Per Capita Impact:
The Effects of the American Health Care Act on County Economies in Ohio

Loren Anthes, Fellow, Center for Medicaid Policy
May 24, 2016

BACKGROUND
The Center for Community Solutions has conducted analysis on the potential fiscal impacts of the American Health Care Act (AHCA) in Ohio, with our model showing between a $16 and $22 billion shortfall in Medicaid funding. To build on this work, we decided to take a look at what this gap could mean for counties, and incorporated information on health care employment to provide an additional perspective on what this impact could mean.

METHODS
To arrive at county-based numbers for funding gaps, we used the overall per capita impact from our model as a baseline. We then used the percentage share of overall county Medicaid expenditures as the proxy to arrive at a county estimate. To demonstrate the potential economic impact any changes may have on Ohio counties, the map measures the differences in health care employment relative to the total employment in a given county, with the darker colors indicating a higher share by the health care industry.

*Click the double arrows to view the legend.

IMPLICATIONS
George Washington University has suggested that Ohio could lose up to 127,000 jobs as the result of AHCA, 50,000 in health care alone. Medicaid would experience the deepest rollbacks in the legislation, creating a significant, negative impact on employment in Ohio counties, particularly rural areas. Indeed, recent research has shown that expanding Medicaid has disproportionately benefitted rural hospitals, with rural hospitals in non-expansion states operating at a negative operating margin. If Medicaid were put into a per-capita arrangement, the likely outcomes would be a reduction in access to care, job loss, and closure. It may also be difficult for these areas to attract non-health care employers as many employers, specifically those in manufacturing, require emergency care in close proximity to their operations.