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Uninsured West Virginians with pre-existing conditions face higher costs after the Legislature failed to let the state run a coverage program for them, some health care advocates warn.
Those enrolling in the new high-risk pool must pay for $2,500 worth of medical expenses each year before the pool coverage kicks in, because the federal government must now operate the program. They would have paid a $1,000 yearly deductible if the state ran it.
The program is for the estimated 1,000 West Virginias with pre-existing medical conditions who have been unable to obtain insurance for at least six months. Perry Bryant, executive director of West Virginians for Affordable Health Care, said the difference in deductibles stymies their access to this coverage.
"It's not a huge number, but these are very sick people who have been priced out of the insurance market altogether, or have been denied coverage by insurance carriers," Bryant said. "People covered under the (state-run) program would have had access to insurance much more quickly each year."
While agreeing that the federally run program has a higher deductible, state officials said it will also offer some enrollees lower monthly premiums than the state-run plan could. That could at least partly offset those higher upfront costs, officials said.
"Theoretically, it would be a perfect trade-off," said Nancy Malecek, a Manchin administration health official.
State officials also noted the pool is temporary: the program will expire in 2014, when the federal health care law passed this year will no longer allow private insurers to deny coverage because of pre-existing conditions. But like Bryant, state officials question the objections that scuttled the legislation meant to allow state oversight of the program.
Bryant blames politics. Republicans in the House of Delegates have been vocal foes of the federal legislation that created and funds the pool. It allowed each state to choose whether to run its own version or leave it under federal control.
West Virginia was among 29 states and the District of Columbia that sought to operate it themselves. Measures proposed during the summer's two special sessions aimed to allow that. GOP lawmakers argued that if that happened, the state would be forced to cough up scarce state dollars if the pool's $27 million in federal funding ran out before 2014.
"By not having that in the state of West Virginia, we have no moral obligation to fund it when the feds stop," said Delegate Craig Blair, R-Berkeley.
Bryant said the federal legislation provides safeguards meant to ensure that doesn't happen, and that he sought to explain that to lawmakers during the sessions. The state could halt enrollment, raise premiums or take other steps, he said.
"The feds were going to require the states to submit a lot of information regarding where they were with their program," Bryant said.
Malecek also cited those federal safeguards, as well as the actuary who oversees AccessWV. Malecek is acting director of that high-risk program, which the state launched on its own five years ago. The federally funded pool would offer coverage to those unable to obtain it even from AccessWV.
"Because the actuary has a big role, we'd make changes to maintain the solvency. That is the bottom line," Malecek said.
Tim Murphy, an Insurance Commission lawyer, agreed.
"We felt very confident that there were enough controls there to ensure that it would run until 2014 without leaving the state in the lurch," Murphy said.
GOP delegates also questioned whether the pool would fund abortions. Bryant considers such fears unfounded. He said enrollees -- in AccessWV, the average age is 55 -- seek coverage for diseases like congestive heart failure.
"It was silly to have this debate over abortion in the first place," Bryant said. "It puts ideology ahead of a competently run program."
But he, Malecek and Murphy also said the Obama administration has issued directives barring elective abortion coverage in these pools.
"We told them it wasn't an issue with us," Murphy said of lawmakers. "It's a non-issue as far as we're concerned."
Blair cited concerns raised by groups like West Virginians for Life regarding the overall federal legislation when it passed this year. He also said other states were funding abortions in their pools.
At least one state -- New Mexico -- initially decided to allow coverage of elective abortion in its pool. Abortion opponents also raised questions about Pennsylvania and Maryland, but officials in those states denied that their plans would have covered abortions.
Responding to such concerns, the U.S. Health and Human Services Department announced in July that the program will not cover abortions except in cases of rape, incest or when the mother's life is in danger -- exceptions traditionally allowed under federal law. That's a more restrictive policy than will be generally applied under Obama's new health care law.
Murphy said he shared that July bulletin with lawmakers during that month's special session. Blair said he was unswayed.
"It's not in the law. That's all there is to it," Blair said.
The July measure idled after Blair proposed an amendment to block any abortion funding.
"What would have been the harm, to have that safeguard in there?" Blair said. "The bottom line is, the reason the bill died is, they didn't want to bring up the abortion issue. ... Don't blame the Republicans. Blame the leadership."
The office of House Speaker Rick Thompson, D-Wayne, did not respond to a request for comment.
Lawrence Messina covers the statehouse for The Associated Press.