I want to be the first to welcome everyone to West Virginia for Affordable Health Care’s new website! 2020 has shown us that we all live online and--just in time--we are starting 2021 with a new, user friendly space where we can share the latest information on the policies at the state and local level. We hope you find this easy to navigate and filled with useful information.


This week we saw the 2021 WV Legislative Session begin. As health care consumer advocates, we not only watch the process closely, we actively support policy that improves the health of West Virginians and oppose policy that will hurt. We always work to defend our Medicaid program but this year another issue bubbled up. The personal income tax repeal proposal. If a repeal of the personal income tax makes it through, there will be hard times ahead--especially for people living with low-incomes. With 43% of our general revenue budget  coming from personal income tax, programs and services would suffer. And the financial burden from an increased sales tax, cutting higher education funding, or any number of the proposals laid out to replace this loss of revenue would impact our most vulnerable in a very negative way. West Virginia literally cannot afford this tax cut. If we want to be healthy, educated, safe, fed and want to attract people to our great state, cutting programs and services and/or increasing costs elsewhere is not the way to do it.

But we do see some positive opportunities! Working with Health Care for All West Virginia coalition, with input from residents and key stakeholders, we created our 2021 WV Health Agenda. This document outlines health care policy proposals that we think could improve health and health care access. This legislative session we are particularly interested in working on a number of issues from the WV Health Agenda (one of which has already been introduced):

Create a New Choice health insurance program to provide adult West Virginians with an additional affordable, quality plan option

A New Choice program would provide adult West Virginians who currently do not have access to affordable health coverage a new, more affordable, quality health insurance plan option.  The plan would cover a comprehensive set of benefits and have low deductibles and copays.  The New Choice program would ensure affordable health coverage for more low-wage workers who are hurt by the Medicaid “cliff effect” – those that earn over Medicaid income eligibility levels but do not have an offer of affordable health insurance through their jobs and cannot afford the premiums and out-of-pocket costs of a private individual plan. Utilizing Medicaid administrative efficiencies and purchasing power, the plan would cost less per person than existing individual market plans.  Lawmakers could explore funding streams for subsidizing the plan to make the premiums even more affordable including pulling down existing federal premium subsidies or considering a state-level funding mechanism.

A Medicaid-to-work transition program already exists in West Virginia but only for people who are disabled or who have a chronic health condition:  the Medicaid Work Incentive (M-WIN) program.

Expand Medicaid coverage to one year postpartum for women up to 300 percent of the Federal Poverty Level 

In 2018, the West Virginia Legislature made huge strides for women and families by passing SB 564, expanding coverage for pregnant women at higher income levels for 60 days postpartum. However, postpartum health needs and conditions can continue long after the first 60 days, and continued Medicaid coverage is vital for parents who are receiving treatment for ongoing health conditions such as diabetes or substance use disorders. For women enrolled in Medicaid during—and based on—pregnancy, the postpartum period can be particularly ominous for their health. Providing 12 months of continuous coverage after the end of pregnancy can improve maternal mortality, enhance long-term family health, and address racial inequities.  Expanding coverage to one year postpartum is estimated to cost less than $1 million per year in state dollars.

The United States is the only industrialized nation with a maternal mortality rate that is on the rise, increasing by 26 percent between 2000 and 2014. And across the nation and in West Virginia, there are the stark racial disparities in maternal mortality: Black women are three to four times more likely to die from a pregnancy-related complication than non-Hispanic white women. Data from the Centers for Disease Control and Prevention confirm that roughly one-third of all pregnancy-related deaths occur one week to one year after a pregnancy ends.

Refund to consumers the cost of unjustified high prescription drug price increases

Prescription drug expenditures are nearly 20 percent of health care costs and growing faster than any other part of the health care dollar.  Four of the top 10 prescription drugs in the United States have increased in price by more than 100 percent since 2011. Brand name drug prices are increasing more than twice as fast as inflation. Nearly one in three adults in 2018 reported cutting a dose in half or even refraining from taking the medicine they need due to costs.

Certain groups are more likely to report difficulty affording medication, including those who are spending $100 or more a month on their prescriptions (58 percent), those who report being in fair or poor health (49 percent), those who take four or more prescription drugs (35 percent), and those with incomes less than $40,000 annually (35 percent).

West Virginia took a first step in 2020 to address high prescription drug costs for West Virginia families by passing the “Requiring Accountable Pharmaceutical Transparency, Oversight, and Reporting Act,” which requires drug manufacturers and health benefit plan issuers who sell prescription drugs in West Virginia to provide cost information, changes in cost information, and prescription drug statistics to the State Auditor who will publish the data on a public website.  In addition, a bipartisan group of legislators worked together to pass a private insurance insulin copay cap of $100 per month.

The state should now move forward to provide refunds to consumers for unjustified high prescription drug price increases in West Virginia. Unfair high drug prices hurt consumers, including those who rely on the Public Employee Insurance Agency (PEIA) program and on Medicaid.  If a prescription drug manufacturer sells a drug with an unsupported and very high price increase in West Virginia, the state will force the manufacturer to pay a refund to the state and West Virginia consumers.  The state will "clawback" part of the Rx drug sale price.  And the state action will send a message to drug manufacturers to stop future bad faith pricing.  To define an unsupported high prescription drug price increase, the state would be able to use an annual list generated by a nationally recognized independent outside group, the Institute for Clinical and Economic Review (ICER), that has a process that allows manufacturers full opportunity to bring in evidence of justification for the price increase before listing a drug price increase as unsupported.

West Virginia should also move forward to protect consumers from high prices for insulin-related supplies necessary for diabetes patients.

Watch our blog over the next several weeks as we follow the legislative session and introduce ourselves! Sign up for our newsletter here (http://wvahc.org/get-involved/take-action/) and consider donating to our cause (https://wvahc.nationbuilder.com/donate).

Thank you and Happy 2021 WV Legislative Session!

Dr. Jessie Ice


policy, equality, facts, data, and stuff like that