National Health Law Program

Three years of all recipient programs/support at FY2025 audited resource cost including donated legal labor. One national implementation pathway quantified; other portfolio net health set zero, not a proven lower bound. Public treatment and wider social costs excluded.

50-state/DC resident beneficiaries only; no headquarters share or California-only allocation. Immigration status does not exclude resident health. Territorial/foreign spillovers not counted.

A=sum(t=start..start+T−1)1/(1+discount)^t; V=N*r*u*A; H=V*q; Q_all=b*(p*a*H−h); Q_USA=g*Q_all; Cost=C*Y; Price10=10*Cost/Q_USA if positive. Central start=2,T=2. Local marginal rate assumes proportional capacity adjusted by b.

C

13035827 USD annual recipient resources (observed). Full audited expense, all functions and recognized donated professional services; original review reused from CA worker. [audit25]

Y

3 funding years (judgment). Three-year capacity cohort, not a priced brief; constant latest expense.

N

1900000 annual Medicaid enrollment difference (observed). Published forecast, not realized outcome: Figure 1 2028 8.6m−6.7m and 2029 8.8m−6.9m; visually verified rounded values. Point-in-year forecast treated as sustained for a full year; this is a temporal approximation, not an observed person-year integral. [nhelp-manatt]

r

0.5 realized/remediable share of forecast (judgment). Half allows forecast error, narrower remedy and incomplete state implementation. [nhelp-manatt] [nhelp-amicus]

u

0.5 share genuinely preventing uninsurance (judgment). Half allows other public/private insurance and enrollment-accounting differences. Effective health among newly insured is separately q. [oregon]

q

0.02 QALYs per additional insured year (judgment). .02 transfer below Oregon's .05 self-rated mapping. No separate mortality, depression or financial benefit added. Assumes the utility improvement persists throughout each credited insured year. [oregon]

p

0.1 incremental coalition probability/intensity improvement (judgment). Ten percentage points from further coalition work over three years beyond baseline public action; not overall litigation success probability. [nhelp-prepare] [nhelp-cms]

a

0.1 NHeLP share of coalition effect (judgment). Ten percent recognizes co-authorship and national expertise; 90% remains with states, other counsel and organizations. Not 1/71 arithmetic or filing credit. [nhelp-amicus] [cases]

b

0.25 marginal capacity additionality (judgment). Quarter allows grants, reserves and other donors; local linearity could fail and zero is possible. [audit25] [careers]

start

2 first benefit year (judgment). Year two approximately 2028, allowing preparation lag; no first-year credit.

T

2 benefit years (judgment). Two years approximately 2028–29 then paths reconverge; no perpetual entitlement credit.

discount

0.03 annual discount fraction (judgment). 3% applied by health event year; no remaining-life multiplication.

g

1 resident share of modeled population (judgment). Population explicitly defined as resident beneficiaries in 50 states/DC; no foreign or territorial spillovers. [nhelp-manatt]

h

0 other net health harm before b (judgment). Net zero for unpriced portfolio and public-resource displacement, not established zero; adverse sensitivities independent of p*a.

Weak-confidence national implementation estimate: Cost: $39.1M; USA QALYs: 44.12126725156421; all-population QALYs: 44.12126725156421. {"C":13035827,"Y":3,"N":1900000,"r":0.5,"u":0.5,"q":0.02,"p":0.1,"a":0.1,"b":0.25,"start":2,"T":2,"discount":0.03,"g":1,"h":0}; A=1.857737568486914; conditional discounted insured person-years=882425.3450312841; conditional QALYs=17648.50690062568.

Broader sustained effect: Cost: $39.1M; USA QALYs: 7405.326138414443; all-population QALYs: 7405.326138414443. {"C":13035827,"Y":3,"N":1900000,"r":1,"u":0.8,"q":0.05,"p":0.3,"a":0.15,"b":0.6,"start":2,"T":4,"discount":0.03,"g":1,"h":0}; A=3.608833400786766; conditional discounted insured person-years=5485426.7691958845; conditional QALYs=274271.33845979423.

Very weak influence and access: Cost: $39.1M; USA QALYs: 0.0017909322273541334; all-population QALYs: 0.0017909322273541334. {"C":13035827,"Y":3,"N":1900000,"r":0.1,"u":0.2,"q":0.005,"p":0.02,"a":0.01,"b":0.05,"start":2,"T":1,"discount":0.03,"g":1,"h":0}; A=0.9425959091337544; conditional discounted insured person-years=35818.644547082666; conditional QALYs=179.09322273541332.

Use .05 health mapping: Cost: $39.1M; USA QALYs: 110.30316812891056; all-population QALYs: 110.30316812891056. {"C":13035827,"Y":3,"N":1900000,"r":0.5,"u":0.5,"q":0.05,"p":0.1,"a":0.1,"b":0.25,"start":2,"T":2,"discount":0.03,"g":1,"h":0}; A=1.857737568486914; conditional discounted insured person-years=882425.3450312841; conditional QALYs=44121.26725156421.

