As Congress considers repealing the Affordable Care Act, health professionals in Kentucky, Ohio, and West Virginia grapple with what that might mean for a region where many depend on the law for access to care. This occasional series from the ReSource explores what’s ahead for the Ohio Valley after Obamacare. See more stories here >>
Since the expansion of Medicaid under the Affordable Care Act, the health care sector has grown by more than 19,000 jobs in the Ohio Valley region. And some economists who focus on health care policy are warning that many of those jobs could well hang in the balance as Congress considers changes to the Act.
One of the ACA’s effects in the Ohio Valley region has been to sharply reduce costs for what’s called uncompensated care — that’s the cost of caring for the uninsured.
Dustin Pugel is an economist at the Kentucky Center for Economic Policy, a nonpartisan research center. He said in Kentucky’s rural hospitals there’s been about a $150 million decrease in uncompensated care costs just in the first quarter after Medicaid expansion. He worries that if the ACA is repealed more people will lose their health insurance, and hospitals will have to cover that cost again.
“We would definitely see hospitals getting squeezed more and more, and that would be devastating for their budgets,” Pugel said.
Pugel said Medicaid expansion payments more than made up for the loss of what are known as disproportionate share hospital payments — the other method by which hospitals were reimbursed for charity care. Those payments from the federal government used to make up for the cost of caring for the uninsured but largely were phased out when more people became insured.
Pugel said even when those payments went away hospitals were still better off because they were getting more money from newly insured patients.
Those changes to hospital finances allowed them to expand programs and add personnel.
“In the first few years of medicaid expansion in Kentucky there were 13,000 hospital jobs alone that grew in the state. Whereas before it was flatlined,” Pugel said.
Pugel said if the ACA is repealed a lot of those people will likely lose their jobs. Kentucky could have the second highest rate of job loss, with estimates of almost 56,000 jobs being eliminated. West Virginia could lose 16,000 jobs by 2019. Ohio stands to lose more than 50,000 jobs if the ACA is repealed.
Kat Stoll is with the West Virginia Center on Budget and Policy. She said West Virginia doesn’t have the room in its state budget to pick up the cost of covering hundreds of thousands of people who would lose their health insurance if Congress moves forward with the repeal of the ACA. She said sick people still get sick, but without insurance they will put off seeking care until it is an emergency, which is usually more costly.
“People will die and the people who do get treatment will put a tremendous burden on our hospitals and providers in our rural state,” Stoll said.
West Virginia gained about 6,500 healthcare jobs since the state expanded medicaid in 2014.
A number of competing plans have emerged in Congress that might replace some or all of the ACA. Stoll said the replacement plans she has seen leave a lot to be desired.