West Virginia: Heart of the Rx Belt

Health care is a funny thing.  Everyone needs it, yet lots of people can’t afford it, and hospitals have to treat them regardless.  Treatment prices vary wildly depending not only on where you live but where you go and whether or not you have insurance.  Oddly, those without insurance are almost always charged more for the exact same treatment than their insured counterparts.  Meanwhile, physicians earn handsome sums of money to treat someone after they’ve gotten sick or injured but are paid peanuts to keep that person from getting sick in the first place — quite a perverse incentive there, right?

And a new report out this week adds another level to the mystery — doctors in certain parts of the country prescribe way more medication than doctors in other parts of the country and it has seemingly nothing to do with the health of their patients.

As it turns out, West Virginia sits right in the heart of what could be called the Prescription Belt.  Or maybe it should be the “overPrescription belt.”  Coming on the heels of the recent study finding that West Virginia leads the country in the rate of overdose drug deaths, it’s time to acknowledge we have a very serious issue in our state.

Rx BeltSource: The Dartmouth Atlas of Medicare Prescription Drug Use, October 2013. http://www.dartmouthatlas.org/

The study by the Dartmouth Institute for Health Policy and Clinical Practice examined prescription trends of Medicare Part D recipients around the country.  In other words, these are Medicare patients over 65 years old who have prescription drug coverage.  The map above shows the average number of prescriptions filled in a one-year period per beneficiary by region of the U.S.  You can see that the average beneficiary in the dark-red areas receives between 52 and 63 thirty-day prescriptions in a year, while those beneficiaries in the light beige receive about 39 to 46 prescriptions per year.  As you can see, West Virginia sits almost entirely within the dark red, as does much of Appalachia.

Your first thought, like mine was, is probably that this is largely explained by health status.  We know that West Virginia has higher rates of obesity, diabetes, cardiovascular disease (the list goes on) than most of the country so it makes sense that our elderly population requires more treatment.  The researchers thought to look at that as well and found that health status only accounts for about 30 percent of the variation in prescription rates, leaving 70 percent medically unexplained.

The researchers found that there was little variation across regions in the treatment of specific conditions like a heart attack where certain medications would be the standard of care. However they did find distinct differences in prescription patterns of “discretionary” and “high-risk” medications.  This includes prescriptions like proton pump inhibitors (like Prilosec) and anti-depressants (like Prozac or Zoloft, shown in the figure below) that may have serious side effects or be ineffective or potentially harmful for certain patients.  On the whole, West Virginia saw much higher than average prescription rates for these types of medications than other areas of the country.

antidepressantsSource: The Dartmouth Atlas of Medicare Prescription Drug Use, October 2013. http://www.dartmouthatlas.org/

Above Figure: Percent of Beneficiaries Receiving an Antidepressant Prescription (SSRI/SNRI)

While this study is looking at a very narrow population, seniors with Medicare Part D, there is no reason to think that this over-prescription pattern doesn’t hold up across all ages in West Virginia.  We already know that the Mountain State leads the U.S. in prescription drug deaths, and now we have quantifiable evidence that physicians here are prescribing significantly more medicines than physicians in other parts of the country. 

But why? And what do we do about it?

Shutdown Costs Keep Adding Up

As stories of the cost of the federal government’s shutdown and its impact on citizens come to light, here’s what it means for individuals, businesses, and the state of West Virginia.

Toll on Citizens

We have all heard the shutdown affects “non-essential” programs, but what does that mean? Programs that provide nutritional assistance for pregnant and post-partum women, infants, and children, and funding for Head Start and home energy assistance, for example, no longer receive federal funding. Instead, they must have that portion of their budget offset by the state or suffer immediate cuts which would harm West Virginians already living in poverty.

But individuals receiving services are not the only ones at risk. Many federal employees working in West Virginia,  such as correctional workers, must take unpaid leave or work without pay due to the shutdown. These lost wages mean workers struggle to afford gas, groceries, and other essentials, pinching pennies to make ends meet.

Impact on Business

The shutdown’s impact on individuals is just part of the story. With wages frozen, workers are spending less, leaving small businesses across the nation reeling. Secondary businesses that serve or contract with the government have already begun feeling the aftermath of the shutdown.

Cost to West Virginia

West Virginia has made up for the federal funding loss for “non-essential” programs with state funds. The good news here is West Virginians are still able to receive assistance from vital programs. However, this impact is likely to worsen as West Virginia and other states become less able to fill the funding gap caused by the shutdown. Similarly, when small businesses take a hit from the shutdown, so too does the state. Just as the loss of wages impacts businesses through decreased spending, when small business revenues fall, state revenue falls leaving the state is expected to do more with less.

