Manchin: "[West Virginians] live within their means." In reality, the state is #1 in medical debt collections.

Voting to cap Medicare out-of-pockets would do a world of good for West Virginians.

This morning I caught the Washington Post’s Eugene Robinson interviewing Sen. Joe Manchin on Morning Joe, and I was struck by what Manchin had to say about his fellow West Virginians.

Manchin, it appears, is now the biggest, and maybe only, roadblock to the passage of the reconciliation bill, also known as the Build Back Better Act. Among many other things, the bill, which the House reportedly might vote on later today,  would allow Medicare to negotiate for lower prices on some drugs, and it would cap at $2,000 the amount of money Medicare beneficiaries would have to pay out of pocket every year. 

This would represent a big win for millions of low- and moderate income people who have prescription drug coverage but still can’t pick up their medications at the pharmacy counter because of what they have to pay on their own before their coverage kicks in. In many cases, that amount is many times the proposed $2,000 cap. 

Manchin’s constituents would benefit disproportionately because West Virginia has the second highest percentage of Medicare beneficiaries in the nation. Only Maine has a higher percentage. And with an average age of 40, West Virginia has the nation’s oldest population.

Robinson was asking Manchin why he was resisting getting on board with the bill, noting that West Virginia has many hard-working people, a lot of veterans and a lot of poor people, all of whom would benefit from the bill. 

In reply, Manchin told Robinson that what he didn’t mention was that West Virginians “live within their means,” implying that he still considers the amount of money the government would spend on social programs under the BBB to be too high and fiscally irresponsible. 

I know West Virginia fairly well. My parents took me there many times when I was a kid to visit my Aunt Mae Hayworth and her husband Ed and their 14 children. You read that right, I had 14 cousins in and around the coal-mining town of Mullens. Being an only child, our summer trips from the mountains of East Tennessee to the mountains of West Virginia were a highlight of my growing up years. 

Robinson was right. The West Virginians I knew were hard-working people. Uncle Ed and many of my cousins worked in the coal mines. And many of them died young. Sadly, all but one of my cousins are now gone. 

My Aunt Mae, who died at the age of 91 in 2000, outlived Uncle Ed and several of her children. Her longevity was an anomaly in this country – and especially in West Virginia. People in West Virginia have the shortest life spans in the United States. The average age of death in West Virginia was 74.4 in 2018. That compares to the 2018 national average of 78.7 – and to 81 in Hawaii, where Americans live the longest on average.

What Manchin didn’t mention but likely knows is that while West Virginians might try to live within their means, a very high percentage of them struggle to make ends meet –and struggle especially to get the medical care they need and can afford. West Virginia leads the nation in the percent of people with medical debt in collections – an astonishing 27%. This despite the fact that a relatively small percentage of West Virginians – 9.6% – lack health insurance (compared to a national uninsured rate in 2019 of 12.4%). 

The cost of coverage – premiums and out-of-pockets – is especially high in West Virginia. West Virginia is one of 16 states – all of them in the South and Southwest – where employee premium contributions and deductibles exceed 12% of median income. 

That’s partly because West Virginia is the second poorest state in the country in terms of median household income, ranking just slightly above Mississippi. The median household income of $46,711 in West Virginia is far below the national median (in 2019) of $65,712 and half the $92,266 median in the District of Columbia, where income is the highest in the country. And 17.54% of West Virginians fall below the federal poverty level, compared to a national 2020 average of 11.4%, according to the U.S. Census Bureau. 

So Sen. Manchin, I would respond to your comment about West Virginians living within their means by saying that they would love to be able to do that but are finding it increasingly difficult to do. That’s largely because many in your state, including many who are enrolled in Medicare, are having to put far more skin in the health care game than people in other parts of the country. 

Voting for a bill that would cap out of pockets drug costs for Medicare beneficiaries would go a long way toward giving the fine people of your state a shot at living within their means – and keeping the medical debt collectors at bay.