States' varied, rocky paths to Medicaid expansion

GOP-controlled Michigan approves provision while study casts doubt on N.H. expansion
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The Republican-controlled Michigan Senate voted 20-18 to expand Medicaid in accordance with healthcare reform Tuesday, the Lansing State Journal reports. Meanwhile, in New Hampshire, a new study indicates that Granite State hospitals may take a $200 million loss by expanding the program while Arizona, another state whose Republican governor supports the expansion, stands to net millions from it, according to the Arizona Daily Sun.

Michigan Gov. Rick Snyder, a Republican, has long gone against the mainstream of his party in pushing for the expansion. According to the State Journal, Snyder praised the vote, saying the expansion "will make our state healthier and stronger. It also will save money for the state's taxpayers and job providers, help control medical costs, improve the state's business climate, and boost our economy. All of these are crucial to continue Michigan's comeback."

Because the expansion was not passed with a two-thirds majority, it will not go into effect until next year, the State Journal reports.

New Hampshire, meanwhile, has a Democratic governor but a divided legislature, with Democrats controlling the House but Republicans controlling the Senate. Senate Republicans prevented the authorization of the expansion in a budget bill, calling for a commission to study its potential effects, according to the Associated Press.

A study released by the Lewin Group found that, due to the expansion shifting providers from private insurance to Medicaid, hospitals would lose up to $228 million from 2014 to 2020; although revenues would partially increase for individual doctors and clinics, the study found there would be an overall net loss of $45 million a year among providers. Henry Lipman of the New Hampshire Hospital Association, which supports the expansion, dismissed the study as using "old information," the Associated Press noted.

In Arizona, where Gov. Jan Brewer signed the expansion into law in June, the Arizona Daily Sun reports a state study determined hospitals should net $108 million in the first half of 2014. But Jim Haynes, COO of the Arizona Hospital and Healthcare Association, cautioned that the gain estimates are based on 2011 numbers, which may affect their accuracy.

Legislative fights over the expansion, particularly in Republican-controlled states have generated anxieties over the loss of federal funds in some cases. For example, Pennsylvania is unlikely to implement the expansion by 2015 even if Gov. Tom Corbett comes out in favor of it. Last June's Supreme Court decision upholding the healthcare reform law potentially further complicated the expansion process by declaring it optional at the state level.

To learn more:
- here's the AP's coverage of the New Hampshire Medicaid fight
- here's the Daily Sun article
- read the Lansing State Journal article
- check out the Lewin Group's study

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