet do anything.
“It requires other actions for the trigger to take place, so nothing changes today,” he said.
“Secondarily, it doesn’t cause anyone to lose anything. It does cause, if the trigger were to take place, it does cause people to have to make other arrangements, to do things differently.”