One place, known for its Appalachian Mountains and rich coal supply, was immortalized in John Denver’s 1970s hit, “Take Me Home, Country Roads.”
The other has white sandy beaches, rum distilling and an average January high temperature of 86 degrees that attracts millions of tourists each year.
From economy to climate, West Virginia and the U.S. Virgin Islands are as different as any two places in the United States.
But that hasn’t stopped them from discussing whether to work together to form a health insurance exchange under the federal health care law, say officials in West Virginia and the Virgin Islands.
While no commitments have been made, the potential partnership is notable because it’s a rare example of states and U.S. territories working together to establish an exchange. The Virgin Islands has also had discussions with Puerto Rico, its larger Caribbean neighbor.
The 2010 federal health law requires states to establish an insurance exchange by 2014 or the federal government will do it for them. The U.S. Territories, such as the Virgin Islands and Puerto Rico, have the option of forming an exchange or using the money to expand Medicaid. Under the law, states have the option to work together on an exchange or with the federal government.
Taetia Dorsett, coordinator of the Virgin Islands Healthcare Reform Implementation Task Force, said West Virginia is a logical potential partner because they are already working together on Medicaid. Later this year, West Virginia will begin processing Medicaid claims for the Virgin Islands.
She said the Virgin Islands initially considered partnering with Florida or Georgia on an exchange because those states have large individual health insurance markets, but decided against that because of concerns about what efforts those states would make on an exchange. Both states are part of a lawsuit opposing the health law.
The Virgin Islands needs all the help it can get if it decides to go the exchange route. Last year, the last two insurers writing individual policies for residents pulled out. While the islands bill themselves as “paradise” for tourists, their nearly 30 percent uninsurance rate and high poverty apparently isn’t a draw for insurers.
The partnership between West Virginia and the Virgin Islands first came up after top officials met at a National Governors Association Meeting. The Virgin Islands invited West Virginia officials for a two day visit last spring to talk about Medicaid. The Virgin Islands paid the tab through an $850,000 federal grant. The meetings were held at the oceanfront Wyndham Sugar Bay Resort in St. Thomas.
West Virginia, the Virgin Islands and Puerto Rico each received $1 million federal planning grants to study whether to develop an exchange.
Martha Salazar, an analyst with the National Conference of State Legislatures, said states’ early discussions about teaming up on an exchange have largely gone nowhere. That’s because most states have different insurance laws and carriers. “It makes is a bit more complicated than they hoped for,” she said.
The National Association of Insurance Commissioners in November said it will be difficult for states to share an exchange. A consortium of New England States are working on helping each other, although each plans its own exchange.
Jeremiah Samples, insurance program manager with the West Virginia Offices of the Insurance Commissioner, said that state is studying whether to develop an exchange.
“As part of that research, we are looking at the potential of partnering with states and territories,” he said. “Collaboration between jurisdictions can take two concrete form — sharing of risk pools, which is less feasible for West Virginia and the Virgin Islands to do at this juncture for a multitude of reasons, and the possibility of sharing information technology and administrative functions in the pursuit of lowering cost through economies of scale.”