NHDP - ICYMI: Time to expand Medicaid options

Key Point: "That cost gets picked up by those who already have insurance in the form of higher rates to subsidize those who don’t. If that’s the model Republicans favor, they they should vote against Medicaid expansion, but we think it would be foolish – at this point, anyhow – for a penny-pinching state that has to watch every nickel to leave millions of dollars on the table. We hope lawmakers – especially Republicans in the Senate – give strong consideration to voting for Medicaid expansion, imperfect as it may be."

Telegraph Editorial: Time to expand Medicaid options

[http://www.nashuatelegraph.com/opinion/editorials/1020474-465/time-to-expand-medicaid-options.html]
Tuesday November 5,2013 
 
There may well be good reason for New Hampshire’s Republican state senators to vote against expanding Medicaid when it comes up during the special legislative session that starts this week, though we can think of about 23,000 reasons to vote for it, too.
 
That’s the number of uninsured adults – among the state’s poorest – that experts believe will be eligible to receive health care benefits if the state goes along with expanded Medicaid as part of the Affordable Care Act. Experts also believe that people who would leave private insurance for Medicaid would push the final number to 48,000.
 
Most Republicans are repulsed by the idea that people will leave private insurance arrangements for a government-funded program and we can understand that. But here’s something everybody likes: money.
 
Gov. Maggie Hassan, a Democrat who has led the charge to get the state to expand Medicaid, says the state is leaving a $1 million in federal money on the table for every day it delays.
 
For the first three years, the cost of treating the poor under Medicaid would be picked up by the federal government. Federal officials say they would then gradually cut that back to pay for 90 percent of the costs over the long haul.
 
Republicans are skeptical and many believe the feds will leave states holding the bag down the road, much as they did with special education costs. We think they’re getting ahead of themselves in that regard.
 
We realize (unlike some in Congress, perhaps) that federal money is real money, too. But not accepting that money isn’t going to make a bit of difference in the federal debt at this stage. It has already been allocated. Telling Washington we don’t want it just means more is available for other states and that New Hampshire’s poorest residents will continue to wait until they’re really sick and show up to be treated at at local emergency rooms. That cost gets picked up by those who already have insurance in the form of higher rates to subsidize those who don’t.
 
If that’s the model Republicans favor, they they should vote against Medicaid expansion, but we think it would be foolish – at this point, anyhow – for a penny-pinching state that has to watch every nickel to leave millions of dollars on the table. We hope lawmakers – especially Republicans in the Senate – give strong consideration to voting for Medicaid expansion, imperfect as it may be.
 
To be fair, Senate President Chuck Morse, R-Salem, has not been dismissive of the need to get low-income residents access to affordable health insurance. In private talks, he’s trying to convince Gov. Hassan and House Speaker Terie Norelli, D-Portsmouth, to give many of these residents private insurance, with federal Medicaid money used to wrap around that benefit.
 
His concern from the beginning has been that adding another near-50,000 citizens to Medicaid will make an already expensive state program unaffordable in the long term.
 
The key question surrounding this issue has always been how accommodating the Obama administration might be to changes to the program that given these citizens private – rather than government-subsidized – health care. To date, four states have been granted waivers from the traditional Medicaid program.
 
Adding a political wrinkle to the mix, the Republican Liberty Caucus last week threatened to mount a primary challenge against any Senate Republican who votes in favor of Medicaid expansion.
 
That threat seems fairly unlikely.
 
First off, we suspect there isn’t going to be a stampede of hopefuls willing to spend lots of their own money to run against incumbents for a job that pays a measly hundred bucks a year. So that cuts down the field considerably, right there.
 
Second, the last we looked, there wasn’t a groundswell in the state to recruit clones of the discredited Sen. Ted Cruz into office. Obamacare might be the biggest rollout disaster since Ford debuted the Edsel, but there’s no evidence thus far to suggest that it has caused most New Hampshire voters to abandon all reason, either.