How the anti-ACA states could wind up degrading care quality

The federal courts struck down differing community standards of care back in the early 1970s. There was a long-held legal theory that a patient in backwoods Alabama should not expect the same quality of healthcare as someone treated by a physician in New York City because of the relative gap in available resources between the two regions. But the country had evolved past such regional differences and citizens expected a national standard of care to be the norm.

As a result, standards of care are the same in Oklahoma City as they are in Washington, D.C. or Portland, Ore. You might find a specialist in one of those cities whose work is considered head-and-shoulders above the rest, but patients expect the average provider in each of those places to possess the same level of skill and competence.

I fear the battle over the Affordable Care Act might change that.

As of today, 25 states will not expand Medicaid eligibility under the ACA, including wide swaths of the South and Midwest. As a result, hospitals in those states won't receive tens of billions of dollars in revenue each year.

A new report issued by Fitch Ratings concluded that this will prompt hospitals in states without Medicaid expansion to seek more efficiencies in order to remain competitive. That means cutting jobs, including both those held by doctors and nurses. Hospitals in Georgia--a state that is against Medicaid expansion--are in the midst of laying off scores of employees, while the state's hospital lobby is pressing hard for lawmakers to change their mind.

Hospitals in anti-ACA states have some options, such as imposing a bed tax on themselves to leverage Medicaid matching funds, but that will be a drop in the bucket compared to actually expanding Medicaid eligibility.

And whether such cuts will degrade care remains to be seen. But governmental bodies, such as the Agency for Healthcare Research and Quality, have linked a lower quality of care delivery to hospitals with fewer nurses on staff. Fewer staff and fewer financial resources rarely spells better care. Hopefully, the states that seem inflexible on Medicaid expansion will change their collective minds.- Ron (@FierceHealth)

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