As health-care costs spiral upward, one in four West Virginians are uninsured at some point in the year. The state Insurance Commission predicts doubled insurance costs. In a continuing series, The Charleston Gazette explores the implications for all West Virginians.
When Sally Richardson was born in 1933, St. Mary's Hospital in Huntington charged her parents $25. Richardson still has the bill. Her father, a lawyer, kept it with his office files. Seventy years later, a birth costs more than $3,000 in hospital charges alone.
About 30 years ago, Richardson was driving her daughter and a little girl named Sonia to kindergarten. Today, Richardson and Sonia Chambers, chairwoman of the Health Care Authority, direct a $1 million project aimed at reducing the number of uninsured West Virginians by half.
They have formed the Health Advisory Council, which is made up of 125 state officials, community leaders, insurance company executives, politicians and health-care providers to help them do it.
When they wrote the federal grant to fund the project in April 2002, they intended to find a way to insure everybody in the state. A few months later, the state discovered that Medicaid — one of the primary health coverage tools — was more than $200 million in the hole.
"You have to realize that what we might have planned when we first got this grant would be different than what we have to plan now," Richardson said. "We have to plan with the understanding that, until the economy begins to get better in West Virginia, we cannot spend large dollars putting more people on insurance."
'We complement each other'
Almost 296,000 West Virginians between the ages of 19 and 64 didn't have health insurance in 2001, according to a survey Richardson directed for the West Virginia University Institute for Health Policy Research.
It won't be easy to cut that number in half, which is the group's current goal. West Virginia's budget is tight. Changes will have to be small and incremental, Richardson and Chambers said. They will start by targeting specific groups, parents of children insured through the Children's Health Insurance Program, for instance.
They have interviewed insurance agents and brokers and surveyed small business employers and employees. In early June, they brought together hundreds of business leaders in Charleston to hear experts explain why large numbers of uninsured people mean higher insurance prices for business.
Richardson helped direct a similar effort in the early 1990s, and she participated in the construction of the Clinton health-care plan. She said she learned how important it is to give business and the public early opportunities to understand the issues.
She and Chambers talk every day.
"We complement each other," Richardson said. "I read all the rules and regulations, and she knows how to get people to understand them." Chambers said she has regarded Richardson as a mentor since she began her career in government, when Richardson held the job Chambers holds now at the HCA.
These days, they talk about the fact that many employers say they can't handle more government mandates without help. They talk about the state's demographics: West Virginians are older and less healthy than people in most states, which makes it more expensive to get insurance here.
And they talk about the fact that many people who have insurance do not realize that the situation threatens them, too. A series of town meetings are planned for this summer to raise awareness of the problem and possible solutions.
The state's options
The people who serve on the Health Advisory Council have put hundreds of hours into the process. "We've got small business, we have hospitals, we've got government people in our group," said Gail Foley of Greenwood, one of the few uninsured people sitting on the committee. "With the steering committee, I think we're all realizing that we have to cooperate."
They will produce a set of proposals that will end up on Gov. Wise's desk, possibly before the 2004 legislative session begins.
"What we will end up with is an implementable plan for the state of West Virginia and recommendations for what the federal government might be able to do to help the situation," Richardson said.
About 30 other states have developed similar plans since 2000. Vickie Gates directs state coverage initiatives at Academy Health, a health policy research firm in Washington, D.C., that helps states with their planning grants, funded by the federal Health Resources and Services Administration.
"Many of them are looking at public-private partnerships," Gates said. People or businesses could buy into Medicaid, for example. Some states propose to cover more people with Medicaid or the Children's Health Insurance Program. Some want to form high-risk insurance pools and provide tax incentives.
The West Virginia group hasn't yet tackled ways to pay for its ideas. But it has put options on the table. The group reviewed them with the business leaders in early June.
"The ultimate goal is to get as close as we can to everybody having some kind of insurance," Chambers said. But before that can happen, the state has to maintain the progress it's already made, such as insuring more children through the Children's Health Insurance Program, she said.
"This is the kind of change you have to make incrementally," Richardson said. A big lesson from the Clinton administration's effort in the early 1990s, she said, was that one solution doesn't always work for everyone. People and their health care are too diverse to be covered by one approach.
In one option on the West Virginia group's table, the state would let uninsured people buy into the state Medicaid program. It wouldn't cost the state anything, but individuals would pay $200 a month. Premiums could be adjusted based on income, Richardson said. The state would have to help pay for that option.
Another approach would have the state give tax credits to individuals to help them buy health insurance. That would cost the state about $120 million.
Richardson leans toward expansion of Medicaid to cover more people. Medicaid already provides coverage to about 290,000 West Virginians. That approach costs less money, she said, because, for every dollar West Virginia puts into Medicaid, the federal government puts in three more. West Virginia has one of the nation's most favorable match ratios.
"Expanding Medicaid would be a damn good idea," said consultant Larry Lewin, founder of the Lewin Group, the consulting firm which is detailing the state plan. Lewin is also advising presidential candidate Howard Dean on his health insurance plan.