The Bottom Line

The government shutdown is not turning off the lights on government; it is the equivalent of a financial earthquake leaving states to pick up the rubble.

West Virginia Tops the List of States Benefiting from Obamacare

Budget Beat – October 11, 2013

Under Obamacare, West Virginia, along with Michigan and Kentucky, will see 81 percent of its currently uninsured residents receive some sort of assistance in getting health insurance, either by qualifying for Medicaid or tax-subsidies in the Marketplace. Of the estimated 270,000 West Virginians without health insurance, about 219,000 of them will qualify for assistance. Read more in Brandon’s blog post.


More From Evidence Counts, the WVCBP Blog

Wanted: ideas on how to prepare West Virginia for the decline of coal production in the southern part of the state. Ted’s blog post explains how one West Virginia leader is calling for a plan.

A top ranking that we’d like to change is West Virginia leading the nation in prescription drug overdose deaths. Investing in our communities is one way to fight the problem which has grown 600 percent since 1999. More in Brandon’s blog post.

graduates-sm.jpgWorkers with higher education rates enjoy lower unemployment and higher wages than those without. One way to help those workers who don’t have the advantage of education is to provide career pathways, a concept Sean explains here. An estimated 260,000 workers in West Virginia would benefit from this program.





On October 28, Ted Boettner will be a speaker at the Synergy 2013 conference in Bridgeport, WV. The conference is sponsored by EnergizeWV and ANGA (America’s Natural Gas Alliance). The event will give the WVCBP an opportunity to educate industry representatives on the proposed Future Fund and how natural gas production can work to help the communities where it is taking place. His presentation will also include tax and budget issues involving the natural gas industry. WVCBP Executive Director Ted Boettner explains the Future Fund at the Bright Future Conference last month

West Virginia Tops List of States Benefitting from Obamacare

West Virginians rejoice!  Rarely does our Mountain State top national rankings on good measures, but a report out this week shows that West Virginia, along with two other states, leads the country in the percent of uninsured state residents who will qualify for health insurance assistance due to Obamacare. Now, before you let your initial partisan reaction get the best of you, take a moment to consider the map below:


Source: “Eligibility for Assistance and Projected Changes in Coverage Under the ACA: Variation Across States.” Robert Wood Johnson Foundation, October 2013. Map via ThinkProgress.org: http://thinkprogress.org/health/2013/10/09/2756641/gop-govs-medicaid-obamacare-subsidies/

West Virginia, along with Michigan and Kentucky, will see 81 percent of its currently uninsured residents receive some sort of assistance in getting health insurance, either by qualifying for Medicaid or tax-subsidies in the Marketplace.  This is not small news.  Currently, there are an estimated 270,000 West Virginians without health insurance.  Based on this report, around 219,000 of them will qualify for assistance which is a pretty big deal since cost is overwhelmingly the number one reason why the uninsured don’t have health coverage.

The flip-side of this is a state like Texas, where only 34 percent of its currently uninsured residents will receive any sort of assistance, and that will strictly come in the form of tax credits on the Marketplace since Texas Governor Rick Perry opted not to expand Medicaid, purely in an effort to defy President Obama.  Texas leads the country in the number and percentage of uninsured state residents, where more than 25 percent of Texans don’t have health insurance, including an embarrassingly high 17 percent of children! Perry’s decision not to expand Medicaid in a state with over six million uninsured residents, 1.7 million of whom earn less than 138 percent of the Federal Poverty Level and would therefore qualify for expanded Medicaid, means that 1.7 million Texans, nearly the entire state population of West Virginia, will be too poor to qualify for assistance.  Yes, you read that right, these people will be too poor to get assistance from their government.

Fortunately, we don’t live in Texas and we have a governor and state legislature who were able to look beyond the Obama in Obamacare long enough to see that expanding Medicaid was both the right thing to do for our most vulnerable West Virginians and the economically smart thing to do for the state and its labor force.

Cheers to being on top of a good national ranking!

Moving Toward an Energy Transition

The Charleston Gazette had another timely editorial on Monday (I’ve been out of town all week) urging West Virginians to embrace the state’s changing energy economy by creating solutions for the ongoing transition.

As the chart below highlights, coal production has declined markedly over the last decade while natural gas is at unprecedented levels. As we’ve discussed before, these trends will continue in the coming decades as the economic (and political) power of the state shifts to the northern part of the state  – where gas production will continue to boom and coal will still be an important player, unlike the southern part of the state where coal is declining rapidly and shale development is materializing more slowly. 


