Budget Beat – April 25, 2014

Report Calls on Governor to Restore Budget Cuts

In a report released this week, the Our Children Our Future campaign called upon Governor Tomblin to restore budget cuts to vital family support programs. In March, the governor vetoed over $1 million in funding to programs that help prevent domestic violence, provide in-home visiting and much more.

The cuts are a mere 0.02% of the state budget and do little to offset the tens of millions in tax credits provided to businesses each fiscal year. In fact, the cuts will kill jobs as Family Resource Centers and other facilities are forced to cut back on services and reduce staffing.

Read more in the Charleston Gazette, the State Journal and the Beckley Register-Herald.

2014 Budget Cuts report cover

A Regional Look at Fracking

As part of the Multi-State Marcellus Collaborative, the WVCBP studies the impact of gas drilling on communities and the state budget. Read this National Journal article for more on how states in the Marcellus Shale region are looking to each other on how to respond to the continuing fast-paced growth in the industry.

Paid Sick Days Benefits Workers, Employers and the Community

More than 260,000 West Virginia workers are not able to take a paid sick day when they are ill. Requiring employers to provide this benefit would not only reduce business costs, it would help West Virginia create a healthy workforce. 40 million workers nationwide lack this basic protection and most affected work in low-wage service sector jobs. Read more in Alyson and Sean’s blog post.

War on Poverty

Poverty rates remain high in West Virginia as the nation marks the 50th anniversary of President Johnson’s War on Poverty. In its coverage of this milestone, the Morgantown Dominion Post cited the WVCBP’s report released last year on how ongoing poverty impacts West Virginia’s children and families.

On the Run

Not one but two WVCBP staff members competed in marathons this past week. Outreach Coordinator Alyson Clements ran in the Boston Marathon and Health Policy Analyst Brandon Merritt in the Kentucky Derby Marathon. Inspirational!

Alyson in marathon 4.21.14

Alyson in the Boston Marathon on 4/21/14 (she’s in a blue t-shirt in the center of the photo, across the yellow lines)

Brandon in marathon 4.19.14

Brandon in the final stretch of the Kentucky Derby Marathon on 4/19/14

West Virginia Needs a Healthy Workforce – Paid Sick Days Can Help

West Virginia is one of the least healthy states in the country. With the implementation of the ACA, roughly 270,000 more West Virginians have access to medical care. This increase in health care services is a huge step toward a healthy state, but access to medical care is only one piece of the puzzle.

Every day workers are faced with the impossible choice of going to work sick or staying home, losing pay and risking job loss. If they choose to go to work sick, their health suffers, contagious illnesses spread, companies lose productivity, and both health care costs and the cost of doing business rise. If they stay home, they put their economic security at risk. Just three and a half days of missed work because of illness is equivalent to an entire month’s groceries for the average family. This is enough to give any sick worker pause.

With this in mind, many states are taking steps to give workers more security with the introduction of paid sick day laws, allowing workers who fall ill to get healthy without jeopardizing their livelihood. While Connecticut is the only state that currently requires paid sick days, a number of  municipalities have passed local ordinances requiring them, including Seattle, WA; Portland, OR; Jersey City, NJ; Newark, NJ; and Washington, D.C. In addition, bills have been introduced in Washington, South Carolina, Nebraska, Maryland, Illinois and other states. In 2014 there were more than 20 active paid sick day campaigns across the country.

More than 260,000 workers in West Virginia, nearly half of its private sector workforce, are not able to take a paid sick day when they are ill, while 40 million workers nationwide lack this basic protection. While workers at all ends of the wage spectrum are affected by a lack of paid sick time, those affected are heavily concentrated in low-wage service sector jobs.

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Workers, businesses, and communities in West Virginia all stand to benefit from the implementation of a paid sick day law. Workers without paid sick time are more likely to go to work sick, and employers bear the cost of the lost productivity that results—a cost that may well exceed that of providing paid sick time. In 2006, nearly 4.4 million hospital admissions in the U.S., costing $30.8 billion, could have been prevented with timely medical care or adequate patient self-management. But workers without paid sick leave have to chose between working while sick, potentially worsening their illness, or missing a paycheck.

