On cue, the data is starting to roll in regarding the impact of Medicaid expansion enabled by the Affordable Care Act (ACA). We’ve heard the political arguments, for and against, leading up to the implementation of this particular feature of the ACA, some with apocalyptic overtones. Now that we’re getting actual data on this policy matter, politicians can run, but they can’t hide.
The Colorado Hospital Association (CHA) and its Center for Health Information and Data Analytics released a report earlier this month that was important. It found that significant changes emerged in the states that expanded Medicaid in the 1st quarter of 2014 compared with those that didn’t. There was a 3.5% increase in Medicaid revenue, on average, in expansion states and at the same time the percentage of self-pay patients decreased by 1.6%. The average charity care per hospital decreased from $2.8 million to $1.9 million, or an approximate 33% decrease. In non-expansion states, the percentage of hospital Medicaid revenues did not change; self-pay patients increased slightly, and average charity care per hospital increased by 10%. I suspect that the evidence will continue to grow that demonstrates the positive impact of Medicaid on the financial health of our rural hospitals.
State hospital associations in non-expansion states have concentrated on ways to expand Medicaid, yet keep it politically separate from the specter of “Obamacare. These “Rube Goldberg” proposals--“complicated structures which perform simple tasks in indirect, convoluted ways”—create elaborate models even though the evidence suggests the traditional, simpler Medicaid program is working.
For example, today the Kansas Hospital Association announced its plans to fight for Medicaid expansion during the 2015 legislative session, after the November elections. The report goes on to say “the legislation being drafted by the hospital association will be tailored specifically to Kansas, though it will borrow elements from so-called private sector expansion proposals in other states.” Presumably like the structure created in Arkansas.
In North Carolina, another non-expansion state, the debate has been directly linked to hospital closures. In fact, a Republican mayor of Belhaven, NC is calling for Medicaid expansion in that state in order to throw a lifeline to the now closed Vidant Pugno Hospital. Mayor Adam O’Neal is urging Republican legislators in NC to take the Medicaid expansion and save his town’s hospital; he said “without Medicaid expansion, it will be difficult to make a rural hospital work.”
I was at a meeting of the Mississippi Hospital Association in early June and heard a presentation of state hospital association executives from AR, SC, AL and MS discuss the lengths to which they are having to go to bring expansion to their states, all with the aim of getting the benefits of Medicaid expansion without the Governor being criticized for supporting “Obamacare.” Which brings me back to Rube Goldberg.
The evidence will continue to roll in as time goes on making it harder to deny that the Medicaid expansion works. In the meantime, how many hospitals will close (there have already been 21 rural hospital closures since Jan., 2013) and lives lost before the picture is crystal clear? You can run from the evidence, but you can’t hide.