Vote Smart's Synopsis:

Vote to pass a bill that establishes a West Virginia Patient Protection Program to provide health insurance coverage for individuals with high-risk medical conditions.

Highlights:

• Establishes the West Virginia Patient Protection Program as a reinsurance program to provide payment to health insurance issuers for claims for health care services provided to eligible individuals with expected high health care costs for the purpose of lowering premiums for health insurance coverage offered in the individual market (Article 53, Sec. 3).

• Requires the Commissioner of Insurance to do all of the following when establishing the program (Article 53, Sec. 3):

• Examine the state’s historical experience with the West Virginia Health Insurance Plan high-risk plan, reinsurance programs in other states, and other information sources that they consider instructive; 

• Consult with health care consumers, health insurance issuers, and other interested stakeholders; and 

• Take into consideration high-cost health conditions and other health trends that generate a high cost. 

• Prohibits a health insurance policy issuer from imposing a pre-existing condition exclusion and from denying enrollment to any individual on the basis of a pre-existing condition (Article 53, Sec. 9).

• Authorizes a policy issuer to (Article 53, Sec. 9):

• Restrict enrollment in a health insurance policy to open enrollment and special enrollment periods in accordance with this bill; 

• Impose an affiliation period on any health insurance policy that is not provided through the individual market provided that said affiliation period does not exceed 90 days and does not apply to emergency services; and 

• Use other alternatives approved by the Commissioner of Insurance to address adverse selection. 

• Establishes the State Commission on Health Care Continuity and will have the objective of identifying state or federal policies to replace the tax credit authorizes in the Patient Protection and Affordable Care Act (Article 53, Sec. 2).

Full Bill Text