**see detailed list of Rockefeller successes for West Virginians in the bill below**
Senator Rockefeller, who serves as the Chairman of the Senate Finance Subcommittee on Health Care issued the following statement upon passage of landmark health care reform legislation in the Senate. “Today the United States Senate stood firm against the status quo of a broken health care system and brought our nation closer than ever before to enacting legislation that delivers on the promise of secure and affordable health care across America. This is a proud and hopeful moment.
“I am confident that this groundbreaking bill can and will make a real difference for countless families in West Virginia and across the country –because those who are uninsured will finally have someplace to go for care and those with health insurance will know that the coverage they count on, and pay for, will be there when they need it. We will rein in spiraling health care costs, and we will end the abuses of a profit-driven health insurance industry that too often plays mercilessly with people’s lives.
“My deeply held desire to ease the struggles facing so many West Virginians is what has always driven me to work so hard to reform our health care system. West Virginians tell me all the time that they need and want to keep their families healthy and make their lives better. In this season of so many profound blessings, I am privileged to be part of this landmark bill for them—and I will not stop fighting until our health care system puts our people first."
The following are key benefits for West Virginia included in the Patient Protection and Affordable Care Act:
TOP 10 BENEFITS FOR WEST VIRGINIANS THAT BEGIN IN 6 MONTHS OR LESS
- Making Health Coverage More Affordable for West Virginia’s Small Businesses. Within six months of enactment, small businesses in West Virginia will have access to tax credits for up to 35 percent of the cost of health coverage for their employees. While small businesses make up 82 percent of businesses in West Virginia, only 37 percent of them offered health coverage to their employees in 2008. This bill could help as many as 20,000 small businesses in West Virginia afford to offer health coverage.
- Significant Help for West Virginians Denied Coverage Due to Pre-existing Conditions. Within 90 days of the bill’s enactment, individuals with pre-existing conditions who are denied health coverage will have access to affordable and meaningful health coverage through a high-risk pool. West Virginians have the highest rates of diabetes and heart disease in the country, with one-third of the total population of the state exhibiting high blood pressure. These are all pre-existing conditions for which health coverage can be, and often is, denied. A complete prohibition on insurance company pre-existing condition exclusions will begin in 2014, when the state health insurance exchanges are operational.
- New Immediate Protections for West Virginia’s Children Suffering from a Pre-existing Condition. Effective immediately, health insurers will be prohibited from denying coverage for children under age 19 due to a pre-existing condition. Almost one-third of children and youth with special health care needs are considered to be underinsured – many of them because they are denied the coverage they need due to a pre-existing condition.
- Stable Coverage for West Virginia’s Children and Young Adults. For plan years beginning six months after enactment, health insurers that provide dependent coverage for children are required to continue providing that coverage until the child turns 26 years of age. Young adults just starting out will no longer be ignored by our health care system.
- Protection for West Virginians against Abusive Health Insurance Rescissions. Within six months of enactment, insurance companies in all markets are banned from dropping your coverage once you get sick (rescissions). All 1.8 million West Virginians can rest assured that their health insurance coverage will not be rescinded when they need it most.
- Protection of Health Coverage for West Virginia’s Early Retirees. As soon as practicable upon enactment, the Secretary of Health and Humans Services is required to create a new, temporary reinsurance program to help companies that provide early retiree health benefits for those ages 55-64 to offset the expensive cost of that coverage. An estimated 41,500 people from West Virginia have early retiree coverage through their former employers, but early retiree coverage has eroded over time. A reinsurance program provides a backstop of additional federal funding in the event an employer is liable for significant health insurance claims that they simply cannot afford to pay. The reinsurance program included in the health reform bill would stabilize early retiree coverage and provide premium relief to both early retirees and the workers in the firms that provide their health benefits. This could save West Virginia families up to $1,200 on premiums.
