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Reform Ramifications

Evan Sweeney, for HealthLeaders Media, July 14, 2010
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Reported by Elyas Bakhtiari on June 4.

States to pay little for Medicaid expansion

Although most of the coverage expansion under the Patient Protection and Affordable Care Act will come from adding to the Medicaid rolls, state governments will not have to spend much more on the program thanks to funding from the federal government, according to analysis from the Urban Institute for the Kaiser Commission on Medicaid and the Uninsured.

Enrollment in Medicaid will increase nationwide by more than 27% between 2014 and 2019, the study predicts. However, state spending on the program will inch up only 1.4%, while the federal government increases spending 22% to cover the cost.

Some of the states with the lowest coverage levels today will get the most bang for their buck. Alabama will see 53% reduction in the number of uninsured patients thanks to the Medicaid expansion, and the federal government will cover 96% of that cost. Texas, which also has a high number of uninsured patients, will see nearly a 50% decrease in its uninsured and pay only 5% of the cost of expansion.

Although the impact will be less in states with low levels of uninsured patients, the financial burden will be even smaller. Massachusetts, for example, already has the lowest percentage of uninsured residents in the country, so the Medicaid expansion will only result in a 10% reduction. However, the federal government is expected to pay for 100%, and state spending on the program may actually decline 2%.

State outreach may ultimately determine the success of the expansion and the financial burden local governments have to bear. A more aggressive outreach and enrollment campaign could lead to much higher coverage numbers, researchers said. The baseline prediction of a 15.9 million increase in Medicaid enrollees could jump to 22.8 million, under what researchers dubbed the "enhanced outreach scenario."

Reported by Elyas Bakhtiari on May 27.

Increased demand hikes safety concern

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As the initial waves of the newly passed healthcare reform law begin to ripple out, safety committee members should consider how the changes could affect environment of care and occupational health concerns.

"To the extent you believe the healthcare reform law will increase the demand for services, it could certainly have the effect in the near term of straining the resources of hospitals—[and] that would affect [managers] who are overseeing the safety and health of employees," says Bradford Hammock, partner at Jackson Lewis, LLP, a law firm in Reston, VA, where he heads the workplace safety compliance practice group.

The law will provide coverage to about 32 million uninsured people and offer tax credits to about 4 million small businesses to help cover the cost of insurance for their employees.

"You have overcrowded emergency rooms right now," says James Blair, FACHE, president and CEO at the Center for Healthcare Emergency Readiness in Nashville. "You're going to make 30 million people eligible [for insurance]. They won't be coming hat in hand."

Some individuals who believe they have a right to medical care—"and that's what the rhetoric has led everyone to believe, that everyone in America is covered," Blair says—may be difficult to physically control when they find out at the ER that they have to wait until certain provisions for covering the uninsured kick in over the next four years.

Hospital security expert Fredrick Roll agrees. "I think a greater number of folks will show up and push for their 'entitlements,'" which will up the ante for workplace violence in medical centers," says Roll, president and principal consultant at Healthcare Security Consultants, Inc., in Frederick, CO.

Others aren't so sure about a long-term increase in ED visits. "Once everyone gets their arms around it...folks won't be coming to the ER with stomachaches," says Randall Snelling, chief physical environment officer at DNV Healthcare, Inc., a hospital accrediting group based in Cincinnati.


Evan Sweeney is an editorial assistant at HCPro. He manages and writes for Briefings on Infection Control, a monthly newsletter directed at IC compliance. He also blogs for OSHA Healthcare Advisor, a resource center for infection control and safety professionals, and regularly contributes to Medical Environment Update and OSHA Watch, which focus on healthcare employee safety and health.

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