• New Hampshire and the Medicaid Expansion

    Avik Roy has a post up entitled, “Report: If New Hampshire Expands Medicaid, State Hospitals Will Lose Hundreds of Millions of Dollars“. That’s… not entirely accurate not the way I’d put it. I believe Avik is working off the 2012 Lewin Group report. Here’s a link to the 2013 report they prepared for their funder, Health Strategies of New Hampshire. Specifically, go look at page 30. It’s the figure Avik uses as E-8. I’ll give you the title of that slide: “Overall, health systems would see an increase in net income of $113 million under expansion, compared to $158 million under no expansion”. So, yes, hospitals will see less of an increase in income with the expansion, but that’s not the same flavor as “losing money”.*

    But don’t let me put words in the Lewin Group’s Mouth. Here’s page 46, the Phase II Summary:

    • Expanding or not expanding Medicaid will have impacts beyond the state’s Medicaid program itself
    • Expanding Medicaid will offset costs to other state programs, thus reducing the total state cost of implementing Medicaid expansion
      • Total offsets under expansion (FFS): $67.1 million (2014-2020)
      • Total state cost of expansion (baseline): $18.4 million (2014-2020)
    • The ACA and Medicaid expansion will also have a measurable positive impact on the state economy at large
    • Impact on the uninsured, on providers, and on the commercial market should also be considered, as the decision to expand Medicaid affects these stakeholders and subgroups in different ways

    You can’t cherry pick. In every policy, someone is likely a loser. You can focus on the bros, or you can focus on how hospitals won’t see as much of an increase in income, but the whole picture is important. Under most of the scenarios on page 47, the expansion actually saves New Hampshire money. Plus, there’s tons of economic upside. Go read the whole report if you doubt me.

    Moreover, this will likely improve the lives of many people who are uninsured, because no matter how many times people say Medicaid is no better than being uninsured, or that it hurts people, it just isn’t true.


    UPDATE: I want to be clear. Hospitals will “lose” $45 million according to the Lewin Group with the expansion, over what they’d get with the ACA without the expansion (if you buy that framing). But I bet the number of people who use these data to deny the Medicaid expansion, while simultaneously opposing repeal of the ACA, can be counted on one hand. If they don’t oppose repeal, then they aren’t that concerned about hospital system “losses”. I also maintain that focusing on this one “loss” and ignoring the rest of the report is cherry picking.

    UPDATE 2: I changed a sentence in the first paragraph to reflect the fact that Avik is not lying at all. It’s a framing issue, and it’s also cherry-picking. Although he’s making a claim of hundreds of millions of dollars, and the slide I see shows $45 million.

    • At this point, I assume that anything Avik Roy writes is an intentional misrepresentation of the truth to make ObamaCare look bad.

    • Yes, when gummint is involved, someone is always a loser, sometimes everyong. That’s the case with Obamacare, but that’s not the way the free market works: when the market sells food, everybody is a winner.

      That’s why we have to get the gummint out of at least the most important aspects of our lives: sex, eating, drinking, food, health care, education and the ownership and running of national parks and forests.

    • Roy has promoted individual health insurance policies to replace group insurance (i.;e., everybody would have a separate insurance contract). That was his contribution to the Romney campaign. Roy “solves” the preexisting condition dilemma for the already insured by precluding insurers from dropping coverage once the insured has a medical condition, “solves” the preexisting condition problem for the uninsured with high risk pools, and “solves” the high cost of insurance by ending the income tax exclusion that subsidizes premiums. Roy has lots of faith in the private insurance market. One might argue that Obamacare, with the creation of the exchanges, is the first step to everybody obtaining individual insurance coverage on the exchanges, which is Roy’s goal and he would support. But Roy opposes Obamacare. Indeed, he claims that Obamacare is intended as the first step to single payer. How insurance exchanges, designed to facilitate individual insurance policies, would be the first step to single payer is a mystery. Roy claims that Obamacare will unravel over time because it will cause premiums to skyrocket. He studied biology (MIT) and medicine (Yale), and is a Fellow at the Manhattan Institute. He is so invested in the failure of Obamacare, as the designer of the Romney health care policy, that his judgment has been affected. It’s a waste of his intelligence that he would devote so much energy in efforts to cause Obamacare to fail rather than in helping to develop ways to make it succeed.

    • When faced with something from someone that you may not agree with you can chose to at least listen to their argument and give it some consideration OR you can reject it because it comes from someone you dislike – or consider to be __________ [fill in the bland with derogatory term of choice]

      I don’t agree with everything Avik Roy posts – I agree with some things – and not other – I have learned a few things from following his posts and reading the comments.

      I agree less with Avik and Aaron, but am probably a more loyal reader of TIE than Avik. AND I have learned more by keeping an open mind and trying to understand their thinking and logic.

      I am reading them – and a number of others to LEARN – I am a student and concerned citizen – trying to better understand a complex problem. I would not ever think of myself as an expert or as smart as any of the above three.

      But this is – IMHO – a mess – a train wreck. It will not be pretty and we are going to have to deal with a ton of unintended consequences – some are emerging – like the Kaiser article on Bare Bones plans still being around – others will emerge as we go down this road – if we go down it.

      • Keeping an open mind and is all well and good, but I think there’s been plenty of evidence of how Avik Roy is arguing in bad faith. See other posts on this site or WonkBlog (Ezra Klein, Sarah Kliff).

        If sources are poorly cited or misrepresented entirely, I think it’s justified and appropriate to call the author to the mat and eventually, simply write him/her off completely.

    • I think Roy is looking at the chart on page 38, Difference in Provider Revenue by Sector, the first chart in the section on the impact on the state economy.

    • LOL! according to the President and Pelosi et al. Under the ACA EVERYONE is going to win. Costs are going to be lower for everyone. (that is what was claimed) “If you like your plan, you can keep it, period!”

      It is hard to take a post complaining about Avik Roy seriously; when this entire law was sold to the public on a pack of lies.

      • I’d be curious as to what any supporter of ACA actually said that amounts to claiming that “everyone will win” and what percentage of people you think will lose their policy because of ACA.

    • So health care will cost less? This is a problem? Hospitals will have more paying customers but will make less money. This sounds like a feature not a bug!