Public Employees Insurance Agency health coverage was, in 2018, the focus of the first statewide public school workers strike in West Virginia history.
The teachers and bus drivers halted ongoing cuts to the coverage. But, instead of giving them the long-term funding solution many called for, Republican Gov. Jim Justice and the GOP-controlled Legislature gave them a temporary reprieve.
They committed more than $100 million more to PEIA, and the moratorium on cuts looks like it will last at least through mid-2022. That will mark four years without premium increases or benefit cuts.
“I don’t know how it gets any better than that,” Justice said Friday, “because I don’t know where in this country anybody that has insurance doesn’t have their health insurance go up over the past four years.”
“PEIA is sound,” he said.
Yet premium increases are projected after mid-2022. Justice’s PEIA Rainy Day Fund can help offset this, but expense increases for PEIA that could total tens of millions of dollars annually may break through that dam.
A PEIA premium increase hammer will likely fall sometime after the Nov. 3 election, unless that longer-term funding solution is found.
Justice’s PEIA Task Force was supposed to work on that. That was part of a promise that helped end the strike.
“We’re going to appoint a task force right off the get-go and we’re gonna dig into PEIA and try to look for solutions and a permanent fix to PEIA,” Justice said in early 2018.
But the group hasn’t met since January of 2019.
The West Virginia a few years from now could greatly resemble West Virginia before 2018: PEIA reserve funds exhausted, annual coverage cuts kicking in, employee anger rising, rumblings of a strike, lawmakers focused on more business tax breaks and history repeating itself.
Current Republican House of Delegates leaders’ last, and quickly scrapped, major proposal to address PEIA’s cost wasn’t additional state funding.
It was to charge workers more to have their spouses covered by PEIA if those spouses had insurance that they could pay for through their own employers.
In all, the future of the program that provided so much to families, like David Wills’, remains in doubt.
David said he started working for the state in 1995, allowing him to buy PEIA coverage for his wife, Angie, himself and their child. He’s extremely grateful for the coverage provided by PEIA.
He said that, two years later, PEIA paid for surgeons to remove the ectopic pregnancy the couple had hoped would be their second child.
He said PEIA paid for Angie’s pap smear, taken just before that surgery, that revealed cervical cancer.
He said PEIA paid for surgeons to remove Angie’s uterus, cervix, an ovary and fallopian tubes.
After recovering, Angie began working for the state herself.
David said that, a few years later, PEIA paid to stick a needle through Angie’s stomach, into her liver — finally revealing, where other tests failed, the source of her new pain. She now had cancer in her liver.
He said PEIA paid for surgeons to operate on her, finding a tumor too large to remove; it paid for chemo; paid for later liver surgery; paid as she returned to work again; paid for the PET scan showing the cancer had returned, but into multiple organs; paid for the hospital-administered-only, last-ditch drug she reacted badly to; and, finally, paid for hospice staff and oxygen tanks before she died Sept. 29, 2002, at age 35.
She left behind David and their only child.
“If we hadn’t had PEIA, we couldn’t have gotten the care she needed, the care that might have saved her, the care that prolonged her life,” David said. “And if we hadn’t had that, even if the medical professionals would’ve agreed to provide the services and everything on a payment plan, I would probably still owe hundreds and hundreds of thousands of dollars.”
But David is one of about 230,000 people insured by PEIA who have no long-term guarantee that their current cost or coverage levels will persist.
Abandoned task force, successful tax cuts
More than 10% of West Virginians are covered by PEIA, including college professors, public school teachers, principals, school bus drivers, school cooks and school custodians. It also covers many police, firefighters and EMS workers.
It’s not as big as Medicaid, which covers about 540,000 West Virginians on any given day, or Medicare, which has more than 300,000 in its traditional program.
But PEIA still unifies more than 10% of the population with a common interest: the fate of a government program that can mean life or death.
Public school workers started the 2018 strike largely to stop the continued coverage cuts PEIA had begun making after it blew through its reserve funds.
Strikers mentioned other goals, like pay raises. But many stressed that PEIA, whose rising cost was cutting into their salaries, was the primary reason for the walkout.
The nine-school-day-long walkout, which shuttered every public school in the state and filled the state Capitol building with thousands of chanting strikers, ended after Justice promised several things.
One was to provide enough short-term funding to temporarily freeze PEIA coverage at its current level. That happened, and the freeze has lasted a few years now.
The other was to appoint the PEIA Task Force to work on long-term funding solutions amid rapid medical cost inflation nationwide.
Justice’s chief of staff, Mike Hall, chaired the group. It included school union leaders, the state Senate president, the speaker of the House, West Virginia University officials, private insurance company leaders, and others.
It hasn’t met since January of 2019.
And last year, while Republicans provided more than $100 million to help shore up PEIA, they also cut coal severance taxes.
That was projected to reduce annual revenue by roughly $60 million. A majority of Democrats in the House joined Republicans to pass these cuts.
Lawmakers also rejected strikers’ calls to increase natural gas severance taxes.
The legislative session earlier this year was a mostly quiet, pre-election affair featuring bipartisan education legislation and base-pleasing bills like one promoting Bible classes in public schools.
But more than halfway through the session came a twist.
Attempt to charge for covering spouses
House leaders, including Speaker Roger Hanshaw, R-Clay, supported House Bill 4043.
