Committee to Study Medicaid Expansion Has Begun Work

After the NH House of Representatives voted in favor of providing 58,000 NH residents with health insurance by expanding Medicaid and all 13 Republican members of the NH State Senate voted against doing so, the House and Senate agreed to establish a special Commission to Study the Expansion of Medicaid.  

 Members of the Commission include 3 state senators (including State Senator Nancy Stiles from Hampton, who voted against expanding Medicaid), 3 state representatives (including Rep. Tom Sherman from Rye/Newcastle, who is a doctor and voted in favor of expanding Medicaid), 3 members of the public and the commissioners of insurance and health and human services.

 The Commission must report its findings to the Governor, President of the Senate and Speaker of the House by no later than October 15.  The House and Senate will then have to vote on any recommendations that the commission proposes.

 Toward that goal the commission has already held three meetings.  Presentation materials, audio recordings and minutes from those meeting are available on the Commission Web Site: http://www.dhhs.nh.gov/sme/index.htm. Additional meetings (and topics to be covered) are scheduled for:

 Medicaid presently provides health and long-term care services to approximately 170,000 NH residents annually.   These are primarily children aged 0 -19, some low income parents and elderly citizens, pregnant women and individuals who are disabled.  The state and federal government share in the cost of providing these benefits 50 -50. 

 The expansion of Medicaid coverage is an important part of the Affordable Care Act ("Obamacare"). The federal government will pay 100% of the cost for the first 3 years which will decrease on a sliding scale to 90% of the coverage cost in the 7th year (2020) and thereafter.   58,000 NH residents - many of whom already work and pay taxes but do not have access to affordable health care - will be eligible to participate; removing the fear of a catastrophic health emergency from their lives, improving their productivity; and -ultimately- reducing costs for all of us. 

 It is projected that the state of NH's share of the cost between now and 2020 to provide these benefits will be approximately $ 18 million.  However, there are potential additional savings that could result in total  net savings of approximately $45 million. 

 During this same period, the state will receive $2.5 billion worth of federal funds.  That represents additional purchases of goods and services and an estimated 5,000 new jobs for NH residents and businesses. Those are federal tax dollars that NH residents have paid and are entitled to. If we do not take advantage of these funds they will go to other states.  Click Here For a Detailed Financial Analysis Presented to the Commission

 There are currently 170,000 uninsured people in New Hampshire; 34,000 of these live in Rockingham County.  By refusing to act on Medicaid expansion earlier this year, Republicans in the NH State Senate have not only placed in jeopardy the ability of 58,000 of these individuals to obtain healthcare coverage on January 1, 2014 but also much needed investment in our economy.  The longer we delay the fewer federal dollars we will receive and the higher the costs and lower the economic benefits to our state.

 Two of the state senators who voted against Medicaid expansion earlier this year (Senator Sanborn of Bedford and Senator Stiles of Hampton) are members of the commission.   They are joined by Rep Neal Kurk of Weare and Charles Arlinghaus,President of the Josiah Bartlett Center for Public Policy who both have also expressed opposition to Medicaid Expansion.   

 Opponents of Medicaid expansion have argued that it will create another "unfunded federal mandate" and the State of New Hampshire will ultimately have to pay the full cost of providing these benefits.  That is not true.  Although the federal government has not fully funded some programs, it has never reneged on its obligations to pay its share of Medicaid program expenses.  In addition, under the Affordable Care Act, if at any point, NH wishes to withdraw from the Medicaid Expansion program we are free to do so.

 Some opponents have talked about lowering the current income eligibility threshold from 138% of the federal poverty level (which is $15,856 for an individual and $32,499 for a family of four) to some other lower - say 100% of federal poverty - level as a way to reduce the cost of the program.   Not only is this not permitted under federal law but how can anyone possibly believe that someone earning $15,856 is somehow "overpaid?"

Along those same lines, some opponents have also argued that they want to encourage people who qualify for Medicaid to purchase private insurance to "maintain that segment of the state's business community. "  The fact of the matter is that someone earning $15,856 or trying to support a family on $32,499 already cannot afford private insurance with or without some form of state subsidy.  Furthermore, the mandate for all individuals to have health insurance that will go into affect on January 1, 2014 will provide significant additional business (and income and profits) for private insurance carriers and is - quite frankly - one of the reasons why private insurance companies were so supportive of the Affordable Care Act when it was enacted in 2010.

 Senator Stiles is on record as saying that she wants to "move forward with [Medicaid Expansion] in the right way."  Hopefully, she and her fellow commissioners will be able to craft a "way forward" that will not restrict the rights of everyone who is eligible to participate in this program and not delay implementation any more than it has already been delayed.   If so, I look forward to voting in favor of the commission's recommendations when they are presented to the NH House of Representatives later this fall and I hope that my colleagues in the state senate will do so as well.