The health care workforce continues to grow faster than the national average. The boost from Medicaid expansion calls for even more support from colleges and universities to produce graduates prepared to meet the needs of the shifting health sector.
As your COE portfolio expands, you need to consider the local opportunities that disruptive health legislation creates.
Medicaid expansions create opportunities in the health professions
First, it’s important to revisit the Affordable Care Act (ACA). In 2010, the ACA mandated the expansion of state Medicaid programs to include more low-income Americans. Although a Supreme Court challenge removed the mandate, coverage continues to expand on a state-by-state basis. At the start of 2016, 26 states and Washington, D.C. had expanded coverage to millions of previously uninsured Americans. However, 19 states have yet to expand their health care offerings, and six more are still in the process of expanding or have expanded coverage since the beginning of this year.
This selective health care expansion creates a natural experiment to see how the employment needs of health care providers can differ based on public access to health insurance. For example, low-income Americans have different, often more severe, health needs. Uninsured Americans living below the poverty level are at greater risk for chronic health conditions such as depression, asthma, obesity, and diabetes.
Managing health outcomes requires a wide range of health professionals
The chronic conditions disadvantaged groups disproportionately suffer from often require continual care punctuated by acute interventions. Uninsured Americans are likely to seek care from physicians for acute episodes, but lack the resources to obtain care that manages and treats conditions over time. Access to ongoing treatment is key under the ACA, which considers overall treatment success in reimbursements for health care providers.
As a result, demand for workers in the “health professions” is increasing at a faster rate in states that chose to expand Medicaid than those that did not. The health professions include a broad range of professionals with specialized skills in evaluation, treatment, support, and rehabilitation in patient-facing and back office roles, ranging from medical assistants and dietitians to audiologists and clinical lab technicians. They are a key part of our health care system, and generally—though not necessarily—provide care at the referral of a physician or nurse.
Continual care professions are growing faster in Medicaid-expanded states
Labor market data shows that employer demand for health professionals has not grown evenly across the country since mid-2013. Specifically, health professionals who tend to work with patients on a continuing basis are increasing their share of job postings in Medicaid-expanded states relative to states that have not expanded Medicaid.
See the percentage of job postings in states by Medicaid status
Professions that tend to work in acute care maintain an equal share of the job market in both sets of states, which show roughly equal growth regardless of Medicaid status. For example, demand for therapists and population health workers, who treat patients across multiple sessions, are growing faster in Medicaid-expanded states. However, radiology staff, who tend to work in acute care, have grown more quickly in states that did not expand Medicaid.
Reform continues to impact the health care workforce
Legislation continues to change coverage for Americans and incentives for health care providers. A new law, the Medicare Access and CHIP Reauthorization Act (MACRA), takes effect in January 2017. In short, it incentivizes providers to take on risk in treating patients, penalizing providers for unsuccessful or unnecessary treatments. In remains to be seen how hiring preferences might change because of MACRA, but you can expect that MACRA will cause new spikes of demand for certain professions and skill sets.
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