By Peg O’Connell, Chair, Care4Carolina
How do I love thee, Medicaid Expansion? Let me count the ways…*
I love thee for the 600,000 people in North Carolina’s coverage gap who will finally have an affordable option for health insurance for themselves and their families;
I love thee for the stability that you will bring to our rural hospitals and healthcare system;
I love thee for the big cupid’s arrow to the heart you will give to our state’s economy by drawing down billions of dollars in federal funding that are currently going to other states;
And now I love thee for a new reason—you will help our state’s healthcare providers by boosting their financial performance and improving their payer mix.
Love is complicated and the issues of provider financial performance and payer mix (that means how and by whom, hospitals, doctors and other health care professionals get paid) are also complicated but are very important components in the larger discussion around Medicaid Expansion.
The Kaiser Family Foundation recently published an issue brief which summarized a variety of studies over several years looking at how provider financial performance and payer mix were impacted in state’s that expanded Medicaid. The short answer is that things got better—even during the pandemic. And things got especially better for our rural hospitals and providers.
The study findings were divided into two topic areas: the impact on payer mix and providers’ financial performance.
The earlier studies indicated that Medicaid expansion was associated with improvements in payer mix for hospitalizations, emergency department visits, community health center visits, and safety-net clinic visits. The payer mix improvements include noted declines in uninsured patients and increases in Medicaid-covered patients.
These studies also found that Medicaid expansion was tied to lower uncompensated care costs overall and for specific types of hospitals, including rural facilities.
According to Kaiser, findings from more recent studies revealed that Medicaid expansion improved the financial performances of hospitals and healthcare providers.
These studies found that expanding Medicaid helped boost hospital revenue overall and for specific services. Some studies also suggested that Medicaid expansion helped reduce the number of annual hospital closures. However, outcomes varied by provider type and some studies indicated that financial performance improvements were greater for rural and small hospitals.
Considering that North Carolina has lost six rural hospitals in the past 9 years and seen a recent acceleration in the closing of clinics in rural areas, expanding Medicaid expansion is becoming absolutely urgent for our 80 rural counties.
There are many reasons to love Medicaid Expansion and to work for its enactment. The folks at the Kaiser Family Foundation have just given us a big Valentine bouquet full of new reasons to expand Medicaid now!
*With all apologies to Elizabeth Barret Browning.
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