CHARLESTON, W.Va. -- Gov. Earl Ray Tomblin has not decided whether West Virginia will expand its Medicaid program under federal health reform, Medicaid Commissioner Nancy Atkins said Wednesday.

About 120,000 uninsured West Virginians stand to gain health insurance if the state expands its program as prescribed by the federal law. State officials are "having discussions on this question every day," Atkins said.

In June, when the Supreme Court ruled the Affordable Care Act constitutional, they also surprised West Virginia officials by ruling that Washington cannot take away all of a state's Medicaid funding if a state refuses to expand coverage to people who earn up to 133 percent of the federal poverty level, as prescribed by the law.

At 133 percent of the federal poverty level, an individual earns $15,000 and a family of three earns about $26,000.

"We're talking mainly about working poor people -- people who work for small employers who can't afford health insurance," said Perry Bryant, executive director of West Virginians for Affordable Health Care.

Atkins and Bryant were among about three-dozen health officials attending a monthly health reform roundtable sponsored by WVAHC.

"If we don't do the expansion, we'll be leaving a lot of poor people unserved," Atkins said, "so we are sifting through the questions and numbers. These are not simple questions."

West Virginia Medicaid insures primarily children. Parents who earn up to 35 percent of the federal poverty level qualify. Childless adults do not.

Kathleen Stoll, Deputy Executive Director of the national health advocacy group Families USA, said via speakerphone, "Medicaid expansion is a very good deal for West Virginia," because the federal government pays 100 percent of the cost for the first three years and 90 percent thereafter.

The Republican governors of Texas and Florida have said they will not expand their programs. "It would be fiscal malpractice to turn away hundreds of millions of dollars and leave people uninsured," Stoll said.

According to the Congressional Budget Office, the Medicaid expansion would add only 2.8 percent, on average, to the amount states already pay for Medicaid, she said, but it would substantially reduce the amount of unpaid emergency room and hospital bills. "The savings will balance the costs," she said.

"We need an actuarial analysis that includes both costs and savings," Bryant said.

Joe Letnaunchyn, CEO of the West Virginia Hospital Association, said many West Virginia hospitals would be hurt if Medicaid does not expand. "We are obviously in favor of the expansion," he said. "Our people are talking daily with the state."

Medicaid expansion would eliminate a lot of unpaid bills in emergency rooms and hospitals, Bryant said. In 2009, the West Virginia Health Care Authority found that unpaid hospital and emergency room bills would decrease by $240 million in 2014 if West Virginia expanded Medicaid coverage to only 100 percent. 

"This is an excellent opportunity for West Virginia to lower some of its chronic disease numbers," Bryant said. West Virginia leads the nation in 10 out of 12 chronic conditions in the 2011 Gallup Healthways ranking. "If people can afford early care, they can catch these diseases early or even prevent them," he said.

Atkins said state officials are not sure what would happen if the state were to expand its program to less than 133 percent. Atkins said it's unclear if the state could still get the 90 to 100 percent federal match. "Only full expansion gets the full federal match," Stoll said.

"If you get four lawyers in a room to talk about this, you'll get four opinions," Atkins said.

Atkins said to "stay tuned" for when West Virginia will make its decision.

Jeremiah Samples, who directs the state's planning for the health insurance exchange, said plans for the exchange are moving forward. "We plan to have actuaries and economists on board in August, so we can present the governor and Legislature with the best possible information."

When the exchange opens in 2014, West Virginians will be able to compare insurance policies and rates online. The state can run its own exchange or let the federal government run its exchange. "Either way, West Virginians will have an exchange," Samples said.

Samples said his staff has been talking with Maryland, Massachusetts and other states about sharing administrative costs.

People who cannot afford insurance will receive subsidies that make the insurance affordable or will not have to buy it, Samples said.

"I know 2014 sounds like it's a long way away, but it's coming up very fast," he said.

Reach Kate Long at (304) 348-1798 or katel...@wvgazette.com.