West Virginia has taken major steps recently to protect the economic security of its workers, from Medicaid expansion to raising the minimum wage. But access to health care means little if a sick worker can’t afford to miss work, and a better wage doesn’t help workers who lose their jobs because they can’t get well. A law ensuring that workers have the ability to earn paid sick time would allow workers to stay healthy and meet their responsibilities at work without compromising their economic security.

Budget Beat – April 11, 2014

Wetzel County Not Seeing Same Impact from Natural Gas Drilling as Neighboring States

West Virginia, Ohio and Pennsylvania are undoubtedly at ground zero when it comes to the gas drilling boom created by fracking in the Marcellus Shale. A new report out this week, however, shows that Wetzel County has felt the gas boom differently than counties in its neighboring states.

The Multistate Shale Collaborative, of which the WVCBP is a member, released a group of case studies this week at that look at the impacts of gas drilling including housing needs, effects on roads and infrastructure, strains on education, increases in crime and more.

The story in Wetzel County is that there really isn’t a story. While gas drilling has certainly increased dramatically, it hasn’t transformed the county’s economy. Unemployment remains high, and the main impact on county services has been an increase in heavy truck traffic. Read the Wetzel County case study.

Read more in the State Journal and the Wheeling Intelligencer.

multistate_shale_logoC2

West Virginia Gets a “C” in Transparency

Tax cuts and credits are often touted as a way to attract businesses and create jobs in West Virginia. Is it working? With little transparency in the process, it is impossible to know. This week West Virginia received a “C” for transparency in government spending, in particular on the data it makes available on economic development subsidies. Read more in this Charleston Gazette article.

West Virginia’s Top Medicare Billers

A step toward more transparency hit the news this week as the Centers for Medicare and Medicaid Services released data on Medicare payments made to doctors across the country. Check out Brandon’s blog post to see the top recipients of Medicare dollars in West Virginia.

Climate Change and the Highlands: What’s at Risk?

Learn about climate change directly from scientists who are studying how it’s likely to affect the West Virginia highlands. The West Virginia Allegheny Highlands Climate Change Impacts Initiative is hosting a conference at Blackwater Falls State Park June 6 – 9, 2014. Register here or sign up for updates. The impressive list of speakers and presenters includes many West Virginia natives.

Williamson RailyardPhoto by Beth Spence

Coal’s Clout Endures

Coal plays a big role in discussions of climate change. It also remains a big player in West Virginia’s politics, despite the projected decline of the industry and coal production. Read more in this piece from Bloomberg BusinessWeek.

West Virginia’s Top Medicare Billers

The Centers for Medicare and Medicaid Services (CMS) announced the release of a bunch of Medicare data today, the biggest release in CMS history, in fact.  The data include information for nearly 900,000 distinct health care providers across the country who received over $77 billion in Medicare payments in 2012.  This is the second big step in Medicare transparency in the past year as this release comes on the heels of last May’s release of the cost of the most common in-patient procedures at every hospital around the country.

What makes these data so interesting and potentially useful is that they include payment information broken down by individual physician and the services they provided. 

The Wall Street Journal has a neat user-friendly database of the top 200 providers in each state. Playing around with the data shows a few noteworthy trends in West Virginia.  For example, five of the 10 providers who received the most Medicare payments were ambulance service providers.  This was led by the Kanawha County Emergency Ambulance Authority, which received $6.3 million in Medicare payments. Of individual providers, we’re able to see that the physician in West Virginia with the most Medicare payments was Dr. Craig Morgan, an ophthalmologist in Huntington who received almost $5 million in Medicare reimbursement.

Table 1: The 20 health care providers, by type, in West Virginia receiving the most in Medicare payments in 2012

Top 20 Medicare Providers in WV

Ophthalmology and oncology are the two medical specialties receiving the most Medicare dollars in West Virginia, in line with national trends. Specialties that, as the Wall Street Journal notes, were singled out by the inspector general of the Department of Health and Human Services urging greater scrutiny of doctors receiving large Medicare payments. In all, fourteen physicians in West Virginia received more than $1 million in Medicare payments in 2012.

