Adam Searing With The Georgetown Center For Children And Families On How Medicaid Expansion Is Helping Hospitals And Families

NC Policy Watch

By: Clayton Henkel

In an interview with NC Policy Watch, Adam Searing, co-author of the Georgetown University’s Center for Children and Families report on Medicaid expansion, answered questions about the report and his personal opinion on the topic. He talked about the benefits of Medicaid expansion, how it has improved those states that have implemented it, especially their integration of care, their rural hospitals, and their economic situation. He also mentioned how he believes those states that have not yet expanded have not done it mainly because of political issues, even though they are all allowed to provide and negotiate their own plan with the federal government.

“Well, everybody knows that when you expand Medicaid there are more people that have insurance, and so hospitals and community health centers see a lot more people who can pay their bills. So that’s great. But our report found that that’s just the start. These hospitals and community health centers also are actually changing the health system for the better, now that they don’t have to worry about people not being able to pay their bills.”

“It’s pure politics, I think. There’s no other reason. The policy reasons to expand are just overwhelming; the financial reasons are overwhelming. States, you know, hospitals and health centers in states that have expanded see 20 to 40% drops in people who can’t pay their bills coming through the door. There’s no reason not to do it, it’s just pure politics.”

“Well, the coverage gap is really just another word for the folks who would be helped by Medicaid expansion. If you make over the poverty level wages, in any state, you are able to buy health insurance on, the health exchange, and get substantial tax credits subsidies. If you make under poverty level, under in, North Carolina you know about $17,000 a year for a family of 3, you have no option: you cannot go buy coverage on the health exchange, you do not qualify for the those tax credits, but neither if you are, say a parent who’s making $14,000 a year, neither are you able to qualify for Medicaid coverage. So you just don’t have any option, and those are people in the gap.”

“Well, I think there are two reasons. The first is that they’ve recognized that there every 60% of the people in this gap are actually working, they’re part of a working family, they’re working in jobs like construction, hotel services, restaurant industries, so they see a lot of people who are working in their states who can’t get coverage. That’s the first thing. The second thing is they realized that “Hey, this is a pretty good deal for the state budget, we could actually save a lot of money.” So for instance, Louisiana’s governor is estimating savings in the hundreds millions of dollars, and in a tight budget a year that makes a big difference. So combine those two and you’ve got reasons to expand.”

“Thousands of jobs! There’s different estimates on how much this is, but it doesn’t take a rocket scientist to know that if you have a lot of people who can pay their healthcare bills, there are going to be more people hired. And indeed, when we were talking to these hospitals CEOs and health centers CEOs, they were talking about how many people they were hiring to meet demand in expansion states. And in fact, one hospital CEO told us how he had to let a hundred people go in the hospital he had in the non-expansion state in Missouri, but yet in Arkansas, he could hire a hundred people because he needed more people to deliver care.”

“Well, you know, people complain about fraud and I think the states have gotten better, in recent years, to move towards using computer systems, to using this new technology we have, to make sure that people who really get Medicaid are the people who really need it. I think we’re moving forward on those things. I find it ironic that a lot of the discussion about reforming the Medicaid program in North Carolina now, a lot of the goals that were set, integrating care, making providers work better together, these are already things that are happening in expansion states… providers are just doing it on their own because they have the financial security, and so, since everybody’s covered, they don’t have to shuffle around the people that don’t have insurance. ”

Listen to the full interview here