In a recent article in the Martinsburg Journal, West Virginia Commerce Secretary Keith Burdette stated:

“We want to take the products and create added value products,” he said. “We do not want West Virginia to be an energy colony. We want to make the products here. We want to take advantage of this opportunity this time, which we’ve missed other times.”

Burdette is absolutely right. If the history of West Virginia has taught us anything, it is that natural resource extraction does not exactly go hand-in-hand with a shared prosperity. That’s why it is so important that we have adequate taxation of our mineral resources, a plan for when they run out, and a idea for how to ensure a just transition as coal declines.

Overdose Deaths Out of Control in West Virginia

A report out this week finds that West Virginia leads the nation in prescription drug deaths.  This may be unsurprising as many of us know someone who has fought addiction to pain-killers, but what is surprising is that overdose deaths in West Virginia have increased by more than 600 percent since 1999! This is an issue that has reached epidemic proportions and the answer is investing in our children through better education and health, not building more prisons.

The report from the Trust for America’s Health shows that West Virginia leads the country in overdose deaths. Obviously this is not something to be proud of in any way, shape or form but as fanatic as we Americans are over sports, we have a tendency to take any opportunity to chant “We’re number 1!” and inevitably some false sense of pride takes over.

drug overdose mortality

Figure: Drug Overdose Mortality 2010. Source: Trust for America’s Health: “Prescription Drug Abuse: Strategies to Stop the Epidemic”

However, we really need to frame it like it is – West Virginia is the worst in the country at controlling prescription drug abuse.  And this isn’t some sort of statistical anomaly either.  It’s not like we’re comparing the average number of fingers per person across states where the difference is hardly perceptible but since it’s a ranking there will always be a 1st and a 50th.  West Virginia has a rate of 28.9 deaths per 100,000 people, that’s over 500 deaths a year in West Virginia due to prescription drug misuse, nearly 50 percent more than the number of people who die in car accidents in the state!  Meanwhile, North Dakota, with the lowest rate in the country, has 3.4 deaths per 100,000 people, or one-eighth the rate in West Virginia. Clearly, something is wrong.

At this point it would be very easy to pile on to all of the other health and well-being statistics where we’re also the bottom of the barrel — things like obesity, smoking, chronic heart disease, diabetes, lack of physical activity — and chalk it up as “just the way it is.”

It may be the way it is today but it isn’t the way it always has to be.  There are clear steps that we must take as a state to get ourselves out of these messes.  We must invest in our future by focusing on good quality education, by focusing on creating a broad range of jobs in new sectors not dependent on a single dying industry, by focusing on health by building safe communities with parks and playgrounds and walkable sidewalks.

The key here is investment. Investing in the future of this state requires time, effort, and money.  Better schools and healthier communities don’t come from cutting corporate taxes. Yet, surprise! More business will come to West Virginia when we have a healthier, better-educated workforce.

Instead of building better schools though, we’re building more prisons to house the drug addicts. Instead of creating better substance abuse treatment policies, we’re cutting mental health funding to save money in the short term.

Obviously these steps have lead us nowhere. Isn’t it time for less “instead” and more invest?

260,000 Workers in West Virginia Need Better Skills and Wages

Unlike in the past, in today’s economy, higher education is very important to finding a good paying job. Workers with higher levels of education have higher wages and lower unemployment rates, as do the states with more workers with higher education. One strategy to help low-income and long-term unemployed workers is through the creation of career pathways. Career pathways are connected education and training services that expand access to post-secondary education and training for these workers.

The Center on Wisconsin Strategy and the Center for Law and Social Policy have created state profiles to estimate the number of adult workers in each state who are in need of better jobs and wages, and who would benefit from a career pathway. Each state profile estimates the number of adult workers (ages 25-64) who are without two- or four-year college degrees or have limited English skills and who earn less than the state median wage or are in the labor force but have not worked for the last year. And West Virginia is one of the states that would benefit the most from a stronger career pathway.

According the the profile, 39.4% of West Virginia’s workers need better skills and wages, the 13th highest percentage among the states. An estimated 263,531 workers in the state fit the profile. Most of those workers fit the profile due to low wages. 60.3% earned poverty-level wages, while 33.5% earned above poverty-level wages, but below the state’s median wage.



Most of the 263,531 workers who would benefit from a stronger pathway only have a high school education. Only 27.8% have some college education, while 15.0% have no high school diploma.


In addition, 55.7% of the workers are women, 7.6% are minorities, and 53.8% are below the age of 45.

Thousands Sign Up for Health Care

Budget Beat – October 4, 2013

stethoscope_dr_pad.jpgThousands of West Virginians signed up for health care as open enrollment for the Affordable Care Act kicked off this week. Have questions about how it all works? Brandon’s OpEd in the Daily Mail answers many questions about Obamacare.

