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But hospitals in general consider the next two or three years to be an area of increased demand for services because of the number of people that are likely to be insured. But all of the people coming on to the insurance rolls—it’s going to cost money. Who’s going to pay for it? Typically, in the past health insurance companies as well as the government have asked that it come out of the rates to hospitals and to doctors in the future.
So in the short term, we’ll probably see increased demand; in the long run, probably a real downward pressure on financial performance in the hospitals and physicians’ practices.
KEVIN JOHNSON: It’s important for people to remember, too, that there’s help out there. In the hospitals we have people that are being trained and certified as navigators for the system. There is help out there for people, and if they’ll seek it—go to the hospitals, go to the broker community, whoever it is that can help them understand how to navigate the system—they can learn how to access the healthcare marketplace, what subsidies are available and what options are available.
BOSWORTH: I can add to that, with a simple solution of dialing 211. 211 is a health and human service line, and we have navigators on tap as well as certified application counselors. We have a longstanding reputation of connecting people to different types of healthcare with our phone service.
Perhaps the biggest healthcare issue facing the governor and our legislature is whether to expand the Medicaid program or not. What are the pros or cons you see in expanding Medicaid in the state?
SPERRY: In the end, it comes down to a philosophical position of what you think is the proper role of government, rather than an economic argument per se. There are a number of people who don’t qualify for any kind of healthcare at work. They don’t have enough money to purchase through the exchanges. If they receive some help there, that may mitigate some of that. There’s a certain segment of society that would benefit personally from Medicaid expansion. The downside is that it will cost the state some money. True, up front the federal government will bear the lion’s share of that, but no guarantees that’s going to continue into the future.
There are some people who are just outright opposed to the concept of government providing that kind of subsidy just based on personal philosophical reasons. It’s difficult to get a rational discussion going on this because it is a personal philosophical issue for so many people.
BARLOW: The thing we need to remember is these are vulnerable populations, and there is the reality of a mandate with a penalty, albeit not large the first year. So we do have a donut hole and if we don’t expand it, what do we do with that population that’s already quite vulnerable and now has additional consequences for not having coverage? So you could argue either side of it. Without an alternate option for those in that donut hole, we need to do something to maintain that constituency base, because they are facing some new consequences they never had before, yet still not accessible coverage without that expansion taking place.
LANGELL: What we’re going to see happen is what happened similarly to Medicaid coverage for transplantation: We’re going to see part of these populations migrate out of states that don’t expand Medicaid to the states that do, so that they can get their coverage.
The long-term impact of that is going to be interesting, because we may see that the young population who’s on their upward trajectory—that human capital that’s going to be working in industry—maybe migrating out. The states that don’t do this may lose that capital and other states are going to gain from it. So there’s a business aspect of this that isn’t often thought about.
BATEMAN: I’d sum it up like this: There’s a case to be made that expansion of the Medicaid safety net would advance community wellness. I’ve seen studies that seem to assert that. And I’m all for that.
I’m not, however, interested in seeing expansion of governmental-provided services in terms of healthcare that serves to crowd out the private market. Most of the hospitals in this state are concerned about that. I sort of end up in the middle of the road, thinking that the proposal advanced recently to the governor that includes a premium subsidy to people at a certain level of the federal poverty limit and, at the same time, partially expands Medicaid is probably the right approach that stimulates the private market, allows that to continue to flourish—and at the same time, advances the welfare of those people that need those services, and probably will be helpful in terms of advancing wellness to everyone in the community.