How the Health Care Law Is Making a Difference for the People of West Virginia
For too long, too many hardworking Americans paid the price for policies that handed free rein to insurance companies and put barriers between patients and their doctors. The Affordable Care Act gives hardworking families in West Virginia the security they deserve. The new health care law forces insurance companies to play by the rules, prohibiting them from dropping your coverage if you get sick, billing you into bankruptcy because of an annual or lifetime limit, or, soon, discriminating against anyone with a pre-existing condition.
All Americans will have the security of knowing that they don’t have to worry about losing coverage if they’re laid off or change jobs. And insurance companies now have to cover your preventive care like mammograms and other cancer screenings. The new law also makes a significant investment in State and community-based efforts that promote public health, prevent disease and protect against public health emergencies.
Health reform is already making a difference for the people of West Virginia by:
Providing new coverage options for young adults
Health plans are now required to allow parents to keep their children under age 26 without job-based coverage on their family coverage, and, thanks to this provision, 3.1 million young people have gained coverage nationwide. As of December 2011, 18,000 young adults in West Virginia gained insurance coverage as a result of the health care law. For more details on these numbers, visit H E R E.
Making prescription drugs affordable for seniors
Thanks to the new health care law, 39,164 people with Medicare in West Virginia received a $250 rebate to help cover the cost of their prescription drugs when they hit the donut hole in 2010. Since the law was enacted, West Virginia residents with Medicare have saved a total of $46,560,757 on their prescription drugs. In the first five months of 2012, 15,839 people with Medicare received a 50 percent discount on their covered brand-name prescription drugs when they hit the donut hole. This discount has resulted in an average savings of $707 per person, and a total savings of $11,197,398 in West Virginia. By 2020, the law will close the donut hole.
Covering preventive services with no deductible or co-pay
In 2011, 236,654 people with Medicare in West Virginia received free preventive services – such as mammograms and colonoscopies – or a free annual wellness visit with their doctor. And in the first five months of 2012, 119,437 people with Medicare received free preventive services. Because of the law, 54 million Americans with private health insurance gained preventive service coverage with no cost-sharing, including 300,000 in West Virginia.
Providing better value for your premium dollar through the 80/20 Rule
Under the new health care law, insurance companies must provide consumers greater value by spending generally at least 80 percent of premium dollars on health care and quality improvements instead of overhead, executive salaries or marketing. If they don’t, they must provide consumers a rebate or reduce premiums. This means that 16,434 West Virginia residents with private insurance coverage will benefit from $2,703,790 in R E B A T E S from insurance companies this summer. These rebates will average $374 for the 7,200 families in West Virginia covered by a policy.
Scrutinizing unreasonable premium increases
In every State and for the first time under Federal law, insurance companies are required to publicly justify their actions if they want to raise rates by 10 percent or more. West Virginia has received $3.1 million under the new law to help fight unreasonable premium increases.
Removing lifetime limits on health benefits
The law bans insurance companies from imposing lifetime dollar limits on health benefits – freeing cancer patients and individuals suffering from other chronic diseases from having to worry about going without treatment because of their lifetime limits. Already, 581,000 residents, including 219,000 women and 147,000 children, are free from worrying about lifetime limits on coverage. The law also restricts the use of annual limits and bans them completely in 2014.
Creating new coverage options for individuals with pre-existing conditions
As of April 2012, 113 previously uninsured residents of West Virginia who were locked out of the coverage system because of a pre-existing condition are now insured through a new Pre-Existing Condition Insurance Plan that was created under the new health reform law. To learn more about the plan available in West Virginia, check H E R E.
Supporting West Virginia’s work on Affordable Insurance Exchanges
West Virginia has received $10.6 million in grants for research, planning, information technology development, and implementation of Affordable Insurance Exchanges.
- $1 million in Planning Grants: This grant provides West Virginia the resources needed to conduct the research and planning necessary to build a better health insurance marketplace and determine how its exchange will be operated and governed. Learn how the funds are being used in West Virginia H E R E.
- $9.6 million in Exchange Establishment Grants: These grants are helping States continue their work to implement key provisions of the Affordable Care Act. Learn how the funds are being used in West Virginia H E R E.
Preventing illness and promoting health
Since 2010, West Virginia has received $9.9 million in grants from the Prevention and Public Health Fund created by the Affordable Care Act. This new fund was created to support effective policies in West Virginia, its communities, and nationwide so that all Americans can lead longer, more productive lives.
Increasing support for community health centers
The Affordable Care Act increases the funding available to community health centers in all 50 states, including the 203 existing community health centers in West Virginia. Health centers in West Virginia have received $38.5 million to create new health center sites in medically underserved areas, enable health centers to increase the number of patients served, expand preventive and primary health care services, and/or support major construction and renovation projects.
Strengthening partnerships with West Virginia
The law gives states support for their work to build the health care workforce, crack down on fraud, and support public health. Examples of Affordable Care Act grants to West Virginia not outlined above include:
- $150,000 to support the National Health Service Corps, by assisting West Virginia in repaying educational loans of health care professionals in return for their practice in health professional shortage areas.
- $600,000 to support teaching health centers, creating new residency slots in community health centers.
- $1.2 million to help West Virginia reduce health care fraud by identifying efficient and effective procedures for long-term care facilities to conduct background checks on prospective employees, thereby protecting its residents.
- $4.0 million for school-based health centers, to help clinics expand and provide more health care services such as screenings to students.
- $330,000 to support outreach to eligible Medicare beneficiaries about their benefits.
- $285,700 for Family-to-Family Health Information Centers, organizations run by and for families with children with special health care needs.
- $4.2 million for Maternal, Infant, and Early Childhood Home Visiting Programs. These programs bring health professionals to meet with at-risk families in their homes and connect families to the kinds of help that can make a real difference in a child’s health, development, and ability to learn - such as health care, early education, parenting skills, child abuse prevention, and nutrition.