For more than a year, I have been trying to come up with creative ways to describe the thoughtlessness of states’ decisions to not expand their Medicaid programs under the Affordable Care Act. It took a stats website to lead me to my most creative comparison yet.

I am a big fan of the website fivethirtyeight.com. Started as a project by uber-stats wiz Nate Silver, the website uses interesting statistical methods to analyze and report on everything from sports to politics to pop culture. I love it because it helps me appreciate the sometimes subtle links between seemingly unrelated phenomena. Last week, I was reading an article on the site about relatively unknown state governors when a strange comparison came to me.

With the federal government picking up 100 percent to start, then later 90 percent of the cost of the Medicaid expansion, and a plethora of academic studies showing the significant economic impact of enacting the Medicaid expansion, this decision would appear to be a “no-brainer.” Yet as of today, nearly half of the states in the union continue to refuse the Medicaid expansion, putting millions of vulnerable people at risk.

The comparison that came to mind for me was of an American League baseball team voluntarily choosing not to use a Designated Hitter (DH).

If you have no idea what a DH is, I’ll give you the one paragraph primer. Here it goes: In professional baseball, pitchers tend to be really bad at bat (average batting average of a pitcher in 2013: .146). So, roughly 40 years ago, the American League decided to allow pitchers to not have to bat, placing a designated hitter – who does not otherwise field the ball – in their place. They are generally pretty good batters (average batting average of a DH in 2013: .267).

The National League does not allow for DHs. In interleague games (including the World Series), the rule is dependent on the location – DHs are allowed in American League ballparks, and disallowed in National League parks.

The differing rules between the two leagues has engendered significant debate over the last 40 years, with strong opinions on both sides. DH supporters argue that their presence makes the game more fun to watch, since it clearly increases offense in a game that for many people can be a bit slow. DH opponents argue that it makes the game less “pure” by not requiring well-rounded players.

Yet, no one that I have seen has made the argument that some teams should choose to forgo using a DH when their opponent is using one in the same game. In 2013, American League teams (playing with a DH) scored 0.23 more runs per game than their National League counterparts (playing without a DH). This may not sound like much, but over the course of a 162-game regular season, this adds up to a little over 37 runs).

In 2013, the Washington Nationals came in second in the National League East, scoring just 32 runs fewer than the Atlanta Braves, who won the division. Those additional runs – particularly if they came in games versus the Braves – could have made the difference between the Nationals staying home during the playoffs and making a run at the World Series. Suffice it to say, no Major League Baseball manager would forgo 37 runs of offense if they could avoid it.

Yet, in the hyper-competitive world of modern state economics, when each governor and legislature works hard to bring employers to their states, that is effectively what nearly half the states have done.
State policymakers are unilaterally disarming against their competitors, allowing other states to reap significant economic benefits – and draw new employers – while doing nothing to keep up. Actually, the situation is even worse:

Since the Medicaid expansion is almost entirely paid for by federal tax dollars, taxpayers in Texas, Florida, Georgia, and the other non-expansion states are actually paying for Medicaid expansions in expansion states. The corollary in baseball would be if the Pittsburgh Pirates were actually paying part of the salary for the Detroit Tigers’ DH. The Tigers, by the way, beat the Pirates’ three games to one in a series earlier this month. The DH, Victor Martinez, went 6-for-12, scoring three times and batting in three runs during the series.

Getting beat by one of the best batters in baseball is one thing, but actually paying for the honor of getting beat is another. That is effectively what taxpayers in non-expansion states are doing – paying for other states to beat them in the never-ending political struggle to bring jobs and economic growth to their communities.