Table 2: These 20 physicians received the most in Medicare payments in West Virginia in 2012

Top 20 Medicare Physicians WV

While it’s important to recognize that this is simply raw data and there is no context of patients’ diagnoses or reasons for treatment, it’s a huge step forward in providing consumers (and researchers) more transparency. It should also help push physicians to reconsider low-value, high-cost procedures or to choose cheaper, generic alternatives instead of costlier brand name drugs.

Budget Beat – April 4, 2014

Governor Tomblin Signs Minimum Wage Bill into Law

Nearly a month after the end of the 2014 Legislative Session, Governor Earl Ray Tomblin signed into law legislation to raise West Virginia’s minimum wage to $8.75 an hour by 2016. Raising the minimum wage will give a raise to over 120,000 working West Virginians, boost the state’s economy and help reduce poverty in the state.

While the governor was making his decision, misguided business interests tried to derail the bill in the 11th hour. The WVCBP worked with legislative leadership and coalition allies to ensure the governor would sign the bill. In case you missed it, articles appeared in the Charleston Daily Mail, Wheeling Intelligencer, Charleston Gazette. Here’s Ted and Alyson’s blog post countering claims from business groups that the bill would be bad policy.

On another front, Senate President Kessler and House Speaker Miley urged the governor to sign the bill and cited WVCBP data in their letter to him.

While this is great news for West Virginia workers, there is also a national effort to raise the wage even higher to $10.10 an hour. This campaign made its way through Charleston on Wednesday. Read more in the Charleston Daily Mail and Charleston Gazette.

Alyson minimum wage bus 4.2.14WVCBP’s Alyson Clements led the effort to bring a higher minimum wage to West Virginia (Charleston Daily Mail photo).

Budget, and All Its Cuts, Also Becomes Law

The day is almost here when we write that check to pay off our state income taxes. Well, not all of us. Many corporations pay zero in state taxes, jumping through loopholes that put West Virginia’s budget into the red this year. Read more here from West Virginia Public News Service.

Tax cuts often lead to budget cuts and the FY 2015 budget has its share. Here’s Sean’s blog posts which give a quick look at how the budget turned out and where the governor’s vetoes were felt.

ACA Enrollment Continues to Rise

The number of West Virginians signing up for health care under Obamacare went up in March as the deadline to sign up loomed. More on the numbers in this Charleston Gazette article. As of April 1, 104,827 West Virginians had signed up for coverage under Medicaid alone.

Hopefully the number of West Virginians signing up for health care will help turn around the state’s ranking as one of the nation’s most unhealthy. Brandon’s blog post looks at county-by-county results which show the state’s poorest counties tend to be its most unhealthy. Pleasants County is the state’s healthiest, while McDowell remains its least healthy.

While Obamacare enrollment numbers continue to rise, the ACA still has its opponents. Check out Brandon’s blog post for rebuttals to some of the lingering arguments against the Affordable Care Act.

Policy in Print

Many state employees enrolled in PEIA can now switch their children’s coverage over to CHIP, saving both their families and the state money. This change is in large part due to WVCBP policy recommendations made to Governor Tomblin last year. Check it out on the cover and page two of this year’s PEIA benefit guide

PEIA coverage guide

Call for A Summer Research Associate

The WVCBP is currently accepting resumes for its summer research associate position. This year’s project will focus on tax and budget research and the revamping of the primer “Guide to the State’s Budget” which was originally published in 2008. If you are interested, or know someone who is, please forward their resume to lframe@wvpolicy.org.

Ted at funders conference 4.2.14This week in Athens, Ohio, WVCBP Executive Director Ted Boettner checks out a 3-D printer at the Appalachian Funders’ Conference this week.

And, Finally

In case you missed it, the New Yorker ran this amazingly comprehensive piece putting in perspective the politics behind January’s chemical spill, lobbyist control over the state legislature and how the state is evolving politically and why. Chemical Valley: The Coal Industry, the Politicians and the Big Spill is worth your time and written by someone who’s lived here. The piece also mentions the WVCBP’s proposal of a Future Fund to diversify the state’s economy.