- Providing Value for the Health Insurance Premiums that West Virginians Pay. Beginning in 2010, insurers in the large group market are required to spend a minimum of 85 cents of every premium dollar paid on medical care, rather than on marketing campaigns or profits. Insurers in the small group and individual market are required to spend a minimum of 80 cents of every dollar on medical care. Insurers that do not abide by these minimum limits would be required to refund consumers the balance of the premium that should have gone towards medical care. Insurers in West Virginia currently spend an average of 65 cents of every dollar on medical care in the individual market and only about 75 cents of every dollar on medical care in the small group market. West Virginians can rest assured that the vast majority of the hard-earned dollars they pay to private health insurance companies will go towards actual medical care.
- No Annual or Lifetime Dollar Limits on Health Coverage for West Virginians. Within six months of enactment, the bill bans lifetime dollar limits on coverage, and tightly restricts the use of annual dollar limits to be sure individuals can access needed care. The bill will completely prohibit annual dollar limits on coverage beginning in 2014, when the state health insurance exchanges are operational.
- Access to Free Preventive Health Services for West Virginians. Within six months of enactment, all new health plans must include coverage of preventive services and immunizations free of charge (i.e. health insurers cannot charge a co-payment). An estimated 45 percent of West Virginians have not had a colorectal screening, and 23 percent of women over 50 have not had a breast cancer screening. This provision will make life-saving health screenings more affordable for West Virginians.
- Substantial Reduction in West Virginia Seniors’ Prescription Drug Costs. In 2010, West Virginia seniors who fall into the Medicare prescription drug coverage gap (the “doughnut hole”) will receive $500 towards their prescription drug coverage. Also, starting in 2010, West Virginia seniors who fall into the coverage gap will receive a 50 percent discount on brand name drugs and biologics. According to West Virginia AARP, roughly 135,000 West Virginias fall into this coverage gap each year.
ADDITIONAL BENEFITS FOR WEST VIRGINIA IN 2010 AND 2011
Increased Medicare Payments for All Primary Care Doctors. Beginning in 2011, West Virginia’s primary care doctors (including family physicians and geriatricians) and general surgeons will receive a 5 to 10 percent bonus in Medicare payments. Roughly 2,300 doctors in West Virginia practice primary care and would qualify for this new bonus.
Free Preventive Services for West Virginia’s 372,000 Seniors. Seniors enrolled in Medicare will receive free annual wellness visits under Medicare starting in 2011. These visits will give seniors a chance to develop personalized prevention plans with their doctors in order to address health conditions and other risk factors for disease. The bill will also provide recommended preventive services and screenings for seniors – such as mammography and colonoscopy screenings – free of charge. Currently, seniors in Medicare must pay part of the cost of preventive services on their own. For a colonoscopy that costs $647, a senior must pay $150 – a price that many seniors cannot afford.
Expanded Primary Care, Nursing, and Public Health Workforce. Nearly 169,000 people, or 9 percent of West Virginia’s population, cannot access a primary care provider due to shortages in their communities. The bill will expand and improve programs to increase the number of health care providers – including doctors, nurses, and dentists – especially in rural and other underserved areas.
New Authority for West Virginia to Begin Covering Vulnerable Adults in Medicaid. In 2011, a new option will allow West Virginia to cover parents and childless adults up to 133 percent of the federal poverty level (FPL) and receive current law federal matching payments. Currently, West Virginia Medicaid covers parents up to 35 percent of the FPL ($6,408.50 for a family of three) but adults without children are not eligible for Medicaid coverage unless they are pregnant, elderly or disabled.
Increased Funding for West Virginia’s Community Health Centers. In order to support West Virginia’s safety-net providers and improve access to care, the health reform bill includes an additional $10 billion in mandatory funding for community health centers (CHCs) and the National Health Services Corps. The 28 organizations and 188 delivery sites for CHCs in West Virginia served almost 350,000 West Virginians in 2008.
