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.

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