CHARLESTON, W.Va. -- In the past year, Jeremiah Samples has worked a lot of 12-hour days.
He comes in early to work at the West Virginia Insurance Commission. At night, after his 1-year-old son goes to sleep, he often goes back to work.
"My son's smile melts any stress away," he said. "He reminds me of what this is all about."
The 28-year-old Kanawha County native is overseeing the creation of West Virginia's health insurance exchange. He and his co-workers have three years, but they're still racing the clock.
After Jan. 1, 2014, at least a quarter-million West Virginians will be eligible to sign up for subsidized or free health insurance under the federal health-care reform law.
"2014 is tomorrow," Samples said, rubbing his eyes. "There's so much to do between now and then."
"This is not a large state, and there are approximately 260,000 West Virginians without insurance," he said, "so what we're doing here will affect the lives of people you know."
Under health reform, each state creates its own exchange. They are likely to be quite different, Samples said. The Utah exchange relies heavily on the free market, while the Vermont legislature has voted for a single-payer system.
If a state decides to have no exchange, its citizens go into a national exchange created by the federal government.
Samples has his eye on the clock. By Jan. 1, 2014, all Americans must have health insurance, and all exchanges must be up and running, so people can log on to compare policies and prices.
People will be able to buy policies through the exchanges. Small businesses will be able to pool their numbers for more buying power.
"We want to work out technical bugs in advance," Samples said. "There's going to be mass confusion out there in January 2014, and I don't want to compound it by having tech glitches in the exchange."
When people sign on, they will see policies offered by private companies like Mountain State Blue Cross/Blue Shield and other familiar names, he said.
The Insurance Commission will have reviewed all policies on the exchange to make sure they cover basic primary and hospital care prescribed by federal law. No scams will be listed, he said.
Since insurance companies no longer can refuse to cover people who have pre-existing conditions or cut off customers who get sick, he said, those policies also will be more reliable.Who gets price breaks?
Starting in 2014, individuals who earn up to $46,000 will qualify for subsidized policies that cost less than before. So will families of four who make up to $93,000 in 2014 dollars, according to the Kaiser Family Foundation.
An estimated 125,000 West Virginians will get subsidies, according to the best available estimates, Samples said. The higher the income, the lower the subsidy.
"Most subsidies go to working uninsured people," people who make too much to qualify for Medicaid, but too little to buy good insurance, he said. "They may work in fast food. Maybe they have a job where the employer does not offer coverage. Or they're self-employed.
"They might not be sick or have a chronic ailment right now, but things happen, and health bills can bankrupt you."
The law pays for the subsidies by specified taxes so as not to add to the deficit. A subsidy averages, nationwide, about $6,000 per year.
In 2014, another estimated 150,000 West Virginians who make less than $15,000 will be eligible for Medicaid coverage that costs them nothing.
What about people who already have insurance or get no subsidy? They will save, too, in a less obvious way, Samples said. Their premiums and medical bills are driven up by millions of dollars in unpaid medical bills and emergency room costs that get shifted each year onto paying patients.
With universal insurance, that cycle stops.
Large employers like the chemical companies, that have self-insured plans can keep them, he said. They will be grandfathered.
For people who don't use computers, the Insurance Commission will create an 800 number and arrange for local "navigators" who sit down with people one-on-one and help them navigate the new exchange. There will be paper applications.
"Lots to do before all this can happen," Samples said.A marathon, not a sprint
What does Samples want to tell West Virginians at this point? "Three things.
"First, don't panic. There's a lot of misinformation out there. People need to educate themselves, sift through all the information and misinformation."
Second: "This is the start of a long process. It's a marathon, not a sprint."