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Tuesday, June 25, 2013

Some Thoughts on Medicaid Expansion for Business

According to the Kaiser Family Foundation twenty one states are not moving forward with Medicaid expansion either due to their governor’s opposition, a legislative body’s opposition, or both. For example, the Wisconsin State Legislature recently voted to reject Medicaid expansion, while neighboring state Minnesota is moving forward with the expansion. The expansion is expected to save Minnesota $120 million over the next two years, while extending Medicaid to an additional 130,000 citizens. Meanwhile, Wisconsin, by refusing the expansion, is neglecting to provide coverage for 85,000 people who fall below 133% of the Federal Poverty Level mandated by the PPACA. Could Minnesota’s expansion potentially benefit low-wage earners in Wisconsin as well and what effect will it have on the Wisconsin economy overall?

Examining the effect that Massachusetts Medicaid Expansion to single adults had on the Rhode Island economy it becomes apparent. When Massachusetts passed MassHealth, which included Medicaid expansion to single adults living within 150% of the Federal Poverty Level, Medicaid enrollment increased by over 5% above the national average at its inception and continued increasing between 1% and 2% above the national average over the next three years according to the Centers for Medicare and Medicaid Services. Upon examination of Medicaid enrollment in the neighboring state of Rhode Island at this time we see Medicaid enrollments 6% annually below the national average during the same period, until the decline began tapering off in 2009. Rhode Island Medicaid does not currently enroll single adults, (they will begin doing so next year under the PPACA).

Did low wage earners in Rhode Island realize a good thing in 2006 when they saw the introduction of MassHealth and move? If so, rather than being detrimental wouldn’t this have been beneficial to Massachusetts economic recovery though the addition to its labor pool for manufacturing and service jobs? According to the Bureau of Labor Statistics, last April Massachusetts posted a jobless rate of 6.4%, significantly lower than the national jobless rate of 7.5%, while Rhode Island with a jobless rate of 8.8% was significantly higher.  Massachusetts' unemployment level was well below the national average in 2006 when Medicaid was expanded to include single adults, and remained below the national average during the entire recession despite the enrollment.
While the Census bureau shows that Massachusetts’ population did not increase above the national average during this period, it did increase percentage wise more than any other New England State. Additionally, while Rhode Island had already begun a slight population decrease in 2003 we see the population decrease markedly after the introduction of Mass Health, (from 1,071,414 in July of 2004 before Medicaid expansion was announced, to 1,052,219 in July of 2009, a total of -1.73%). In fact, the only Massachusetts border state where population decreased at this time was Rhode Island. Notably as well, according to the Census Bureau, we see the Median Annual Income of Massachusetts residents decrease by 1.25% from 2005 to 2006, while we see the Median Annual Income of Rhode Island residents increase by 7.9%. It seems plausible that many of the mobile Rhode Islanders ended up in Massachusetts; however, did they do so for healthcare reasons? Newspaper and magazine articles at this time were actually encouraging people to move to Massachusetts in order to gain health care, so it seems likely that many of the low-wage earners ended up there.
Rhode Island’s largest city, Providence, lies just over the Massachusetts border. In fact the population of the greater metropolitan area of Providence is larger than the population of the state due to the inclusion of Massachusetts residents. It would seem to be quite easy for a low wage earner, especially a single adult, to move less than five miles in order to gain health insurance. Additionally, according to the Center for Economic Advancement, Rhode Island saw the greatest increase in poverty in the nation during the recession, from 10% in 2006-2007 to 12.9% in 2008-2009; could this have potentially been much worse? Are businesses in Minnesota primed to receive an abundant supply of low wage earners that come equipped with federally-supplied health care and won't this eventually support expansion of businesses throughout the state?

If two single adults were working for the same low wage at the same business, one living in Rhode Island without coverage and the other in Massachusetts with coverage, wouldn't the worker without coverage move at the first opportunity especially if they could maintain their position? It is a common occurrence for people who live on a border to take jobs in their neighboring states, employers in Massachusetts regularly employ people who live in Rhode Island. As Rhode Island at this time didn't have Medicaid coverage for single adults, and as this population was most dramatically effected by the change in Medicaid enrollment it would seem to make sense that workers left the state, especially in light of the 2013 Kaiser Family Foundations June tracking poll where the value young adults place on healthcare is illustrated: http://kff.org/health-reform/poll-finding/kaiser-health-tracking-poll-june-2013/ 

It appears highly unlikely that some states are going to expand Medicaid as there is no mandate to do so, by not doing so, their border states will reap the same economic gains through the PPACA’s Medicaid Expansion that Massachusetts did.


Expansion makes good sense for businesses, especially those employing low-income workers and it makes good sense for the workers in these positions as well, especially as businesses are unlikely to offer affordable healthcare to their employees and are not mandated to do so until 2015. We have already seen that many businesses would rather reduce hours than give their workers heath benefits. Once one state has this economic advantage they are going to maintain it, a young workforce will move to a border state for a benefit as important as health care, it would be doubtful that they will move back for no obvious advantage and many of the available jobs will have already crossed with them. It will be interesting to watch the economies of the early adopting Medicaid expansion states unfold in comparison to their border states that chose not to increase Medicaid enrollment.

