President Donald Trump has promised to repeal and replace the Affordable Care Act, also known as Obamacare, and has already made steps to do so. Under the ACA, Medicaid Expansion means health insurance for more than 174,000 West Virginians, and now, the future is unclear for them.

Professor Christopher Plein is an expert in public policy. He spoke with Managing Editor Jennifer Gardner about what the ACA means for West Virginia and what he expects could happen under the Trump administration.

Q. What do you think this would look like in our state?

A. One of the most important things to understand is that the ACA is a very broad law, so there’s many different pieces of it. In WV, we use the ACA to expand Medicaid coverage to lots of low-income adults. Probably between 170,00 to 200,000 people came into the Medicaid program because of the expansion of eligibility. There’s a lot of bipartisan support for preserving Medicaid expansion. From what I’ve gathered, from reading the reports, letters and communications from policy makers, the state doesn’t want to lose ground on the gains that we’ve made in providing health insurance, especially Medicaid. The state wants to have flexibility, which most states do. So I think you’ll see WV take a very practical and pragmatic path in this.

Q. What causes the need for flexibility within a state? Can this complicate lawmaking at the national level?

A. States often say they need flexibility in how they deliver Medicaid services and how they pay for services. The ACA is really complicated, and so two areas where the state has some control is in the operation of its Medicaid program, which you have to remember is an insurance program, not a welfare program. It is helping people who work, people who are elderly, and so West Virginia needs to have flexibility to match the needs of a rural state that has an older population. I think most people at the national level realize that one size doesn’t fit all, but at the same time, you have to have some kind of consistency, so there’s a push-pull relationship. The other thing is that the state probably wants to have some flexibility in how it regulates the private insurance market because all insurance is subject to some regulation.

Q. What issues do rural areas face in relation to health policy?

A. One, is that there often is a lack of providers. We can take for granted, if you or I get sick, that we can go to Urgent Care or a clinic, but in rural WV, we might not be able to access that care immediately. The other is that, believe it or not, recreational activities are sometimes not always as prominent and available in rural areas as they are in a more urban area. You have to remember that health is not just about caring for somebody, it’s also about preventing and promoting healthy behaviors. The other thing, too, is just managing a chronic condition that needs regular medical attention. You and I can see a specialist right across town, but if I’m living in rural WV, I may have to drive to Morgantown or Charleston or Winchester, Virginia, Pittsburgh, to see somebody.

Q. How does a program like Medicaid, which gives healthcare to low-income individuals, help the population which is paying the taxes to support it?

A. On so many different levels, and it’s a wonderful question, because I think one of the challenges we have in our society right now is that we tend to see things in a zero-sum way; "your gain is my loss," and we have to overcome that. One, if we provide health insurance for individuals, that helps everybody just in terms of financing the healthcare system. A lot of it is coming from Medicaid and Medicare, so on one level, all of those dollars help to flow into the healthcare system and to help build infrastructure. Another benefit is that we may be in a good position financially, but we may have family members or friends who are not, so it’s nice that they have health insurance, because practically speaking, it almost sounds a little too logical that if a friend or family member is getting healthcare coverage with Medicare or Medicaid, then that means that I’m protected as a caregiver.

President Donald Trump has promised to repeal and replace the Affordable Care Act, also known as Obamacare, and has already made steps to do so. Under the ACA, Medicaid Expansion means health insurance for more than 174,000 West Virginians, and now, the future is unclear for them.

Professor Christopher Plein is an expert in public policy. He spoke with Managing Editor Jennifer Gardner about what the ACA means for West Virginia and what he expects could happen under the Trump administration.

Q. What do you think this would look like in our state?

A. One of the most important things to understand is that the ACA is a very broad law, so there’s many different pieces of it. In WV, we use the ACA to expand Medicaid coverage to lots of low-income adults. Probably between 170,00 to 200,000 people came into the Medicaid program because of the expansion of eligibility. There’s a lot of bipartisan support for preserving Medicaid expansion. From what I’ve gathered, from reading the reports, letters and communications from policy makers, the state doesn’t want to lose ground on the gains that we’ve made in providing health insurance, especially Medicaid. The state wants to have flexibility, which most states do. So I think you’ll see WV take a very practical and pragmatic path in this.

 

 

Q. What causes the need for flexibility within a state? Can this complicate lawmaking at the national level?

A. States often say they need flexibility in how they deliver Medicaid services and how they pay for services. The ACA is really complicated, and so two areas where the state has some control is in the operation of its Medicaid program, which you have to remember is an insurance program, not a welfare program. It is helping people who work, people who are elderly, and so West Virginia needs to have flexibility to match the needs of a rural state that has an older population. I think most people at the national level realize that one size doesn’t fit all, but at the same time, you have to have some kind of consistency, so there’s a push-pull relationship. The other thing is that the state probably wants to have some flexibility in how it regulates the private insurance market because all insurance is subject to some regulation.

 

Q. What issues do rural areas face in relation to health policy?

A. One, is that there often is a lack of providers. We can take for granted, if you or I get sick, that we can go to Urgent Care or a clinic, but in rural WV, we might not be able to access that care immediately. The other is that, believe it or not, recreational activities are sometimes not always as prominent and available in rural areas as they are in a more urban area. You have to remember that health is not just about caring for somebody, it’s also about preventing and promoting healthy behaviors. The other thing, too, is just managing a chronic condition that needs regular medical attention. You and I can see a specialist right across town, but if I’m living in rural WV, I may have to drive to Morgantown or Charleston or Winchester, Virginia, Pittsburgh, to see somebody.

 

Q. How does a program like Medicaid, which gives healthcare to low-income individuals, help the population which is paying the taxes to support it?

A. On so many different levels, and it’s a wonderful question, because I think one of the challenges we have in our society right now is that we tend to see things in a zero-sum way; "your gain is my loss," and we have to overcome that. One, if we provide health insurance for individuals, that helps everybody just in terms of financing the healthcare system. A lot of it is coming from Medicaid and Medicare, so on one level, all of those dollars help to flow into the healthcare system and to help build infrastructure. Another benefit is that we may be in a good position financially, but we may have family members or friends who are not, so it’s nice that they have health insurance, because practically speaking, it almost sounds a little too logical that if a friend or family member is getting healthcare coverage with Medicare or Medicaid, then that means that I’m protected as a caregiver.