What Will The NH Senate Do About Medicaid Expansion?

Written by Matt Murray from the NH Labor News.  
Originally posted on the NHLaborNews.com 

New Hampshire is at what is unfortunately shaping up to be an ideological crossroad. Do we as a state expand Medicaid or not.

Both the left and the right agree that expanding Medicaid would help tens of thousands of Granite Staters.  They quibble over the number of people who are uninsured versus the number of under-insured who would leave private insurance for Medicaid.  Obviously having Medicaid (which has no cost to the resident) is better that paying a premium for private health insurance.  Then again you have to be living at the poverty level already to qualify for Medicaid.

There are other disagreements in this debate.  One of the main reasons that people are opposed to expanding Medicaid is because they do not pay healthcare providers as much as private insurance.  Hospitals say that the difference between Medicaid payments and private insurance is a loss. Yet even with those losses the NH Hospital Association is pushing for the expansion.  Why, because a lower payment for care, is better than no payment for care.

The Affordable Care Act marketplaces (or exchanges) do not provide subsidies to everyone.  Medicaid is also a very restrictive program when it comes to who qualifies. Expanding Medicaid will bring the two programs closer together.  These are the very poor. These are the people who could not afford to buy healthcare even if they had the option.  They are children, pregnant women,  seniors, and people with disabilities.

Here is where the ideology comes into play.  The Medicaid expansion is part of the Affordable Care Act (aka Obamacare).  With the expansion comes large amounts of federal funding. In fact the federal government has agreed in the law to pay 100% of the  costs for expanding Medicaid for three years. Then they will pay 90% from then on.

The opponents of the Medicaid expansion want you to believe that the federal government will not uphold their end of the deal.  They say that they will not pay the 100 percent as they say they would.  Here is the deal, this is a federal law.  There is no question about whether or not they are going to pay for it, they have to.  The only way out of it, is to change the law. After 37 attempts to repeal it, the law is not going away.

Every day there is news about how the new ACA marketplaces are going to save middle to low-income families vast amounts of money in their healthcare costs.

Opposing the expansion means that NH will lose out on $250-$300 million dollars in federal funding. Once again the opponents are attempting to detour the expansion by using the federal deficit. They are trying to say that expanding Medicaid is the reason we have a deficit problem.  This is an ideological fight that neither side can win.  The right wants austere cuts to social programs to reduce the budget, while the left wants to cut defense spending and re-invest in America.  The opponents of the ACA seem to be overlooking that even before the ACA is fully implemented it is already saving the federal government hundreds of millions dollars.

Here is the best part of the Medicaid expansion. If for some reason the federal government does not fund the program at 100% like they say, NH can immediately go back to the previous levels.  They can back out of the expansion at any time. The US Supreme Court already ruled that Medicaid expansion was not mandatory under the ACA. The means the expansion is voluntary, and NH can walk away at any if the program fails for any reason.

I implore the NH Senate to listen to the people of New Hampshire who need your help.  Listen to the over 25,000 low wage workers who would benefit from this expansion. They need you to vote to expand Medicaid.  Listen to the hospitals who in favor of the expansion, because some reimbursement is better than no reimbursement.  Do not leave 22,000 needy families without healthcare another day.