Hopping Over The Affordable Care Act

While I appreciated reading a column this week by Hoppy Kercheval about the ACA, I was disappointed to see him recycle the same arguments that have been disproved for months now.

Hoppy’s biggest concern is how we’re going to pay for Medicaid expansion in the future. He points out that the actuarial estimates showed that over 10 years West Virginia will take in $5.2 billion in federal funds while having to spend an additional $375 million in state dollars. What he doesn’t consider is the impact of all that additional money on the state’s overall economy. Many states that debated Medicaid expansion did a study on the economic impact of expansion (unfortunately, Governor Tomblin never requested one) and in most states that did them, it was determined that there would be a net economic gain. Next-door neighbor Kentucky, for example, found that expanding Medicaid would save the state $800 million over the next eight years. This is because the increased federal and state dollars will create permanent jobs, an estimated 16,700 of them in Kentucky alone, which generates significant economic activity and tax revenue that otherwise would not exist. Using Kentucky as a guide for a little napkin math, I previously estimated that West Virginia could see the creation of over 6,500 jobs and a net positive economic impact of over $40 million per year. Put another way, it would cost West Virginia more money not to expand.

Another concern of Hoppy’s is that the federal government will renege on its promise to fund 90 percent of the Medicaid expansion in the years ahead. However, there is no historical precedent in which the federal government has backed out on a legal promise to states to fund programs.  Had something like that ever happened, especially at this scale, it may be a reasonable argument, but otherwise it sounds little different than “I don’t want to take this new, better job because I may get laid off one day.”

Hoppy’s next concern is that “there is no guarantee that providing people with free health insurance…will encourage people to make price-conscious decisions about their care.” This ignores the fact that uninsured people who get sick or injured are forced, by default, to make the least price-conscious decisions possible. If you are uninsured, you will be unlikely to afford preventive care but that doesn’t mean you won’t seek care when your condition gets so bad you really need it. Many of these folks enrolling in Medicaid today have conditions like diabetes which can be effectively controlled at a much lower cost with regular care than being forced to wait until they go into diabetic shock and show up in an ER via ambulance.

There’s a related point to be made here that lack of price transparency, arguably one of the biggest problems in American health care, makes it difficult for anyone to make price-conscious decisions. Very rarely will anyone, whether that’s your doctor or your insurer, be able to tell you in advance how much a particular visit or procedure will cost. Imagine going to a restaurant with no prices on the menu and neither the waiter nor the chef are willing or able tell you how much your dinner will cost until they send you a bill in the mail weeks later. You’d have quite a hard time making price-conscious decisions without that information, but that is the very frustrating reality in which we currently live.

Hoppy’s next concern exemplifies the disingenuous tactic that opponents of the ACA often use which is to point out historical problems with our health care system and suggest they are somehow related to the ACA.  He states that West Virginia has a provider issue. While this is both true and false, most importantly it is nothing new.  First off, when you look at the state as a whole, we actually have a higher rate of primary care physicians than most states while we also have the highest proportion of Federally Qualified Health Centers in the U.S. (Hoppy acknowledges both of these, which contradicts his opening statement).  The bigger point though is that provider access issues are highly localized. This is just as true across the country as it is in West Virginia. For example, Ohio County has a ratio of one primary care doctor per 632 residents, ranking it one of the highest in the entire U.S., while Clay County, with only one primary care physician per 4,679 people, is much lower than the national average. But this issue of provider shortages in rural or underserved areas has been acknowledged for decades. It could be argued that these issues may be exacerbated as more people gain health insurance but it could also increase the number of providers willing to practice in underserved areas as more people in the community can pay for care. And even if it were true that we don’t have enough providers, is the acceptable course of action limiting the number of people who can afford to access those providers?

None of Hoppy’s concerns that he expresses here are anything new, they are all issues that have been addressed and disproven across the country.  Are there consequences to expanding Medicaid? Certainly there are some, but the evidence has shown that they are greatly outweighed by the benefits, both for the economic health of our state and the physical (and financial) health of its residents.