CHARLESTON, W.Va. -- Under the state's health insurance exchange, a cap on what older West Virginians pay and other issues could be risky, an official with the state's Insurance Commission said.
Jeremiah Samples, an insurance commission official in charge of planning for the exchange, spoke to the West Virginians' Campaign for a Healthy Future on Thursday concerning the risks of the exchange.
"There's certainly a lot of things that are going to happen that are going to benefit a lot of people," Samples said of the exchange, which is required to be in place by Jan. 1, 2014. "But just to bring a reality check to the situation that there's a lot of risks that we need to ... be thinking through."
Gov. Earl Ray Tomblin's office has decided that the state and the federal government will share the responsibility of the state's health care exchange or marketplace, a system that allows residents to compare the costs of insurance plans and purchase plans.
One way the exchange is risky is its "3:1 age band" on consumers, which will limit how much older people will pay in premiums to no more than three times what a younger person will pay, he said. West Virginia typically has a 7:1 band now.
"Basically what that means is that younger, healthier individuals are going to have to pay more," Samples said. "The fear for that is that younger, healthier individuals are not in the marketplace because they'll just do a personal cost-benefit analysis and the risk pool will be much poorer."
It would take an act of Congress to fix the age band and other problems, which would make the marketplace more stable, Samples said.
West Virginia's small size and its unhealthy population make the insurance market weak already, he said.
"The worst-case scenario is you can have carriers not able to sustain themselves through this transition," Samples said. "What this does to the rest of the market -- obviously there's negative consequences there."
The exchange is part of the Affordable Care Act. Another component of the ACA is a possible expansion of the state's Medicaid program. Tomblin has yet to decide whether to expand Medicaid to those who make up to 138 percent of the federal poverty level, or about $15,000 for an individual.
If the state expands, the federal government will pay 100 percent of the expansion at first and the federal share would drop to 90 percent in the future.
Results from an actuary study of the costs of expanding are expected by the end of March, said Nancy Atkins, the state's Medicaid commissioner.
Reach Lori Kersey at lori.ker...@wvgazette.com or 304-348-1240.