21 states have not (yet) chosen to expand Medicaid; one can (and I have) argued that this is nonsensical at best, as
- the Feds are paying for ALL of the additional cost for another two plus years, and
- the vast majority of the cost (90% +) thereafter; and
- the savings to the states for uncompensated care would be anywhere from $4 to $9 billion;
- health care providers in non-expansion states are in dire straits due in large part to the “non-expansion.”
My sense is the non-expansion states will eventually decide to accept the Medicaid deal as the financial cost to hospitals and health systems will force them to. And, the Feds will work with the states to create different models that will be ideologically palatable, providing cover to those politicians obsessed with such things.
But until – and unless – Texas, Florida, Virginia, Wisconsin and the rest expand Medicaid, there’s a raft of problems created by their principled if (in my view) wrong-headed position.
Mostly, these problems are due to two things. Over the short term, the cost pressure placed on facilities and health systems and the fallout therefrom will lead to increased pressure to cost shift – and yep, work comp is a pretty soft target.
And long term, the 6.4 million adults who remain uninsured will be less healthy, have more incentive to get care under workers’ comp, and heal more slowly with more complications if they do get injured on the job.
What does this mean for you?
For work comp payers, nothing good.