How Repeal of the ACA Would Devastate West Virginia

The Republican-controlled United States Congress took initial steps this week to repeal the Affordable Care Act (ACA), the federal health care legislation enacted in 2010, colloquially, “Obamacare.” Thomas Kaplan & Rober Pear, House Joins Senate in Approving Groundwork to Revoke Health Care Law, N.Y. Times (Jan. 13, 2017).  Unfortunately, pro-repeal legislators have failed to publically announce an ACA replacement plan.  As noted commentators and several recently-published studies make clear, repealing the ACA’s coverage provisions would work a significant detrimental impact on many West Virginians.


More than 200,000 West Virginians have gained healthcare insurance coverage under various provisions of the ACA since the law’s enactment.  According to West Virginia Medicaid, 178,394 individuals have gained coverage under the ACA’s Medicaid expansion program, which amounts to a 61% percent increase in coverage since the State expanded Medicaid in 2013. Another 33,236 West Virginians have become insured by purchasing subsidized healthcare plans on the ACA exchange.  It has been widely acknowledged that West Virginia has experienced one of the most dramatic decreases in its uninsured population as a result of the ACA.  West Virginia’s uninsured rate plummeted from 14% in 2013 to just 6% in 2015The Urban Institute projects that even a partial repeal in the ACA will result in a 208% increase in West Virginia’s uninsured.


An ACA repeal also would mean the widespread elimination of perhaps the most effective arsenal in West Virginia’s on-going fight against its opioid epidemic: mental health and substance abuse treatment.  See, e.g., Natalie Schreyer, Expert Says ACA Repeal Would Hurt WV Medicaid Recipients, Charleston Gazette-Mail (Jan. 7, 2017); Wendy Holdren, ACA Repeal Could be Detrimental to Fight Against Opioid Epidemic in WV, The Register-Herald (Jan. 12, 2017).  West Virginia suffers the highest opioid overdose death rate in the United States.  As The Register-Herald explained this week, “nearly 205,000 [West Virginians] who suffer from both [substance abuse disorder and mental illness] are at risk of losing coverage.” As Senator Joe Manchin aptly acknowledged, “[w]ith our state leading the nation in drug overdose deaths, West Virginians cannot afford to have this critical funding ripped from them with a replacement ready.”


Unfortunately, the West Virginia potential parade of horribles associated with an ACA repeal does not end there.  For example, a repeal of the law would make it much more difficult for coal miners—and their families—to receive black lung benefits.  This is because the ACA both relaxed the eligibility requirements for black lung benefits and extended those benefits to surviving widows/widowersWest Virginia children will also be at risk because the State stands to lose more than 12 billion federal dollars in Medicaid and the Children’s Health Insurance Program (CHIP) funding. Moreover, the ACA has saved West Virginia millions of dollars in uncompensated care costs.  According to the federal Department of Health and Human Services, “[i]nstead of spending $70 million on uncompensated care, which increases costs for everyone, West Virginia is getting $840 million in federal support to provide low-income adults with much needed coverage.”  Worse yet, the Commonwealth Fund estimates that an ACA repeal will cost West Virginia $16 billion in business output, $9.1 billion in gross state product, $348.5 million in tax revenue, and 16,000 jobs by 2019.