Study: Expand Medicaid, NH uninsured drops by 20K

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CONCORD, N.H. (AP) — The number of uninsured residents in New Hampshire would drop to about 71,000 by 2020 if the state expands its Medicaid program under the federal health overhaul law, compared to about 93,200 if it decides against expansion, a report released Friday says.

The state Department of Health and Human Services hired a health policy research firm to study the pros and cons of expanding the program after the U.S. Supreme Court ruled in June that expanding Medicaid was optional under the Affordable Care Act.

The first phase of the Lewin Group's report was released in November and focused on the overall cost to the state from 2014 to 2020. It estimated expansion could cost the state $85 million, but said the state would get $2.5 billion in federal funding. Without expanding, the report said, the state could save up to $114 million over the seven years.

The second phase, released Friday, examined the impact on the uninsured population, the economy, health care providers, insurers and specific state agencies.

With its release, Gov. Maggie Hassan said that while she looks forward to working with lawmakers and others in shaping the new system, the report makes clear that expanding Medicaid will help the state by injecting federal money, creating jobs and reducing the amount of uncompensated care at hospitals.

"This is an important opportunity to help families and strengthen our economy," said Hassan, who took office this month and supported expanding Medicaid during her campaign.

Under the federal law, people under age 65 will qualify for Medicaid if they earn up to 138 percent of the federal poverty guidelines, which is about $15,000 a year for a single adult.

Expanding the program in New Hampshire would boost enrollment by about 58,000 people, the report estimates, and together with the law's other provisions, would reduce the number of uninsured residents from roughly 170,000 to 71,000.

Without expansion, the number of uninsured residents would drop by 76,800 to 93,200 over the seven-year period, according to the report.

With Medicaid expansion, the average out-of-pocket health spending for uninsured residents would decline by about $370, compared to a drop of about $220 without expansion, the report estimates. That's money that would then get pumped into the economy, Deputy Medicaid Director Lisabritt Solsky said in releasing the report.

But those who remain uninsured if Medicaid isn't expanded likely will be low-income people who have the greatest need for health care, she said.

A "tremendous amount of movement" will occur whether Medicaid is expanded or not because of the federal law, Solsky said.

"In any kind of complex, wide-ranging change such as this ... there are going to be winners and losers. And it's sort of up to everybody to look across the silos and say, 'What is for the greater good,'" she said.

The report also looked at other economic impacts, including jobs. It estimates that the state would gain about 5,100 jobs between 2014 and 2020 if it expands Medicaid, compared to a gain of about 4,400 jobs without an expansion.

While federally subsidized health clinics and community mental health centers would see financial benefits from Medicaid expansion, hospital revenue would be greater without it, the report said.

Health systems, which include hospitals and the physician groups and other offices they own, would see an increase in net income of about $113 million under Medicaid expansion over the seven year period, but an increase of $158 million if Medicaid isn't expanded. That's because more people would end up covered by private insurance, Solsky said.

She said the Department of Health and Human Services isn't taking a position on whether Medicaid should be expanded but hopes the report helps frame the discussion for lawmakers and the governor.

"I do think that reading the tea leaves in terms of what the governor has signaled and what the Legislature has signaled, that there's a lot more traction in favor of Medicaid expansion than there was a few months ago," Solsky said.

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