NHDP - ICYMI - Editorial: Expanding Medicaid makes sense

Key Point: "Republicans in both the House and Senate spent Wednesday throwing obstacles at efforts to move the state forward.  Instead, they should have been focusing on how best to control health care costs and provide care to those who need it most. Expanding Medicaid — at no cost now, and eventually moving those who enrolled to private plans when more choices become available — would help accomplish both goals.  We hope when the issue is resurrected — presumably in January when the Legislature reconvenes — the Senate leaders are willing to remove the obstacles."

Keene Sentinel Editorial: Expanding Medicaid makes sense

And so what began as a promising special session of the New Hampshire Legislature ended Thursday with nothing more accomplished than partisan political sniping.

The session was called to deal with one goal, to allow for the expansion of the state’s Medicaid program to include those earning up to 138 percent of the federal poverty level. That would mean providing basic health care coverage to an additional 50,000-60,000 Granite Staters.
The move was mandated under 2010’s Affordable Care Act, but as the U.S. Supreme Court determined the law to be constitutional last year, it also gave states the leeway to opt out of the expansion. Last spring, the N.H. House backed the expansion, while the Senate dragged its heels, so a compromise was reached — a panel was created to study the issue.
That panel’s report backed the expansion, but with some sensible caveats: Those who can enroll in a health plan other than Medicaid must, and the state should have the option of revisiting the issue if the federal government doesn’t cover its share of the costs.

Not enough, say Senate President Chuck Morse and Majority Leader Jeb Bradley. They’ll back the expansion only if it fast-tracks moving the bulk of those eligible for Medicaid onto private plans set up through the ACA.
The problem is those plans don’t exist yet, save for a sole offering for 2014 from Anthem. Gov. Maggie Hassan and the Democrats expect it will take at least three years to get some real choice there, and that’s the timetable they proposed. Not coincidentally, the ACA calls for the federal government to pay 100 percent of the state’s Medicaid expansion cost for the first three years, then reducing that reimbursement to 90 percent by 2020.

The idea behind the ACA to begin with was that providing affordable access to health care to everyone will drive down costs for all. A Kaiser Family Foundation report on the impact of Medicaid expansion on states’ economies indicates those states expanding the program will see costs fall in 2014, which it attributes to “reductions in spending for state funded services such as mental health, corrections health, uncompensated care or care from other state programs for the uninsured.”

In other words, expanding Medicaid will reduce the state’s costs in other areas. Even if the state were left on the hook eventually for 10 percent of the cost of those who gain access to, and remain on, Medicaid through this expansion (and our bet is that would be a relatively small number), the cost would be outweighed by savings to the courts, corrections, and Health and Human Services budgets.

The position of Morse and Bradley, then, — that the state would be on the hook for tens of millions of dollars in added “entitlements” — sounds like a straw man argument.

Republicans in both the House and Senate spent Wednesday throwing obstacles at efforts to move the state forward.

Instead, they should have been focusing on how best to control health care costs and provide care to those who need it most. Expanding Medicaid — at no cost now, and eventually moving those who enrolled to private plans when more choices become available — would help accomplish both goals.


We hope when the issue is resurrected — presumably in January when the Legislature reconvenes — the Senate leaders are willing to remove the obstacles.