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David Hector Thibodeau

1045 Wylie Street SE • Atlanta, GA 30316

• davidhectorthibodeau@gmail.com



Professional Experience:



Georgia College & State University - Milledgeville, GA 31061 2008 - Present

www.gcsu.edu



­Serials/Acquisitions Coordinator

­• Establish policies and procedures for the efficient operation of the Serials and Acquisitions Department, oversees database maintenance and quality, and processing of materials.

­• Supervise full-time faculty, staff, and student positions.

­• Manage electronic serials collection using electronic management software systems.

­• Update bibliographic holdings for serials collection using standard library utilities.

­• Direct all major projects and daily activities involving the management of the serials collection.

­• Oversee participation in National Library of Medicine’s DOCLINE ILL program.

­• Meet with department faculty to review their acquisitions needs and serve as a library liaison with academic departments.

­• Provides assistance and advice to the Dean/University Librarian in the overall administration of the library, including strategic planning and the establishment of overall goals and objectives.

­• Assist library administration in monitoring the budget and expenditures, recommends equipment, supplies, personnel, and other needs. Perform fiscal period close in Voyager integrated library system.

­• Serve as primary liaison to vendors and as the technical contact for electronic databases, including setting up trials, negotiating licensing agreements, managing SLAs, and authoring RFQs and other correspondence.

­• Participate in collection development to support the curriculum by recommending acquisitions and participating in the evaluation of current collections.

­• Develop and prepare statistical and narrative reports.

­• Provide reference services as assigned.



KPMG LLP - Atlanta, GA 10/2003 - 10/2007

http://www.kpmg.com/



­Southeast Area Library Associate

­• Relocated from Miami to Atlanta by KPMG due to assuming additional offices in 2006.

­• Reference, research, and collection management for fifteen Southeast area libraries.

­• Developed on-line training sessions for proprietary accounting research platform.

­• Set up, developed, and administered SharePoint internal collaboration web site.

­• Liaison to National Operations teams on SharePoint development.

­• Redeveloped external acquisitions web site to be high functioning and suitable for firm-wide use.

­• Collaborated with marketing department to improve collateral for delivery to clients and targets.

­• Account contact and administrator for firm-wide on-line subscription.

­• Coordinated development of the Latin American Tax Handbook between the European Tax Centre, the Latin American Tax Center, and the International Bureau of Fiscal Documentation.

­• Led a team to develop an electronic tool to survey library users.

­• Appointed Work Environment Initiative Local Action Committee Representative in South Florida.

­• Promoted from Area Library Coordinator to Area Library Associate and relocated from Boston to Miami in 2003; originally responsible for library collections, acquisitions, vendor relations, and accounts in 13 Northeast area offices.



KPMG LLP - Boston, MA 03/200- - 10/2003

http://www.kpmg.com/



­Northeast Area Library Coordinator

­• Implemented integrated library system software in area libraries.

­• Assisted in creating a collection development database on MS Access to track expenditures.

­• Substantially decreased print purchases through resource sharing and eliminating duplicative materials.

­• Developed electronic process for Partners to select and order professional literature annually that resulted in $60K savings in the Northeast in the first year, (project adopted firm wide).

­• Piloted on-line access to tax literature platform in Northeast Area that resulted in over $25K cost savings in Northeast area and a wider distribution of resources, (project adopted firm wide).

­• Coordinated and developed training programs for Lexis/Nexis, Westlaw, and other information platforms for professionals and support staff, (project adopted firm wide).



Education:



American Intercontinental University

­• 2010 – Present, MBA – Project Management Concentration



­Simmons College--Boston, MA

­• Summer 2000; audited - Knowledge Management

­• Summer 1999; audited- Management of Information Technology

­• 1996-1998 MLIS, Graduate School of Library and Information Science



­Boston College--Newton, MA

­• 1984-1988 BA, College of Arts and Sciences: Double Major: English and Psychology





­Hebrew University--Jerusalem, Israel

­• Summer 1988 & summer 1990, Assistant Archaeological Field Supervisor and associated graduate level classes.



Leadership:



Georgia Leadership Institute – State Personnel Administration

­• 2009 – The Seven Habits of Highly Effective People



­Florida Library Leadership Program -- Tallahassee, FL

­• 2005-2006 - Year-long comprehensive series of learning sessions that focuses on developing an understanding of leadership, within a conceptual framework and practical applications.



Certifications:



Emory University - Center for Lifelong Learning – Atlanta, GA

­• 2008 - Emory University: Management Certification.

­• Courses included: Essentials of Personnel Management, Win-Win Negotiations, Essentials of Supervision, Essentials of Motivation, and Essentials of Coaching for Managers.



­New Horizons--Boston, MA

­• 2002 - Certified Internet Webmaster – Foundation Fundamentals

­• Courses included: Networking, Internet, and Web-Page Authoring Fundamentals.



Professional Memberships:

SLA Georgia Chapter Board Member 2009 - Present

­Tennis Club II Condominium Association President, Fort Lauderdale, FL 2005-2006

­Member: ALA, NASIG, CIP



Skills / Strengths:

• Lexis/Nexis, Westlaw, Factiva, ProQuest, EBSCOhost, & other information databases.

­• Conversational French, some Spanish

­• MS office: Excel, Access, PowerPoint, Word, Outlook, SharePoint, Visio, and Project.