Health care jobs spike with Medicaid expansion

Through the first 11 months of 2014 — the first full year of Medicaid expansion in Ohio — statewide employment in health care and social assistance, which includes jobs at hospitals, doctors’ offices and other facilities providing medical care, rose by about 7,000 positions, according to figures from the Ohio Department of Jobs and Family Services.

That’s up about 1 percent from job growth in the health sector for the same period a year ago, and just slightly below the full-year forecast. The figures, however, do not reflect jobs created in other sectors that benefit indirectly from increased health care spending.

The influx of federal dollars into Ohio to fund the expansion of Medicaid was projected to boost employment in health care and other industries by at least 9,000 jobs by the end of last year, according to economic impact studies from the Urban Institute and Regional Economic Modeling Inc.

“When additional funds are coming in for any particular type of program…you would expect to see job growth tied to additional expenditures in those areas,” said Richard Stock, director of the Business Research Group at the University of Dayton. “That would be as true for something like the Affordable Care Act and increases in Medicaid spending as for (U.S. Department of Defense) spending.”

Still, it’s hard to say exactly what percentage of job growth can be attributed to the $2.5 billion in extra Medicaid funds Ohio accepted to expand Medicaid eligibility.

An improving economy has boosted overall job growth and is at least partly responsible for growth in the health care sector.

But the addition to Ohio’s Medicaid rolls of more than 450,000 residents, who became newly eligible last year under guidelines granting coverage to most adults earning up to 138 percent of the federal poverty level, has created a huge group of new health care consumers who are driving hiring at local medical practices.

“Over the past two years, our Medicaid volume has increased steadily….and we have services in place that required additional staffing,” said Holly Card, director of oncology services at Dayton Physicians Network, the largest oncology practice in the local area.

Robin Arthur, a recent hire, said she left Five Rivers Medical Surgical Health Center in Dayton last September because of a surge in new Medicaid patients that placed increased demands on staff.

“We enrolled a lot of Medicaid patients last year at Five Rivers because of expansion, and I became more of a case manager than a specialist,” Arthur said. “I came here (Dayton Physicians) because I wanted to be able to focus on oncology infusion.”

Local hiring appears to reflect the national trend, according to at least one study by Missouri state officials who found jobs in the health industry grew three times faster in states that expanded Medicaid than than in those that did not.

As originally written, the Affordable Care Act meant for every state to expand Medicaid, but a 2012 Supreme Court ruling left expansion up to each state to decide.

The Missouri report looked at health care hiring in Arizona, Colorado, Maryland, Minnesota, and Washington, which approved expansion that went into effect at the beginning of last year.

Researchers compared hiring trends in those states to the non-expansion states of Alabama, Indiana, Louisiana, Missouri, and Tennessee and found employment in the health care and social assistance sector grew by an average of 2.1 percent in expansion states and less than 1 percent in non-expansion states.

The study only covered the first six months of the year, which makes it hard to determine whether the spike in hiring represents a long-term trend. And opponents are quick to point to several studies that indicate the long-term outlook for job growth with expanded Medicaid may not be as rosy as the current jobs picture.

“While it (Medicaid expansion) may, temporarily, increase the number of jobs in the health care sector, its overall impact will be to reduce employment in other areas of the economy,” said Greg Lawson, a policy analyst with The Buckeye Institute for Public Policy Solutions, a right-leaning think-tank based in Columbus.

Lawson cited a study by the Congressional Budget Office that projects a decline in the number of full-time workers as a direct result of expanding Medicaid, which will “reduce incentives to work.”

The report estimates that as many as 2.5 million people will opt to reduce their hours or drop out of the labor force entirely so they can stay under the income cap for Medicaid and federal subsidies for private insurance sold under the ACA in state and federal health insurance marketplaces.

The CBO projects that total employment will still increase over the coming decade, but that increase will be smaller than it would have been in the absence of the ACA.

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