Lawmakers must decide this year whether to continue spending millions each year to provide additional health coverage for the 50,000 to 90,000 low-income people through the expanded Medicaid program. The New Hampshire Institute for Fiscal Policy, long looked to by lawmakers for nonpartisan financial analysis, released a report this week with several arguments for doing so.
Medicaid’s continued expansion has done more than improve the health of beneficiaries through earlier cancer screenings, increased dental treatment, and improved pregnancy care, according to analysis.
It also allowed beneficiaries access to the health care they needed to stay in the workforce, which is a plus for them and for state employers desperate for workers. Medicaid’s expansion has given state hospitals millions of dollars to cover healthcare costs for uninsured people who would otherwise not be able to pay. According to the analysis, it has reduced the cost of health care to the state for inmates.
The state bears only 10 percent of the cost, and the federal government covers the rest. Between 2015 and 2022, the state has committed $210 million into the program, most of which has been paid for by insurance companies. This is a fraction of the federal government’s $3.22 billion contribution.
The question is, will that data convince lawmakers to continue a program that raised doubts before it was enacted in 2014.
Here are five notes from the institute’s analysis.
There was a 42.3 percent decrease in the number of uninsured granite staters in the five years after the Medicaid expansion began compared to the previous five years. Who got health insurance?
Newly insured people live in rural parts of the state, and nearly half are under the age of 45. The analysis found that about 74 percent of beneficiaries are white and people of color are disproportionately likely to be recipients of a Medicaid expansion relative to the overall population.
Like traditional Medicaid beneficiaries, they are low-income people. But they don’t meet other Medicaid eligibility rules, which require someone to have a physical or developmental disability, be under 19, pregnant, or care for children or other family members.
In December, about 154,000 Granite Staters qualified for traditional Medicaid, according to the state’s Department of Insurance. The population of Expanded Medicaid in New Hampshire, New Hampshire, has traditionally been less than half that number, about 52,000 people.
Eligibility for Granite Advantage, the state’s expanded Medicaid program, considers age and income only.
Recipients must be between the ages of 19 and 65 and earn less than 138 percent of the federal poverty level. In 2022, this would equate to $18,754 per year for a single person and $38,295 for a family of four.
The expanded Medicaid population jumped to more than 90,000 during the pandemic because of job losses and public health concerns that kept people at home. This number is expected to decrease as the state reviews post-pandemic employment and financial status of beneficiaries.
Compared to the state’s population, there are a disproportionate number of recipients who identify as Hispanic, 5 percent, or Black or African American, 2.1 percent, according to the analysis. A higher percentage of recipients live in rural areas of the state; Coos County has the highest rate at 16.5 percent, followed by Sullivan County at 13.8 percent.
Granite Advantage recipients often work in low-paying or seasonal jobs that do not offer stable employment or health benefits. They may sign up and leave the program when work becomes available.
The analysis found this to be especially true in low-wage industries like retail, lodging, and food service, among the largest employment sectors in the state.
Has the decrease in the number of uninsured adults made them healthier?
It looks that way.
The analysis cited research showing that parents who enroll in expanded Medicaid are more likely to enroll their children in Medicaid. Medicaid-covered parents are also more likely to ensure their child receives an annual health visit, which is critical to monitoring the child’s physical and mental health and keeping them up to date on vaccinations.
The analysis found that there are additional indirect health benefits when adults are able to work and do not have the financial burden of health insurance. This includes continuous access to housing and food.
The analysis includes research by the Kaiser Family Foundation on the impact of expanded Medicaid. It found a relationship between expanding Medicaid and reducing deaths, including deaths during pregnancy or childbirth, and from some types of cancer, as well as heart and liver disease.
The analysis indicated that states with Expanded Medicaid experienced a greater decline in child mortality than states without. But she noted that the research was not conclusive.
The Fiscal Policy Institute of New Hampshire found compelling evidence, however, that tens of thousands of Granite Staters on Expanded Medicaid used it for treatment in the past fiscal year.
More than 30,000 have received mental health treatment and/or medication. Nearly 12,000 have used their benefits for hospital stays, and more than 10,000 have sought treatment for a substance use disorder. About 30,000 have sought care for COVID-19, and nearly 64,000 people have used their coverage at pharmacies.
Granite benefited from state hospitals.
When hospitals treat a patient without insurance, they use their revenue and state funding to cover costs. The analysis found that state hospitals have seen these unpaid costs decrease since the inception of expanded Medicaid.
It cited results from the New Hampshire Hospital Association showing the average cost of unpaid care fell from $157 million across 2012-2014 to $65.1 million across 2017-2019. The analysis found that these savings allow hospitals to remain open and avoid curtailing services. This, in turn, helps preserve healthcare options for all.
The advantage of granite saves taxpayers money.
Yes, the state has spent more than $200 million since 2015 on expanded Medicaid. But because the federal government bears 90 percent of the cost of the program, it has seen a decline not only in what it sends to hospitals for unpaid care but also in what it spends on other services. This includes healthcare for inmates, the analysis said.
Traditional Medicaid covered just under 7 percent of the medical care provided to inmates by community-based providers. According to the analysis, Medicaid’s generous compensation saved the Department of Corrections $10.2 million between 2015 and 2021.
The state has been inventive in covering its share of expanded Medicaid.
State officials maintain that the General Fund, which pays for nearly all state services, is not paying for Medicaid expansion. This is technically correct.
In 2022, insurance companies will pay a large portion, about $31 million, of Medicaid’s expanded costs. The state has drawn just over $10 million from the Alcohol Abuse, Prevention, and Treatment Fund, and $8.7 million from Liquor Commission funding to cover some of its cost. Most of the remaining funding came from the previous year’s surplus or money returned to the program.