West Virginia recently decided to expand Medicaid but of course, it didn't happen overnight.
Medicaid expansion comes from the Affordable Care Act, passed in 2010. The act originally mandated all states to expand Medicaid but the U.S. Supreme Court struck down that provision.
According to the Washington Post, 20 other states and the District of Columbia have expanded Medicaid and 14 are planning to reject it.
The topic of Medicaid expansion has been studied in West Virginia.
Families USA and West Virginians for Affordable Health Care released a report in February, saying if West Virginia expanded Medicaid, the state would create 6,200 new jobs and generate $664 million in economic activity by 2016.
The report also stated West Virginia would receive an additional $721 million in federal Medicaid funds.
The report acknowledges that some states have expressed concerns that expanding Medicaid would increase their costs.
"While there will be some costs for states, they may not be as large as states believe. Furthermore, there are offsetting savings in addition to increased state revenue," the report states.
Additionally, the report continues, in 2017, the state will begin pricing up a percentage of the costs of covering the new population
In a previous interview, Bill Freedman, a partner out of Cincinnati's Dinsmore office, said Medicaid is the single largest budget item in 49 states and the act would allow the federal government to pay a majority of costs for a fixed number of years.
However, states would be left to pick up the burden after that time limit expires. Not only that, Freedman said, Medicare eligibility would be expanded to include anyone whose incomes is less than 130 percent of the federal poverty level. Currently, only those who are disabled or earn less than 150 percent of the federal poverty level are eligible for Medicare.
Later, 18 West Virginia delegates and senators sent a letter March 30 to Gov. Earl Ray Tomblin, asking to expand Medicaid.
The letter was signed by Sens. Jeff Kessler, D-Marshall; William Laird, D-Fayette; Ron Stollings, D-Boone; Ronald Miller, D-Greenbrier; Jack Yost, D-Brooke; Rocky Fitzsimmons, D-Ohio; Herb Snyder, D-Jefferson; Donald Cookman, D-Hampshire and Larry Edgell, D-Wetzel and Delegates Don Perdue, D-Wayne; Stephen Skinner, D-Jefferson; Meshea Poore, D-Kanawha; Barbara Fleischauer, D-Monongalia; Mike Manypenny, D-Taylor; Margaret Anne Staggers, D-Fayette; Clif Moore, D-McDowell; Nancy Peoples Guthrie, D-Kanawha and William Hartman, D-Randolph.
In their letter, legislators said expansion to 138 percent of the poverty line under the Affordable Care Act would cover 120,000 uninsured West Virginians.
"Though it will not be easy to offer health care to 120,000 working West Virginians, we pledge to work with you to make the program a success," they wrote.
The Medicaid expansion is expected to cover 91,000 additional West Virginians, according to Jeremiah Samples, health policy director with the West Virginia Insurance Commission.
Legislators also wrote that expansion would be good for the state's businesses and medical workers, citing the Families USA report.
"Furthermore, we hear from business owners everyday who support this program for a host of reasons," the letter continued. "Small business owners see this as their best chance to make sure their workforce is healthier and better able to keep a job. And big businesses want to make sure that if they are paying into Medicaid, that their workforce will see the benefits."
Legislators continued, saying businesses will save thousands of dollars from expansion because they will be exempt from the Affordable Care Act tax.
"Medicaid Expansion would reduce that financial burden on hospitals greatly. … By providing working West Virginians with insurance, it encourages them to seek better help earlier, and more inexpensively," the letter states.
There also have been concerns.
Some state leaders are concerned about the total cost, which they estimate to be $375.5 million from the 2014 fiscal year through 2023.
According to a handout state officials passed out at the May 2 Medicaid expansion announcement, the state's share will be about $5 million a year in the first three years.
However, by 2020, the state share increases to $65 million, so state officials say West Virginia must "find secure, long term funding streams" for that portion of the expansion cost.
West Virginia Attorney General Patrick Morrisey also expressed concerns about the expansion.
"As someone who participated in the legal and legislative efforts to overturn this law, I am deeply concerned that Obamacare and this expansion will have a very negative impact on economic growth in our state and nation," Morrisey said. "That's not what we need as federal spending slows down and places even greater pressure on West Virginia to kick start economic growth."
Morrisey additionally said paying for the expansion could be difficult.
"While paying for the state's portion of this expansion will be daunting enough today, does anyone really believe that the federal government will maintain its same level of Medicaid funding in the future when it is staring at a $16 trillion debt and desperately needs to reduce spending? The federal matching rate for existing West Virginia Medicaid payments has been dropping in recent years as the infusion of monies from the stimulus law went away. Why do we expect that the federal government will maintain a 90 percent matching rate?"