Today, key elements of the Affordable Care Act (ACA) go into effect. The political noise will continue, but it's undeniable that many more people will have excellent health coverage and insurance companies are no longer able to discriminate against those with pre-existing conditions.The ACA, however, does a lot more. It promises to reduce costs and inefficiencies and improve care for patients based on proven ideas and practices. In fact, the Office of Economic Advisors reported recently that real per-capita healthcare spending has grown annually at just 1.3 percent over the last three years, the lowest rate since these records began. Although the recession was a factor in this slowdown, most experts believe that many already-implemented provisions of the ACA are contributing in a meaningful way. This should only get better.Over the last few months, it seems that the media has been obsessed by the problems of the flawed federal website and canceled individual health policies. Yet, there is little acknowledgement of the success of several state websites or the fact that the number of canceled policies is relatively small, with many of them mostly worthless.Additionally, reports have failed to emphasize that, because of the ACA, many people who want to retire before 65 or who want to move to a more desirable job now have the opportunity to obtain affordable insurance without their previous health being a concern. Business interests seem oblivious to the fact that entrepreneurial activity and innovation should blossom, as start-ups now have access to significantly improved health insurance options. In fact, the business newsweekly Kiplinger Reports predicted last month that corporate use of the marketplaces will accelerate because of less administrative work and the expectation of saving money over time.Public perception is that the ACA is a single federal program, but each state's approach is unique, including West Virginia's. The negative impact of a lack of insurance here is huge with our extraordinarily high rates of poverty and chronic disease. We see exorbitant costs, decreased worker productivity, lower quality of life, depressed school attendance, and poor image. The AMA reported over a year ago that our state has the greatest potential of all to cover its uninsured population with the ACA.
I am happy to report that the Mountain State has done many good things. In May, Gov. Tomblin elected to expand Medicaid and, thanks to the inspired work of the Department of Health and Human Resources, West Virginia already has more than 90,000 new enrollees in expanded Medicaid, arguably the largest per-capita addition of any state.Unfortunately, although we were behind only California in enacting legislation authorizing a state-based insurance marketplace, the state administration has been unwilling to move forward with our own marketplace or to take additional federal money to assist with outreach. This reluctance greatly contributed to the distressingly low private insurance signup numbers of those ineligible for Medicaid because of limited support, the default to the federal website and higher premiums caused by a less-competitive environment for insurers.On the other hand, with exceptional vision in a similar poor and sick state, Kentucky Gov. Steve Beshear sees the ACA as a "transformational tool" that will lead to "a very different Kentucky than you see today". By putting in place a well-organized state-based marketplace, he has overseen perhaps the most successful ACA rollout in America. Gov. Beshear expects this to be the most important act of his tenure and has stated, "we cannot afford to waste another day or another life."Neither can West Virginia. Although there has been a nearly 40 percent reduction in our uninsured in only three months, just think what these numbers would have been with the full commitment of our leaders.As we prepare for many more months of toxic partisanship about health reform, remember that this should not be a debate driven by the election of 2014, but rather by the possibility of better health for West Virginians. To that end, we should not be afraid to look outside our borders for ideas. Fortunately, it's not too late for our policymakers to begin the process of creating our own state-based marketplace, to accept additional federal grants for promotion, or to collaborate with our demographic twin to the west. If not now, when?Dr. Foster is a Charleston physician and former state senator who campaigns for medical reform.