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Hospitals and Medicaid Expansion

September 10, 2013 Common Cents

Hospitals in New Hampshire would do better financially if Medicaid is expanded to more low-income families, according to the Lewin Group report that looked at New Hampshire’s situation.

“We estimate that health systems would see an increase in net income of about $113.1 million under the Medicaid expansion assuming full implementation in 2014, which would represent a 28 percent increase from their current net income,” the report concludes

This is in direct contradiction to an online Forbes article by commentator Avik Roy who suggested incorrectly that New Hampshire hospitals will lose money under the Medicaid expansion.

The state of New Hampshire, through the Department of Health and Human Services, commissioned the Lewin Group, a national consulting firm, to analyze what would happen to New Hampshire’s budget and economy if it went forward with the Medicaid expansion.  Lewin found that the Medicaid expansion would improve both.  To wit:

“The ACA boosts NH’s economy and revenues, and Medicaid expansion maximizes these economic and fiscal impacts,” the report reads.

Roy concludes hospital will lose money by relying on a comparison of the impact on hospitals if Medicaid expansion went forward against what would happen if the expansion did not.

But in both scenarios, hospitals benefit, according to Lewin.

“Overall, health systems would see an increase in net income of $113 million under expansion, compared to $158 million under no expansion.”  That is to say, under either scenario, hospitals will see an increase in net income under the Affordable  Care Act.

Furthermore, the New Hampshire Hospital Association remains firmly in support of expanding Medicaid.

In a recent news release, the association observed that “[the online Forbes article] misinterprets the Lewin Group analysis on the impact of expanding Medicaid to New Hampshire’s hospitals and greatly misses the mark on what Medicaid expansion is all about… In the end, this is about getting patients the right care, at the right time, in the right place.”

The Forbes article also suggests the Medicaid expansion will cause more people to lose their private insurance than will gain it under Medicaid.

To the contrary, the Lewin report actually says that 38,000 uninsured people will be covered by the Medicaid expansion and that 20,000 people who are currently privately insured may choose to leave that private coverage for public coverage. The number of people with coverage, private or public, increases; it does not fall.

Critics who use the Forbes article as justification for not moving forward with the Medicaid expansion should review both the Lewin Group reports and consider the testimony from hospitals, community health centers, community mental health centers, doctors, nurses and citizens – all of whom cite compelling reasons for New Hampshire to accept the federal funds to get more people covered.

For more information, including copies of the Lewin Report and public testimony, visit our Resource Page.


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Unsettled Business Tax Revenues Push Surplus Upward, Offer Limited Insight for the Future

7 Dec 2018

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The fortunes of State revenues continue to rise and fall with New Hampshire’s two primary business taxes, which provided positive signs for near-term revenue but have not shown these levels are sustainable. While the two business taxes remained healthy, other revenue sources were relatively flat overall, leaving the State with a revenue surplus entirely dependent on the two business taxes. The lack of growth in other revenue sources combined with the uncertainty around business taxes creates an environment in which it will be very difficult to accurately project revenues for the new State Budget biennium.