Amid the ebb and flow of efforts by congressional Republications to repeal and replace the Affordable Care Act (ACA), the nation’s hospitals can reasonably expect that the Medicaid expansion initiated with the passage of the ACA will for the most part remain intact. Regardless of the final outcomes of the repeal and replace efforts in Congress, however, the nation’ s hospitals, and academic medical centers (AMCs) in particular, need to be more strategic in their approach to serving the underserved. This is true whether Medicaid is larger or smaller within a larger segment of the uninsured.
Although the direct financial impact of the expansion on providers has been positive, the more indirect effects on various classes of providers have not always been straightforward, particularly in the case of AMCs. In some of the markets that AMCs serve, Medicaid is now the single biggest insurer, and one that AMCs, for the first time, need to approach deliberately and strategically. Similarly, many states, now contending with burgeoning budgets and enrolled populations, are looking for ways to innovate to improve value for both enrollees and taxpayers and to improve the condition and performance of care delivery in their states. At this juncture, it is useful to consider the specific impact of the expansion on and the strategic implications for AMCs and for state Medicaid policymakers contemplating a role for AMCs in their Medicaid systems.
AMCs and state policymakers have myriad opportunities to work together to create value and innovate in the context of the expansion. A structured approach is recommended for the two sides to work together for mutual benefit.
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