Generally, it would have charged roughly $300 monthly premiums for spouses of state agency, college and public school employees to be covered by PEIA.
Currently, employees who pay the higher family coverage rate for PEIA can cover their spouses — even if those husbands and wives work for companies or organizations that offer other, perhaps inferior, insurance plans.
The rarely convened House Banking and Insurance Committee didn’t reveal that the bill would be on its Feb. 10 agenda until an hour before it met.
The bill regardless died that afternoon in an 11-11 vote.
Delegate Trenton Barnhart, R-Pleasants, joined all the Democrats in voting no, and Republican Delegates Eric Householder, Patrick Martin and Eric Porterfield missed the vote.
The next day, Delegate Isaac Sponaugle, D-Pendleton, brought up what Republicans had tried to do on the floor of the full House.
Sponaugle commonly delivered speeches in a yell or close to it. This was no exception.
“Fix, and fully fund, P, E, I, A!” he began. “Now we’ve been down here now for five, six years talking about that, over and over and over, the history of that program. We didn’t fix it, we didn’t fund it. All we’ve done is frozen it.”
He recounted how the bill suddenly appeared on the committee’s agenda. He asked whether Republican leaders were trying to “suck up” the 10% average pay raise they recently gave state and public school employees — after pressure from the strike — and give all that money to PEIA.
“If there’s a motion to reconsider [the bill], if there’s a motion to discharge it, if you want to bring the fight out here on the floor, we’ll be more than happy to do that,” Sponaugle said. “Fixing PEIA does not mean kicking the costs down to our public employees.”
Later that day, Joe White, executive director of the West Virginia School Service Personnel Association union and another fan of high-volume speechifying, read off the names of those who supported the bill in a Facebook Live broadcast.
“These folks tried to do you harm — there’s no other way you can spin this,” White told his members.
But, for the rest of the week, it was Porterfield — the Mercer County Republican who infamously made anti-LGBT comments last year — who attracted the most media attention.
He accused Delegate Brandon Steele, R-Raleigh and sponsor of the bill, of accosting him for missing the vote.
Discussion of the actual bill that sparked the argument faded as media reported on Porterfield asking other delegates to punish Steele and — after they declined — Porterfield slowing down the full House’s ability to continue considering bills. Porterfield later apologized.
PEIA had — for just a moment, and only in response to another proposed cutback — re-entered the legislative conversation. And, again, it had fallen by the wayside amid another distraction.
Porterfield lost his attempt for reelection in the Republican primary.
Steele, however, progressed to the coming general election.
But PEIA still doesn’t have a long-term funding solution.
Justice’s challengers pitch long-term solutions
At a January American Federation of Teachers gubernatorial forum, Democratic candidate Ben Salango told the union members in his opening statement that funding PEIA would be a priority.
He stood up from the desk the union had sat him and his challengers at, walked up to the edge of the stage and made his promises. The other two Democratic candidates — Justice wasn’t there — emulated this.
Sometime after the opening statements, the debate moderator asked the candidates about their PEIA funding plans.
“Let me make you this promise,” Salango said. “On Day One, I will call a special session to make sure that we fully fund and come up with a permanent revenue source for PEIA.”
He noted that Republicans were instead filling in holes for the lost revenue from the coal severance tax cuts, while planning more business tax cuts that would reduce annual revenue by another $100 million. Those additional business tax cuts were a Senate GOP priority at the time Salango spoke, but they ultimately failed to pass this year.
“There’s plenty of money out there if they just won’t give it away,” Salango said.
Stephen Smith, former head of an anti-poverty nonprofit, was back then challenging Salango for the Democratic nomination. Smith also offered several funding methods.
But Smith went further, saying “we’re not going to go after just one of these things, or just try to fund PEIA, because it’s not just about working around the edges. We have to fundamentally change who our economy and who our state government works for and is owned by.”
His ideas included fully legalizing marijuana, increasing taxes on those with over $2 million in wealth and resurrecting an idea the 2018 strikers had: increasing the natural gas severance tax.
Smith suggested doubling that tax.
He also suggested reversing Democratic U.S. Sen. Joe Manchin’s business tax cuts, which cut revenue by hundreds of millions of dollars annually. Manchin pushed and signed those cuts into law in the 2000s, when he was governor.
Further, Smith said that “it is not inevitable that health insurance costs have to go up every single year.”
“That is a political choice by the people in that building,” he said, indicating the state Capitol, “and the people in Washington, D.C., to choose pharmaceutical companies and insurance companies over patients.”
“We could actually end the practice of our money, our health care being sold to the highest bidder,” he said. “But only if we take on the insurance companies and the pharmaceutical companies, and we are ready to do that.”
Salango defeated Smith in the primary, 39% to 34%. Salango now faces Justice.
Angie Wills’ daughter is now 27 — past the age allowing her to be on David’s PEIA plan.
David is remarried. He’s got fewer than 15 days until he retires from state government.
But he still worries about PEIA’s future. PEIA also provides retiree health insurance.
He cautioned that he’s no expert, but suggested possibly increasing taxes on extractive industries, like natural gas and timber, and ceasing the push for more tax cuts.
“Discontinuing taxes that can bring revenue into the state and not having a way to replace those funds — wishful thinking doesn’t replace the money,” he said.