State officials hope the way West Virginians view health care is undergoing a major change.
Since Medicaid, the U.S. social health care program for low income families and individuals expanded under the Affordable Care Act, West Virginia - one of only two states in the southern United States that chose to expand Medicaid - enrolled the second-highest number of people of any state in the nation since September 2013.
Karen Williams of Charleston, West Virginia, has a full house. When the retired pre-school administrator has time between her husband, three children, a grandson, her mother who lives up the street and four pets, she volunteers to help people sign up for health care through the Affordable Care Act.
Williams says her family always had good health care, but when her kids got older, the story changed.
“My son was a college student and there were many semesters when he did not have health care insurance," she said. "My daughter was still in college, had not graduated, did not have health care insurance,.
Both of Williams’ daughters have taken advantage of Medicaid expansion in West Virginia. For 29-year-old Jocelyn, a student who works two part-time jobs, Medicaid offers peace of mind.
“I was recently in a car accident also, and if I did not have it, it would probably be a totally different story of what the bills would look like and who they would go to and everything,” Jocelyn said.
Brandon Merritt with the West Virginia Center for Budget and Policy says there were an estimated 270,000 uninsured West Virginians before Medicaid expansion went into effect January 1.
“The majority of them are working and they just did not have access to health insurance through an employer and did not qualify for any sort of public assistance program like Medicaid prior to the expansion,” he said.
Merritt said an estimated 130,000 of West Virginia’s uninsured were expected to qualify. Medicaid expansion applies to anyone ages 19 to 64 that make less than 130 percent of the federal poverty line - about $33,000 for a family of four. Previously, a family of four could had to make less than $8,300 annually to qualify for Medicaid.
West Virginia has enrolled nearly 154,000 new individuals into their Medicaid programs - second in the nation. The Federal Centers on Medicare and Medicaid numbers show almost 509,000 West Virginians have health insurance under one of the two programs.
But funding remains an issue.
A study commissioned by Governor Earl Tomblin projected Medicaid expansion would cost the state $375 million for the first six years after 2020, when federal government funding for new enrollees drops to 90 percent. Officials say they are not sure where that money will come from, but Tomblin said the costs would be greater if they did nothing.
According to Department of Health and Human Resources Deputy Director Jeremiah Samples, West Virginia will need to figure out how to keep costs down. Samples also said West Virginians need to see health care in another way, taking advantage of preventative care instead of waiting until a trip to the emergency room forces them to address a health issue.
“Unless there is a change in culture and a change in the way people approach managing their health, then the coverage or the health insurance will not matter," he said. "People need to take some personal responsibility and then we will start to see those population health statistics improve.”
Although it is too early to see the true effects of Medicaid expansion, Charleston Area Medical Center, the largest hospital system in the state, recently reported their uninsured population has declined from seven percent to around one percent.
Karen Williams said this is the perfect opportunity to change health care in West Virginia.
“We were always told we were the most obese, we had the highest rates with diabetes with, the cancer statistics - we can go one and one," she said. "But this may be the turning point.”
This story was funded by the Hearst Foundations and administered by the International Center for Journalists in Washington, DC.