Guest columnist Loren Anthes is Fellow, Medicaid Policy at The Center for Community Solutions, a nonpartisan, nonprofit think tank addressing health, social, and economic issues in Northeast Ohio.
Ohio Medicaid spends about $48,000 per minute. While that number sounds dramatic, it’s important to understand the context of how costs grow in Medicaid, otherwise we are limited to the politics of the moment, oversimplifying one of the most significant investments made in our society.
Medicaid provides a critical safety net. While many believe Medicaid is a program only for the poor, the majority of the spending, over half, goes to the disabled and the elderly. In fact, Medicaid provides more resources for the regular health care needs of the aging population than does Medicare.
Additionally, Medicaid enables many working families to move up and out of poverty, with nearly four in five of the adults and children enrolled coming from a working household. Medicaid also disproportionately covers individuals in rural Ohio counties, with the expansion of Medicaid benefiting mostly white, unmarried men with a high school diploma or less, and many of the major employers in these same counties relying on Medicaid as a major source of funding. Still, the concern of cost is a legitimate one and something policymakers must address. But how?
An oft-cited Centers for Disease Control (CDC) statistic tells us that 80 percent of the factors that affect the cost-effectiveness of our delivery system happen outside the walls of the hospital. These factors, commonly referred to as “social determinants,” include individual behaviors, the social and economic environment, and the physical environment. As a recent Health Policy Institute of Ohio report shows, Ohio’s total achieved value is underwhelming, ranking us 46th in the nation – meaning we are spending more and achieving less. If we are to control costs, then, we have to invest in those things we know bring us the most value.
Recently, I authored a paper on the intersection of housing and Medicaid as housing insecurity is a key social determinant of health. To be severely insecure means a household spends nearly half its income on housing. In the buckeye state, this translates to nearly 600,000 Ohioans.
When looking at the medically based research, it has been demonstrated that being homeless means a person’s life expectancy is 30 years lower than the general population and that housing insecurity can lead to poor mental health, developmental delays, higher risk of injury, elevated blood pressure, respiratory issues, exposure to infectious disease, and lack of access to basic medical services. It is also a key contributor to infant mortality. These health issues, which are not driven by individual behaviors or clinical intervention, are very expensive and are some of the key factors driving costs in Medicaid.
Ohio’s Medicaid program cannot be the only way in which we address value in health care. This is why policymakers should revisit proposals, such as the recently rejected expansion of the Ohio Housing Trust Fund, as a cost containment measure in health care. Taxpayers deserve that kind of return on investment.
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