Hospitals in West Virginia increasingly point to “payer mix” as the explanation for shrinking services and financial strain, arguing that heavy Medicare and Medicaid enrollment forces them to rely on higher commercial prices and special regulatory protections. But that claim has become a policy argument more than a financial reality. This paper examines what the numbers actually show, using audited financial statements, payer-specific margin data, and public reporting from the state’s dominant systems.
The findings challenge the story West Virginians are often told: PEIA functions more like a commercial payer, commercial margins drive system profitability, and the state’s largest systems show substantial liquidity and positive operating performance even as rural services disappear. The takeaway is straightforward: payer mix should not be used as a blanket justification for higher prices, reduced accountability, or policies that block competition.