A Medical Student's Perspective On Medicaid

My patients’ income or zip code should not determine the number of days they’ll stay in the hospital or the care they will or will not receive after being discharged.
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I recently co-authored a study, published in the Surgery edition of the Journal of the American Medical Association (JAMA Surgery), which compared how differences in Medicaid expansion in three states affected hospital lengths of stay following trauma. We found that the number of days patients with Medicaid insurance stayed in George Washington University Hospital’s trauma center varied significantly based on the state from which they came. Patients from Washington, D.C. stayed in the hospital nearly one day less on average than those from Maryland, and 1.3 days less than those from Virginia.

The study wasn’t designed to answer why, but anecdotal evidence and recent political history both point toward the same likely cause. In 2012, the Supreme Court ruled that states had the power to choose whether or not to participate in the Medicaid expansion originally mandated by the Affordable Care Act. An outcome of the ruling was that states could individually decide which services they would cover with Medicaid. Washington, D.C. chose to offer more comprehensive Medicaid services than Maryland or Virginia.

If you speak to any social worker or doctor at GW Hospital, they will tell you how much easier it is to get a Medicaid patient from Washington, D.C. approved for recovery services after leaving the hospital. These include placement at rehabilitation centers or the opportunity to get healthcare treatments at home. When these services are available to patients, they are likely to be discharged from the hospital sooner; when they aren’t, doctors have to keep them until they are fully able to care for themselves and are safe for discharge.

I’m a third year medical student at the GW School of Medicine and Health Sciences. While I still have a lot of training ahead of me, I’ve recognized that people don’t like being in the hospital and want to spend as little time there as possible. Hospitals make great efforts to make patients comfortable, but nobody wants to be away from their families and the comfort of their homes for even a day longer than is absolutely necessary. Time spent in the hospital is also extremely expensive. The average inpatient hospital expense per day is $2,609 in D.C. – a cost borne by insurers, taxpayers, as well as patients.

The American Health Care Act, renamed the Better Care Reconciliation Act, that passed through the House in early May drastically scaled back Medicaid funding by $834 billion, according to the Congressional Budget Office. The Senate is reworking its own version with similarly massive cuts to Medicaid coverage, but the bill recently failed because there was not enough support. If these cuts are enacted in a future version of the bill, Americans covered by Medicaid can expect fewer recovery services to be available to them, likely resulting in longer, and more expensive, hospital stays.

My great uncle Senator Ted Kennedy believed that increasing access to affordable, high-quality health care through programs like Medicaid was a critical component to building a more just society. He worked on health care reform for more than 40 years in the Senate, helping to lay the groundwork for the Affordable Care Act. While the bill was not perfect, it greatly expanded Medicaid, and provided health care coverage to tens of millions of Americans who did not have it before.

I chose to study medicine largely thanks to Teddy’s influence. He helped me recognize that in order to be a good doctor, I’ll need to understand the health care laws that will dictate the quality of care my patients receive. My patients’ income or zip code should not determine the number of days they’ll stay in the hospital or the care they will or will not receive after being discharged. That’s why, with Teddy in mind, I will continue to fight for laws that provide access to high-quality, affordable health care for all.