Only 5% additional capacity: Cost: $39.1M; USA QALYs: 8.824253450312844; all-population QALYs: 8.824253450312844. {"C":13035827,"Y":3,"N":1900000,"r":0.5,"u":0.5,"q":0.02,"p":0.1,"a":0.1,"b":0.05,"start":2,"T":2,"discount":0.03,"g":1,"h":0}; A=1.857737568486914; conditional discounted insured person-years=882425.3450312841; conditional QALYs=17648.50690062568.

No implementation change: Cost: $39.1M; USA QALYs: 0; all-population QALYs: 0. {"C":13035827,"Y":3,"N":1900000,"r":0.5,"u":0.5,"q":0.02,"p":0,"a":0.1,"b":0.25,"start":2,"T":2,"discount":0.03,"g":1,"h":0}; A=1.857737568486914; conditional discounted insured person-years=882425.3450312841; conditional QALYs=17648.50690062568.

No additional health from coverage: Cost: $39.1M; USA QALYs: 0; all-population QALYs: 0. {"C":13035827,"Y":3,"N":1900000,"r":0.5,"u":0.5,"q":0,"p":0.1,"a":0.1,"b":0.25,"start":2,"T":2,"discount":0.03,"g":1,"h":0}; A=1.857737568486914; conditional discounted insured person-years=882425.3450312841; conditional QALYs=0.

Only substitute existing financing: Cost: $39.1M; USA QALYs: 0; all-population QALYs: 0. {"C":13035827,"Y":3,"N":1900000,"r":0.5,"u":0.5,"q":0.02,"p":0.1,"a":0.1,"b":0,"start":2,"T":2,"discount":0.03,"g":1,"h":0}; A=1.857737568486914; conditional discounted insured person-years=882425.3450312841; conditional QALYs=17648.50690062568.

No policy benefit plus 50 QALYs harm: Cost: $39.1M; USA QALYs: -12.5; all-population QALYs: -12.5. {"C":13035827,"Y":3,"N":1900000,"r":0.5,"u":0.5,"q":0.02,"p":0,"a":0.1,"b":0.25,"start":2,"T":2,"discount":0.03,"g":1,"h":50}; A=1.857737568486914; conditional discounted insured person-years=882425.3450312841; conditional QALYs=17648.50690062568.

200 QALYs other net harm: Cost: $39.1M; USA QALYs: -5.878732748435787; all-population QALYs: -5.878732748435787. {"C":13035827,"Y":3,"N":1900000,"r":0.5,"u":0.5,"q":0.02,"p":0.1,"a":0.1,"b":0.25,"start":2,"T":2,"discount":0.03,"g":1,"h":200}; A=1.857737568486914; conditional discounted insured person-years=882425.3450312841; conditional QALYs=17648.50690062568.

Twofold future cost: Cost: $78.2M; USA QALYs: 44.12126725156421; all-population QALYs: 44.12126725156421. {"C":26071654,"Y":3,"N":1900000,"r":0.5,"u":0.5,"q":0.02,"p":0.1,"a":0.1,"b":0.25,"start":2,"T":2,"discount":0.03,"g":1,"h":0}; A=1.857737568486914; conditional discounted insured person-years=882425.3450312841; conditional QALYs=17648.50690062568.

Counterfactual: Existing state litigation, other amici, public administrators, grants and clinical care continue. Only further work's change in strict versus less restrictive administration counts, not repeal or all losses. r removes forecast/remedy overreach, u removes replacement coverage, b removes financial substitution.

Attribution: p=.1 incremental coalition contribution, a=.1 NHeLP share and b=.25 funding additionality are separate subjective factors. Current amicus and strategy show a live role but identify none of them. Existing work receives no automatic future-donation credit.

Weak-confidence best-estimate opinion, not measured return or statistical interval. Root may reject numeric acceptance if these judgments are insufficiently supported. Policy influence and funding additionality dominate; zero/harm explicitly retained.

Sensitivity

• Conditional central H=17,648.51 QALYs; p*a=.01 and b=.25 reduce this to 44.12. Expected discounted attributable insured person-years are 2,206.06, not millions of observed recipients.
• At other central inputs, p*a must exceed .088636 for $1 million per 10 USA QALYs, or .886364 for $100,000; central .01. These are requirements, not evidence of achievable influence.
• Halving q or u doubles the price. A Medicaid enrollment forecast cannot replace genuinely additional insured person-years.
• Other net harm above 176.485 QALYs over the three-year cohort erases central benefit before b; harm is not discounted by policy success probability.
• The favorable four-year case is finite, not perpetual. Setting p, q or b to zero removes this pathway.
• A social comparison needs public payer costs, uncompensated-care transfers, provider capacity and alternative government uses; recipient price does not include those.
• If the point-in-year enrollment difference persists for only half of each modeled benefit year, health is halved and cost per 10 QALYs doubles. This temporal assumption is distinct from replacement coverage.

Unresolved inputs

• Costed unfunded implementation plan and staffing/output response given current grants and reserves.
• Case/administrative outcomes with and without incremental NHeLP capacity, separate from states and other counsel.
• Actual state implementation, remedy scope, duration, uptake and alternative coverage.
• Current beneficiary utility, public treatment/opportunity costs and other portfolio health/harms.