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PPACA, State-by-State: A Q&A with West Virginia Insurance Commissioner Jane L. Cline

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Q: What challenges do you anticipate your particular state running into with upcoming health care reform provisions?

JC: Time and uncertainty are major challenges to implementing the provisions of the Affordable Care Act. For example, on a project like the exchange, there is a necessity for infrastructure development, and this infrastructure needs to be created to meet yet-to-be determined exchange policy decisions and constructed in a public and transparent manner. This is a challenge that each state is facing. Concerning uncertainty, there are a lot of questions still outstanding concerning particular provisions of the ACA. HHS has not had the time to develop a number of rules so states have to make a lot of assumptions in policy models. Regarding uncertainty over the ACA itself, West Virginia is moving forward to implement the law and protect the best interests of our citizens. If the ACA were deemed unconstitutional, the law would be repealed or federal implementation funding withheld, and then the Offices of the Insurance Commisioner would adjust accordingly.

Q: For producers licensed to sell health insurance in your state, what developments might they look out for?

JC: Producers should continue to be constructively engaged in the implementation of the reforms. The reforms anticipate providing health insurance coverage in the most cost-efficient manner; therefore, all components of the premiums are being assessed. We continue to meet with producers to ensure that the services they provide, and the value of those services, are fully understood. To that end, the NAIC has an active working group studying this issue and has passed a resolution pledging its support of the use of producers and the recognition of the value of their services.

Q: What should producers concentrate on the most over the next 10 years with regard to health care reform’s affects in West Virginia?

JC: Producers should remain engaged in the process of helping consumers procure health insurance. In particular, the large number of uninsured West Virginians who will have coverage for the first time will greatly benefit from the knowledge producers have.

Q: Is your state doing anything differently or preparing in any special way for health care reform?

JC: West Virginia was looking at some of the core concepts of the ACA prior to passage of the legislation. Expanding coverage to the working uninsured, expanding access to care, organizing the health insurance market for consumers, collecting population health data, and encouraging personal responsibility of citizens in regards to their health and use of the health system are all areas where West Virginia has been recognized as a national leader, both before and after the passage of the ACA.

Q: What did you get out of President Obama’s 2010 meeting with state insurance regulators?

JC: What I got out of the meeting was that we all want to help the underinsured and uninsured find accessible and affordable health care. It was also nice to see that there was an appreciation and understanding for what state insurance commissioners do to regulate the insurance industry and find solutions for insurance issues in their respective states.

Jane L. Cline was appointed West Virginia insurance commissioner Jan. 15, 2001. In addition to her responsibilities as commissioner, she is a member of the National Association of Insurance Commissioners (NAIC) and serves as the organization’s immediate past president. She was responsible for the transition of the West Virginia Workers’ Compensation Commission from a state monopolistic system to a competitive system.

West Virginia Facts At-A-Glance

West Virginia

United States


Total population



Median annual income



Health costs and budget

Health spending per capita


$5,283 (by state of residence)

Average employee contribution for family premium (% of total premium)



Health coverage

Uninsured population (% of total population)



Uninsured children (% of children)



Medicaid enrollment (% of total population)



Medicare enrollment (% of total population)



Monthly CHIP enrollment, June 2009



Health status

Infant mortality rate (per 1,000 live births)



Teen death rate (per 100,000 population)



AIDS diagnosis rate (per 100,000 population)



Overweight or obese children (% of children)



Adults who visited the dentist/clinic (% of adults)



Adults with disabilities (% of adults)



Source: Kaiser Family Foundation State Health Facts


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