“It certainly opened my eyes,” said Kain. “It was the first time I'd heard it.”
Job seekers who choose to limit their options to states with Medicaid expansion will rule out employers in roughly half the country, though that may change.
New Hampshire last month agreed to Medicaid expansion and Virginia may follow suit.
States are not required to expand Medicaid after the U.S. Supreme Court struck down a penalty to enforce expansion. Nearly half of states rejected expansion, leaving 5 million uninsured adults ineligible for coverage, by one Urban Institute estimate.
States that did expand coverage reduced the number of uninsured residents by 3.6 million between September and March, a new RAND estimate said. The newly insured gained access to primary and preventive care, and one recent study of Oregon's early Medicaid expansion suggested they are using it.
Primary care visits and prescription requests increased by 35% and 15%, respectively, among newly insured Oregonians, researchers reported last fall. Meanwhile, hospitals have gained insurance revenue for poor patients who could not otherwise afford care. “There is so much that's hanging in the balance,” Kain said. “You end up with such different marketplaces.”
In addition, top executive turnover could make an already challenging recruiting job more difficult for health systems in non-expansion states. Last year, one out of five hospital executives left their jobs.
Kain's experience could be an outlier. So far, no other job candidates working with Tyler have refused to work outside of Medicaid expansion states, Kain said. Other recruiters surveyed said they had not heard of job seekers rejecting work in non-expansion states. “It's not affecting our candidate pool,” said Heidi Leeds, a healthcare recruiter for Korn Ferry who largely works with Medicare and Medicaid health plans.
Recruiters with physician and executive search firms Cejka Search and B.E. Smith agreed.
Rulon Stacey, the newly appointed president and chief executive officer of Fairview Health Services in Minneapolis, said Minnesota's Medicaid expansion was not a factor when he considered the job. “Public policy has been a menace to our industry for a century,” he said. Executives are hired to meet the challenge of any policy circumstance, he said. “We manage around whatever the public policy is,” he said. Stacey joined the six-hospital Fairview from the University of Colorado Health, which operates four hospitals across Colorado, a state that has also expended Medicaid.
But Kain's encounter also could be the tip of a newly forming iceberg ahead for healthcare recruiters. “We'll see if it really develops,” he said.