Modern Healthcare reporters take a deep dive with leaders in the industry who are standing out and making a difference in their organization or their field. We hear from Adam Searing, associate professor at the Georgetown University McCourt School of Public Policy’s Center for Children and Families, who helped advocate for the passage and implementation of the Affordable Care Act. He discusses his predictions for Medicaid eligibility expansion and the arguments for doing so.
Related: Medicaid agencies take on health equity, social determinants
Did you foresee the U.S. Supreme Court ruling that states could opt out of expanded Medicaid eligibility under the Affordable Care Act? What are the main arguments for expansion, and the main arguments against it?
Like most health policy people, I was flabbergasted at the 2012 Supreme Court decision. I didn’t realize that the Supreme Court would make expansion optional for states.
I would say this is probably one of the most closely studied health policy issues in history. The arguments for expansion have grown over the years. At their core is something very simple: If someone is sick or hurt, or gets cancer, they should be able to go to the doctor or hospital and not worry about going bankrupt. And that’s exactly what Medicaid expansion does. It’s health coverage.
The other benefits are a healthier workforce, healthier families and more kids who get coverage.
I think arguments against expansion have narrowed over the years, especially in the face of research on the positive effects. I think those arguments boil down to one: We can’t afford it as a society, whether it’s the federal or state government [paying for it].
And two: There’s an ideological opposition [saying] the government shouldn’t be helping people who can’t get health coverage through their work.
In your role at Georgetown, you follow what’s going on with access to coverage and care nationwide. How could expanding Medicaid eligibility help rural hospitals, in particular, address the challenges they’re facing?
There are many different drivers that rural hospitals have to deal with regarding their expenses. I think hospital administrators are like farmers. I don’t think I’ve ever met a farmer who says, “I’m doing great, I have plenty of money and I’m going to be able to buy that hay baler I need.” They’re going to have problems. And we do have that situation, especially for our rural hospitals.
I collaborate with the University of North Carolina, which has a rural health research program. When you look at its map of rural hospitals that have closed in the last 10 years, you see those hospitals closing are centered in non-expansion states. Seven of them are in North Carolina. They have a lot of financial pressures on them.
So how would expansion make a difference in terms of revenue generated for these rural hospitals and the services they’re able to provide to patients?
I’ve sat down with a lot of hospital administrators in North Carolina, Kansas—a lot of non-expansion states.
First, a lot of people coming through the door of your emergency room, especially at rural hospitals, don’t have health insurance. Medicaid expansion means that many more people walking into your hospital have health insurance, so you can treat them in the way they need to be treated and you’re going to get compensated for that time.
Second, I’ve found from talking with leaders of community health centers and hospitals that there’s an opportunity for more collaboration when the financial picture is better for everyone.
That means you’re not worrying about who’s going to take care of the uninsured or whether you’re sending them to a community health center or the emergency room. When that financial pressure is off, then those institutions can collaborate more effectively.