About a week ago a group called West Virginians for Affordable Health Care held a workshop in Shepherdstown to explain how the new federal Affordable Care Act will be implemented in West Virginia.

This was one of a half dozen such workshops the group is holding around the state. Due to scheduling difficulties, I was only able to catch the last half hour of the four and a half hour meeting. But I talked with several of the participants and presenters afterwards and was able to pick up some of the flavor of the meeting. And much of what was presented I already knew, as it involved the actions of the legislature this year to apply the new federal law to our state.

I know two of the presenters, Perry Bryant and Renate Pore, quite well. They are both well-versed on health care and true experts on the subject.

The Affordable Care Act calls upon each state to implement at least one “health exchange,” through which people who have not been able to afford adequate health insurance in the past can purchase it at an affordable price. The federal law guarantees the result but many of the operational details are left to each state. States may even co-operate with each other in developing and operating the exchanges.

Only a half-dozen states have passed laws implementing the new federal law within their borders. West Virginia became on March 12 the second state after California to do so.

The legislature assigned the responsibility of developing our exchange system to the office of the Insurance Commissioner. Jane Cline, our insurance commissioner for the last several years and a strong advocate of the Affordable Care Act, left that post shortly after the Legislature acted. But the work to set up the exchange was already in the hands of Assistant Insurance Commissioner Jeremiah Samples, who is in my view one of the brightest people in all of state government.

The Insurance Commissioner is to report to the legislature in January and recommend at least one plan to set up our exchange(s). We may get more than one option.

A number of folks have asked me if there might be a so-called “public option” as part of West Virginia’s exchange system. This would be a government-run entity competing with private sector providers. The idea is that the public option would keep the private sector providers from overcharging.

The public option was seriously considered when the federal law was passed, but was not included in the Affordable Care Act because the votes could not be found. At the zenith of its support, only 58 U.S. senators were willing to vote for the public option, including one Republican (Olympia Snowe of Maine). Three Democrats – Ben Nelson of Nebraska, Mary Landrieu of Louisiana and Blanche Lincoln of Arkansas – told their leaders that they would never vote for the public option under any circumstances. In the 100-member U.S. Senate, 60 votes are needed to pass anything because it takes that many votes to cut off debate.

We have a similar situation in the West Virginia House of Delegates. It was difficult to pass the exchange law we did because a significant number of Democrats joined most of the Republicans in opposition to doing anything. They want the U.S. Congress to repeal the whole thing. Under those circumstances it would be very difficult to get a public option passed.

Personally I favor what is called “single-payer” health care. That’s the Canadian system. The private sector provides the care and the government pays the bills. But I don’t think it’s realistic to hope for even a public option, much less single-payer.

Both of these ideas are falsely called “socialized medicine” by some of their detractors. Neither is socialized medicine. That term is properly applied to the British system and the health care system I had while I was in the U.S. Army. Under these systems providers are employees of the government.

Apparently about two-thirds of Americans mistakenly believe the public option was included as part of the Affordable Care Act. This bit of information comes from a health reform survey done by the Henry J. Kaiser Foundation.

This survey also discovered about that many Americans believe that so-called “death panels” (committees to determine whether or not to cut off someone’s health care) were made part of the federal law (they were not). And that many think that all businesses, even the smallest, will be required to provide health care to their employees. Again, not true (that’s one of the reasons for the exchanges).

The law does prevent insurance companies from denying coverage for pre-existing conditions and prevents them from having lifetime caps on coverage. It also guarantees that children may remain on their parents’ coverage until age 26. And it closes the so-called “donut hole” over time. The donut hole is a gap in guaranteed coverage for drug costs of seniors. They get full coverage for the first $2,840 in drug costs and for anything above $6,448, but are not covered for anything in between. Beginning this year there’s a mandated discount (50 percent on brand-name and 7 percent on generic) in the hole, and the hole eventually goes away entirely.

The Affordable Care Act requires all Americans to buy health insurance, but it provides subsidies for low income folks to help pay for it. About 30 million Americans now without health insurance will have it. This will I believe result in lower health care costs for the rest of us who already have health insurance, because the market will be bigger by those 30 million souls.

West Virginia has a higher percentage than the nation of people without health insurance as well as a higher pecentage of people with inadequate health insurance. Our state particularly needed the U.S. Congress to pass the Affordable Care Act and I’m glad the legislature stepped up to the plate on this issue.