IHP 610 Module 9 Final Project Example

Closing the Gap: Policy Analysis and Recommendation for the Prairie Ridge Health Board

[Student Name]

Southern New Hampshire University

IHP 610: Health Policy and Law

Module Nine Final Project

[Instructor Name]

[Date]

The organization, setting and figures below are a composite written as a model document. No real employer, client, colleague or patient is described.

Closing the Gap: Policy Analysis and Recommendation for the Prairie Ridge Health Board

This report asks the Prairie Ridge Health board to take a public position on state coverage policy for the first time in the system's history. It sets out the problem, the evidence, the options, a recommended course and a plan for pursuing it, so that trustees can decide with a full view of the benefits and risks.

Summary for the Board

About 180,000 adults in the state earn too little for marketplace subsidies and too much, or are the wrong category, for Medicaid. Prairie Ridge absorbs about $48 million a year in unpaid care, and its two rural hospitals lose money. Of four options examined, expansion using Medicaid funds to purchase private coverage best balances coverage, equity, hospital effects and the chance of passage. The report recommends that the board endorse that option, oppose work requirements and fund an $85,000 advocacy effort within federal lobbying limits.

How the Gap Arose

The Affordable Care Act assumed that every state would extend Medicaid to adults below 138% of poverty, so it began marketplace subsidies at 100%. After the Supreme Court's 2012 ruling made expansion a state choice, adults under the poverty line in states that declined were left with neither option. The state's own Medicaid program covers few nondisabled adults, and its indigent care fund reimburses only a small share of hospital losses.

Costs to the System and Its Patients

Uninsured patients made up 22% of emergency visits across the system and nearly 30% at the rural hospitals, whose margins were minus 1.4% and minus 3.1%. Clinicians report patients arriving with advanced disease that earlier primary care could have caught. The flagship now subsidizes the rural hospitals, limiting investment in the whole system.

What Coverage Changes

Miller et al. (2021) linked survey responses to death records and found that low-income adults aged 55 to 64 in expansion states experienced significantly lower mortality after the Affordable Care Act expansions than comparable adults in states that did not expand, largely because of fewer deaths from treatable diseases. Dranove et al. (2016) found that uncompensated care fell substantially at hospitals in expansion states, especially those that had served many uninsured patients, while hospitals elsewhere saw no similar decline. Together, these studies indicate that coverage would benefit both Prairie Ridge's patients and its rural hospitals.

Options and Criteria

Four options were judged against six criteria weighted toward coverage and political feasibility: traditional expansion, expansion through private plans, a partial expansion to the poverty line at the regular federal matching rate and a larger indigent care fund. The table summarizes the results.

Table 1. Summary of Options Analysis

Note. Composite estimates from the Milestone Two analysis.

Why Private Plans

Sommers et al. (2016) compared low-income adults in Kentucky, Arkansas and Texas and found that both Kentucky's traditional expansion and Arkansas's use of private plans produced large gains in coverage, better access to primary care and improved self-reported health relative to Texas, with few differences between the two approaches. Because private plans generally pay hospitals more than Medicaid and appeal to legislators skeptical of public programs, this route offers similar patient benefits with better prospects of passage and stronger hospital finances, at a modestly higher state cost.

Why Oppose Work Requirements

The most likely amendment is a work requirement. Sommers et al. (2019) found that in Arkansas's first year, coverage fell among adults subject to the rule without any increase in employment, because most already worked or qualified for exemptions and many lost coverage through reporting problems. Supporting a requirement would undercut the purpose of expansion and expose the program to litigation.

Advocacy Plan

The coalition will seek a bill directing a Section 1115 waiver for private-plan coverage up to 138% of poverty, with a trigger ending the program if the federal share drops below 90%. Targets are the health committees, eleven rural legislators and the governor. Business chambers, agricultural and faith organizations and patient advocates round out the coalition. Messages focus on rural hospitals and working people, delivered by hospital leaders, employers and patients through one-page district data sheets, site visits and testimony.

Legal and Reputational Safeguards

Prairie Ridge has elected to measure its lobbying under section 501(h) and will track spending against the resulting limits, register lobbyists under state law and avoid any involvement in candidate campaigns. Staff will advocate officially only through designated channels. Publicly, the system will acknowledge that it benefits financially from expansion while emphasizing patient outcomes, which is both honest and more persuasive than hiding the interest.

Risks

The effort may fail, as expansion bills have for eight sessions; it could strain relationships with some legislators; and a bill could pass with harmful amendments. The board should set conditions in advance: Prairie Ridge will withdraw support if a work requirement or enrollment cap is added and will continue advocacy through the interim if the bill fails.

Measures of Success

Short-term measures include bipartisan sponsorship, a committee hearing and committee passage without work requirements. Longer-term measures, if the policy passes, include the uninsured rate in the system's counties, uninsured emergency visits, uncompensated care and rural hospital margins, tracked annually for three years.

Recommendation

The board should adopt a resolution endorsing private-plan Medicaid expansion without work requirements, authorize $85,000 for advocacy within 501(h) limits and direct management to report monthly during the session. This course of action is supported by evidence on health, hospital finances and program design, fits the system's mission and positions Prairie Ridge as a credible voice for rural communities.

Conclusion

The coverage gap costs lives, strains rural hospitals and reflects a policy choice the state can revisit. The evidence supports expansion, the private-plan route offers the best chance of passage and a disciplined, lawful campaign gives Prairie Ridge a meaningful role in closing the gap.

References

Dranove, D., Garthwaite, C., & Ody, C. (2016). Uncompensated care decreased at hospitals in Medicaid expansion states but not at hospitals in nonexpansion states. Health Affairs, 35(8), 1471-1479. https://doi.org/10.1377/hlthaff.2015.1344

Miller, S., Johnson, N., & Wherry, L. R. (2021). Medicaid and mortality: New evidence from linked survey and administrative data. The Quarterly Journal of Economics, 136(3), 1783-1829. https://doi.org/10.1093/qje/qjab004

Sommers, B. D., Blendon, R. J., Orav, E. J., & Epstein, A. M. (2016). Changes in utilization and health among low-income adults after Medicaid expansion or expanded private insurance. JAMA Internal Medicine, 176(10), 1501-1509. https://doi.org/10.1001/jamainternmed.2016.4419

Sommers, B. D., Goldman, A. L., Blendon, R. J., Orav, E. J., & Epstein, A. M. (2019). Medicaid work requirements: Results from the first year in Arkansas. New England Journal of Medicine, 381(11), 1073-1082. https://doi.org/10.1056/NEJMsr1901772