Advocates are asking Congress to consider the needs of people with disabilities in West Virginia, where an estimated one in five people have a disability, as lawmakers consider whether to repeal or replace the Affordable Care Act.
During a press conference at the state Capitol Wednesday, surrounded by other advocates and people with disabilities, Ann McDaniel, executive director of the West Virginia Statewide Independent Living Council, urged West Virginia representatives not to allow Medicaid to be transformed into a block grant or per-capita program; to keep the provision of the Affordable Care Act that prohibits insurance providers from discriminating against people with pre-existing conditions; and to preserve disability-specific provisions of the Affordable Care Act “so that the most vulnerable populations aren’t harmed.”
The news conference, held with a disability advocacy group called the Fair Shake Network, was part of a national effort.
“We have great concerns about Medicaid caps and Medicaid block grants,” McDaniel said. “That would have a huge impact on people in West Virginia — not just poor people but people with disabilities who access Medicaid as their source of health insurance. We have a high rate of disability in West Virginia — the highest in the country. We have a high unemployment rate. We have a lot of people who are low income. Without adequate Medicaid coverage, those individuals are all going to be at risk.”
The U.S. Census Bureau estimated that from 2011 to 2015, 19.4 percent of West Virginians had a disability — the highest rate of all 50 states.
The way Medicaid is funded now, states receive matching funds from the federal government for qualified expenditures. The match rate varies by state. In West Virginia, the federal government pays about 75 percent of Medicaid expenses.
Under a block grant program or a per-capita program, which would set caps on funding states could receive, advocates warn that saved costs could come at the expense of people with disabilities.
“If they cap it, they’re going to have to look at who qualifies, because there won’t be enough money to serve everybody that qualified,” McDaniel said, in an interview.
McDaniel believes a per capita or block grant Medicaid program would have “a disproportionate impact on West Virginia.”
“Most everything that is done by formula at the federal level is based purely on population,” she said.
Medicaid provides insurance for one in three non-elderly adults with disabilities, according to the Kaiser Family Foundation. People with disabilities account for 15 percent of total Medicaid enrollment, but 42 percent of program spending due to greater needs and more intensive service use, “especially long-term care in the community and nursing homes, that are generally unavailable through private insurance and too costly to afford out-of-pocket.”
“We are talking about real people and their lives,” McDaniel said. “We’re talking about their ability to access health care so that they can stay healthy and be able to participate in their communities and be a part of the community.”
Greg McGraw, 50, of Crab Orchard, suffered a brain injury at 25. He catches a ride to the Legislature on Wednesdays to lobby lawmakers. “You have to be on your toes,” he said.
He said he’s been following the news, because he worries about potential cuts to his own health insurance — Medicaid/Medicare. He’s trying to save, but he relies on a disability check and help from his parents. But he’s also worried about other people who might develop disabilities in the future.
“They need Medicaid/Medicare like we do,” he said.
Also Wednesday, the Kanawha-Charleston Health Department held a community forum on the potential repeal of the Affordable Care Act. Panelists included representatives from West Virginians for Affordable Healthcare, Recovery Point, Cabin Creek Health Systems and Charleston Area Medical Center, all of whom also expressed concerns with potential changes to Medicaid.
Bob Whitler, of CAMC and Partners in Health Network, said that in Kanawha County, 17,652 people had coverage through Medicaid expansion.
As of December 2016, West Virginia had enrolled 567,064 people in Medicaid and CHIP, an increase of 59.94 percent since October 2013. More than 173,000 West Virginians were enrolled in Medicaid expansion as of Monday, according to DHHR.
Whitler, citing the American Hospital Association, said that current legislative proposals would reduce statewide Medicaid enrollees by 68,000 in 2018 and 125,000 in 2026.
“Medicaid expansion not only benefits the working poor, but also benefits our hospitals,” he said.
At CAMC, uncompensated care, which is charity and bad debt combined, declined from 5.69 percent of gross revenue in 2013 to 2.6 percent in 2015 and 3.29 percent in 2016. At the same time, the company’s Medicaid percentage increased from 18.2 percent in 2013 to 23.1 percent in 2015 and 21.8 percent in 2016.