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Friday, July 12, 2013

When States Reject the Medicaid Expansion, They Hurt Hospitals Too

Amy Traver

Staff Writer

A few weeks ago, the Washington Post ran an article about Grady Memorial Hospital in Atlanta, Georgia, and some tough decisions it is confronting related to financial strains it anticipates and services it may have to cut because Georgia’s governor has rejected the Medicaid expansion.

Grady Memorial is a cornerstone of Atlanta’s health care system. It trains 25 percent of Georgia’s doctors, it is home to one of two Level 1 Trauma Centers in Atlanta, and it serves more than 600,000 patients annually. Grady provides more care to the uninsured than any other hospital in the city, making it Atlanta’s leading safety net hospital.

Safety net hospitals serve a disproportionate share of low-income patients, who are more likely to be uninsured and unable to pay for the care they receive. For years, as part of the Medicaid program, states have made payments to safety net hospitals to make up for unpaid bills. The federal government contributed more than $11 billion to those payments in 2012.

In addition to requiring that states expand Medicaid, the Affordable Care Act reduced state payments to safety net hospitals. The Medicaid expansion would provide health coverage for millions of low-income uninsured Americans, leaving hospitals with significantly fewer unpaid bills and making these payments less necessary.

But the Supreme Court decision that made the Medicaid expansion an option for states changed that calculation. In states that do not expand Medicaid, a large number of citizens will remain uninsured, meaning safety net hospitals will still be on the hook for unpaid medical bills. The only difference will be that they will just receive much lower payments to help cover those costs.

That’s why safety net hospitals like Grady Memorial in states where the governor has rejected the Medicaid expansion are contemplating service reductions. These service cuts will certainly hurt low-income, uninsured patients who depend on safety net hospitals for care. But the cuts will hurt other state residents too. Safety net hospitals are often the leading teaching hospitals, trauma care providers, or burn centers in a state. They are often the places where all residents turn for critical care.

Accepting federal dollars to expand Medicaid helps ensure that all state residents will have an opportunity to get health coverage. It also makes for a stronger health care infrastructure for everyone. If your state has not made the decision to expand Medicaid, it’s not too late. States can take up the Medicaid expansion at any time. Contact your state representatives today and tell them that you support expanding health coverage through Medicaid. You can find your state representative’s information by looking up their website or the phone number for your state house.