In Case You Missed It

This week the WVCBP released Giving West Virginia’s Workers a Raise: Increasing the State Minimum Wage which outlines reasons why an increase is long overdue. As state policymakers focus on decreasing the number of children living in poverty in West Virginia, helping to provide a higher wage to working families is an important step. It’s time for West Virginia to join the other 19 states that have raised the wage instead of waiting for federal action.

West Virginia ranks worse than most states in terms of the number of women who live in poverty. Sean’s blog post cites a Center for American Progress report which measures women’s well-being in three categories: health, economics and leadership.

Several Kanawha County mayors have spoken out against the proposed school excess levy that would fund the county’s library system. What will your tax bill look like if the levy is passed? Find out here.


The State of Women in West Virginia

Last month, we released our State of Working West Virginia report, which looked at how workers in West Virginia are faring. Taking another perspective, the Center for American Progress released its State of Women in America report last week, which analyzes how women are faring in all 50 states. The report measures women’s well-being in three categories: economics, leadership, and health and looks at thirty-six factors within those categories. The thirty-six factors are shown below:



According to the report, women on average are faring the best in Maryland, and the worst in Louisiana.

Overall, the report ranks West Virginia 25th in well-being for women, with a grade of C.

West Virginia ranks 34th for economic security, with a D grade. West Virginia ranks worse than most states for the percentage of women living in poverty, hurting its economic security score.

West Virginia ranks 30th for leadership, with a grade of C-. Only 16% of the seats in the legislature are held by women, while women only hold 39% of management jobs.

West Virginia ranks 24th for health, with a grade of C. Unlike other states, West Virginia does not have laws stripping access and funding to Planned Parenthood and other health care providers, and West Virginia is moving forward with Medicaid expansion.

How Much is Kanawha County’s Proposed Library Levy?

Kanawha County is getting set to vote on a proposed school excess levy in order to fund the county’s library system, which recently lost the financial support of the county school district.

The proposal would increase the school excess levy from 29.82 cents  to 45.9 cents per $100 for class II properties, and from 59.64 cents to 91.8 cents per $100 for class III and IV properties. According to the Charleston Gazette, this would equal a $125 per year increase for property owners with a $100,000 house and $15,000 in vehicles.

Several mayors in Kanawha County have spoken out against the proposal. Chesapeake’s mayor called the proposed increase “incomprehensible” noting that Kanawha County would be the only county with two school excess levies, while Belle mayor Buck Chestnut is opposed to the proposal because, “Most of our people are senior citizens and don’t have children in school anyway.”

But how big of a deal is Kanawha County’s proposed increase, compared to the rest of the state?

First, while it’s true that Kanawha County would be the only county with two school excess levy rates, in practice, it’s not that big of a deal. As the Gazette article notes, the proposal would lift the current cap on the school excess levy, allowing it to increase up to the maximum amount allowed under state law. So while there would be two levies, together they would equal the maximum rate of 45.9 for Class II property. And 21 other counties already have set their excess levies at the maximum rate.

If the proposal passes, Kanawha County’s rural district rate would be 125.64 cents per $100 for Class II property. While that’s higher than it was before, it’s still lower 8 other counties in the state, including neighboring Putnam.

So what would a typical tax bill in Kanawha County look like compared to the rest of the state if the proposal passes? Before the propsal, Kanawha County’s rural district rate is 109.56 cents per $100 for Class II and 219.12 cents per $100 for Class III. Statewide, the average levy rate for class III property, property outside of municipalities, was 219 cents per $100. This would make the class II rate for property outside a municipality 109.5 cents per $100, since class III rates are simply twice that of class II rates (average municipal rates aren’t separated out in the Tax Department data). So current Kanawha County rates are right at the state average.

That makes the proposed rate in Kanawha County about 15% higher than both the state average and the current rate, but as I mentioned earlier, still lower than eight other counties. So in the proposed scenario in the Gazette article, the taxpayer with the $100,000 house and $15,000 vehicles would pay $854 under Kanawha County’s current rate, which is roughly the same as the state average, and about $980 under the new proposal, a difference of $126, or just about what the Gazette reported.

As for seniors, whom Mayor Chesnut expressed concern for, the difference would be smaller, due to the Homestead Exemption. Seniors claiming the Homestead Exemption, again with the $100,000 house and $15,000 vehicles, would owe $635 before the proposal, and $729 after, for a difference of $94. And I think it goes without saying that you don’t have to have a child currently enrolled in school to realize the benefits of an educated population.