Improvements to the Black Lung Benefits Process for West Virginia Miners. To address unacceptable delays in the administration of black lung benefits, the bill eliminates the prohibition against requiring eligible survivors to file a new claim. The bill also simplifies the process by eliminating certain exceptions to the rebuttable presumptions for those claims filed after the Black Lung Benefits Amendments of 1981. This provision starts upon date of enactment and will apply to pending Black Lung claims filed after January 1, 2005.
EVEN MORE BENEFITS FOR WEST VIRGINIA WHEN REFORM IS FULLY IMPLEMENTED
Extension of the Children’s Health Insurance Program (CHIP) so that West Virginia Children Will Continue to Have Access to Coverage that Meets Their Needs. At Senator Rockefeller’s urging, the Senate health reform bill continues the successful, bipartisan Children’s Health Insurance Program for an additional two years beyond its current reauthorization – until 2015. CHIP currently covers more than 7 million children nationwide, including 37,645 children in West Virginia last year. By 2013, more than 14.1 million children will be enrolled in the program. For the first time, the children of West Virginia’s state employees will also be able to enroll in CHIP.
Premium Subsidies to Help West Virginians Afford the Cost of Coverage. Individuals and families in West Virginia currently spend $1.8 billion out-of-pocket to cover premiums, deductibles, and co-payments. That number is expected to increase in 2019 without reform. Starting in 2014, this bill will provide premium subsidies to help with the cost of health insurance coverage for approximately 204,000 West Virginians between 133 percent and 400 percent of poverty.
Better Health Insurance Coverage for West Virginians. Beginning January 1, 2014, West Virginians will have access to health insurance coverage that is more affordable, comprehensive, and reliable. In addition to the insurance reforms required prior to 2014, private health insurance companies will be required to achieve guaranteed availability and renewal of health coverage, no discrimination in health coverage based on health status, limitations on increasing the cost of coverage based purely on age, prohibitions on excessive waiting periods for employer-based coverage, minimum coverage requirements for health plans available in the exchange, limitations on cost-sharing, reforms to better spread risk and make health coverage more affordable, and comprehensive information on health coverage options for consumers.
Coverage for More than Half of All Uninsured West Virginians. Currently, there are more than 271,000 West Virginians who do not have health insurance. That number is expected to increase to more than 307,000 by 2019 if nothing is done. According to a December 2009 report by Families USA, an additional 177,000 West Virginians will have health insurance coverage as a result of this health reform bill. That is more than half of the West Virginia’s uninsured – a significant step forward.
Medicaid Coverage for Nearly 100,000 Low-Income West Virginians. In 2014, the bill will increase Medicaid eligibility for all non-elderly parents and childless adults, children, and pregnant women in West Virginia with annual income up to 133 percent of poverty ($29,300 for a family of four). From 2014 through 2016, the federal government will pay 100 percent of the cost of covering newly-eligible individuals. New federal dollars for Medicaid will act as a stimulus to West Virginia’s economy – by reducing uncompensated care and by increasing jobs, wages, and business activity in West Virginia.
Protecting Health Benefits of West Virginia’s Coal Miners. Beginning in 2013, health insurance companies will be taxed on high end health insurance plans. Senator Rockefeller helped secure special protections (higher benefits) for those in high risk professions, including coal miners.
An End to the “Hidden” Tax on Individuals and Families in West Virginia. Nearly half a billion dollars is spent on uncompensated care each year in West Virginia. Uncompensated care often gets passed on to individuals and families that have insurance in the form of increased premiums. By expanding coverage to the majority of uninsured West Virginians, health reform will eliminate the uncompensated care burden on West Virginians who already have insurance.
Setting Medicare on a Path to Long-term Solvency. Health care reform will finally begin to take politics and lobbyists out of the business of deciding Medicare payment rates. Rockefeller secured the establishment of an independent Medicare advisory board to improve Medicare quality and keep it solvent for the long term.
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