A Medical Student’s Perspective On Medicaid

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…

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