January 2013
New Hampshire Department of Health & Human Services (DHSS)
Lewin contact: Randy Haught
As a result of the June 2012 Supreme Court ruling that the federal government cannot require individual states to expand their Medicaid programs for adults under the Affordable Care Act (ACA), The Lewin Group is working with the New Hampshire Department of Health and Human Services (DHHS) to explore the potential financial impacts of expanding or not expanding the state’s Medicaid program.
Phase I of the study, released in November 2012, analyzes Medicaid enrollment and costs under the option of not expanding Medicaid compared to the option of expanding the program under various program design options. We find that if the state does not expand Medicaid, it could reduce state Medicaid spending by $66 to $114 million over the 2014-2020 period. However, expanding Medicaid would (1) reduce the number of uninsured in the state by an additional 22,300 people, (2) provide subsidized coverage for low income adults in the state, who would not have access without the expansion, and (3) increase federal revenues in the state by $1.8 to $2.7 billion over the 2014-2020 period.
This report represents Phase II of the study, where we estimate the secondary effects of expanding versus not expanding Medicaid in the state. We estimate the impact of Medicaid expansion versus no expansion on other state programs, the uninsured, various provider groups, the state economy, and the commercial market. Here, we find that deciding to expand or not expand Medicaid in New Hampshire will have impacts beyond the state’s Medicaid program itself. If expanding Medicaid under a fee-for-service program, the state will see offsets (savings) to other state programs totaling $67.1 million from 2014 to 2020, reducing the total cost of expanding Medicaid to $18.4 million over this period. If expanding Medicaid under a managed care program, the state would save $47.1 million from 2014 to 2020, compared to projected costs without the ACA.
Phase II findings also indicate that the ACA will have a measurable, positive impact on the state economy at large, and expanding Medicaid will maximize this impact. The 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.
Client Area: State and Local Governments
Expertise Area: Medicaid and CHIP
December 2012
Lewin contact: Grace Yang
Lewin senior researchers just published an article in the December 2012 issue of Health Affairs on the long-term health and economic implications of smoking cessation in the Military. The article, "Simulation Of Quitting Smoking In The Military Shows Higher Lifetime Medical Spending More Than Offset By Productivity Gains" is based on a Lewin study for the Department of Defense using Lewin's Health Promotion Microsimulation Model. The study found that cessation accompanied by weight gain would increase average life expectancy by 3.7 years, and that the average lifetime medical expenditures would increase slightly as a result of prolonged life. Avoidance of weight gain after quitting smoking would increase average life expectancy by four additional months and reduce mean extra spending. Overall, the average net lifetime health care cost increase of $1,700 or less per ex-smoker would be modest and, for employed people, more than offset by even one year’s worth of productivity gains. These results boost the case for smoking cessation programs in the military.
Client Area: Federal Government
Expertise Area: Chronic Disease / Cost of Illness
November 2012
Health Strategies of New Hampshire
Lewin contact: Randy Haught
As a result of the June 2012 Supreme Court ruling that the federal government cannot require individual states to expand their Medicaid programs for adults, as under the Affordable Care Act (ACA), The Lewin Group is working with the New Hampshire Department of Health and Human Services (DHHS) to explore the potential financial impacts of expanding or not expanding the state’s Medicaid program. This report provides estimates on Medicaid enrollment and costs under the option of not expanding Medicaid compared to the option of expanding the program under various program design options. We find that if the state does not expand Medicaid, it could reduce state Medicaid spending by $66 to $114 million over the 2014-2020 period. However, expanding Medicaid would (1) reduce the number of uninsured in the state by an additional 22,300 people, (2) provide subsidized coverage for low income adults in the state, who would not have access without the expansion, and (3) increase federal revenues in the state by $1.8 to $2.7 billion over the 2014-2020 period.
In Phase II of the study, to be released in December 2012, Lewin will estimate the secondary effects of expanding versus not expanding Medicaid in the state. This will include the impact of additional federal revenues on the state economy if the state expands Medicaid, the impact on spending for other state programs, the impact on Medicaid Disproportionate Hospital Share (DSH) payments and provider uncompensated care, the financial impact on health care providers, and the potential impact on cost shifting and its effect on commercial premiums.
Client Area: State and Local Governments
Expertise Area: Medicaid and CHIP, Health Reform
August 2012
American Association of Nurse Anesthetists
Lewin contact: Paul Hogan
Certified Registered Nurse Anesthetists (CRNAs), educated with specialized training, skill, and expertise in pain management, provide chronic pain management in rural areas, underserved by physicians and healthcare facilities. CRNA services are often the sole source of chronic pain management services in these areas. If the patients are not able to access care from the local CRNAS, the alternatives are to travel great distances for care from physicians, to have expensive and invasive surgery, or to be institutionalized as a result of untreated pain.
The report discusses four case studies about four Medicare beneficiaries who are currently receiving pain treatment from their local (rural) CRNA. Each case discusses the costs – medical and indirect (non-medical and opportunity cost) – of the current treatment pathway, and alternative pathways that do not include access to a CRNA for chronic pain treatment.
Client Area: Associations
Expertise Area: Health Professionals Workforce
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