Thursday, November 20, 2014

Medicaid and groceries

According to a new study from the Robert Wood Johnson Foundation and Urban Institute, Texas stands to lose $100 billion over the next decade if it sticks to Governor Perry's promise not to expand Medicaid with federal funds made available to the state.  Expanding Medicaid would cost the state something under $6 million, a comparatively meagre investment. 

Refusing the expansion makes no sense whatsoever in economic terms. 

All the talk about Medicaid got me to thinking.  Expanding the low-income health insurance product in Texas faces another fundamental challenge:  even if expanded, there aren't nearly enough doctors in the state who will accept Medicaid patients due to the low reimbursement rates defined by the program, among other reservations associated with treating the very poor. 

Given the stalemate, I'm wondering if Medicaid expansion funds could be used for other efforts to improve community health outcomes among the poor and marginalized?  Already, some states are using these funds to invest in decent, affordable housing for the homeless.  Housing has been identified as a determinant of health, and therefore worthy of use of these funds.  Reports on this innovative approach have been written by our friends at the Corporation for Supportive Housing (

Today, I'm imagining using Medicaid funds to incentivize grocery stores to move into low-income, marginalized communities.  Why couldn't Medicaid funding be used to wipe out "food deserts" so prevalent in our inner cities in this nation? 

I haven't figured out the business model yet, but it would include several factors. 
  • Advance funds to grocery store chains for development of the stores
  • On-going reimbursement or "value added" supplemental income, if needed, that could be indexed to the pounds of produce sold in the stores. 
  • Company marketing would produce ad campaigns for fresh foods to drive these on-going income supplements. 
Ultimately, the benefit and cost savings would be realized via better public health outcomes in neighborhoods that today are "hot spots" for chronic disease sets like hypertension, diabetes and obesity. 

Just thinking out loud while billions of Texas funds remain on the shelf  in D. C.!

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