March 14--HUDSON -- Expanding Medicaid would be pragmatic, save the state millions in
the long haul and would immediately provide health care coverage to 38,000
people now without it, according to the head of a state hospital association
and an official with a state health care advocacy group.
New Hampshire is considering expanding Medicaid. Legislation that would
bar the expansion is pending before the House of Representatives.
The proposal to expand Medicaid was part of the federal Affordable Care
Act until the U.S. Supreme Court ruled that the federal government can't
require states to expand the coverage. Individual states, including New
Hampshire, are now weighing whether to approve the expansion. Gov. Maggie
Hassan has included it as part of her proposed biennial budget.
Two advocates of the expansion met Wednesday morning with The Telegraph's
editorial board. Tom Bunnell, a consultant with New Hampshire Voices for
Health, and Steve Ahnen, president of the New Hampshire Hospital Association,
said the expansion would provide access to health care for tens of thousands
of residents, many of them waiters, landscapers, hair stylists, custodians and
other workers who toil at low-paying jobs.
Savings in various areas would offset the projected $85 million cost of
the expansion over seven years, they said.
The Affordable Care Act had required all states to extend Medicaid to
residents making up to 138 percent of the federal poverty level, or just under
$30,000 a year for a family of four. Adults earning up to $18,000 a year can
be eligible for Medicaid in New Hampshire, though children can be covered in
families that earn up to 185 percent of federal poverty. The U.S. Supreme
Court ruled the Medicaid mandate was unconstitutional, leaving it up to
governors and legislatures to decide if they wish to participate.
Under the law, Washington will pick up 100 percent of the cost of
benefits for the expanded population from 2014-16, a percentage that will drop
gradually to 90 percent by 2020. States have to pay the cost of administering
the program.
The Lewin Group, a national health care consulting firm, was hired to
analyze the impact of Medicaid expansion on taxpayers. Typically, low-income
people without health coverage rely on visits to hospital emergency rooms
instead of seeing a private doctor, Ahnen said.
"It's not the place where you should get primary care," he said of the
hospital emergency rooms.
Such visits drive up health care costs, he said. But if thousands of
people received health care and saw doctors instead of visiting hospitals,
it's unclear whether people would see reductions in their health premiums, or
whether just the health insurance companies and hospitals would benefit,
Bunnell and Ahnen admitted.
But they said the savings would help businesses and give an overall boost
to the economy.
A number of Republican governors, including Jan Brewer in Arizona and
Chris Christie in New Jersey, have backed the expansion. Bunnell called the
issue "bipartisan" and predicted the Republican-led New Hampshire Senate would
support the measure.
Opponents tend to be highly partisan conservatives vehemently opposed to
"Obamacare," Bunnell said.
"It's very hard to separate ideology and hyperpartisanship from
thoughtful, meaningful opposition," he said.
Opponents distrust the federal government to keep its promise, though it
has never hedged from Medicaid payments, Ahnen said. They also believe
expanding Medicaid would "bust the federal budget, though that's not factually
true," he said.
The bottom line, Ahnen said, is expanding health care coverage by
expanding Medicaid is logical, pragmatic and moral.
"In the end, getting people covered is absolutely the right thing to do,"
he said.
Consider the option of a parent with no health coverage whose child wakes
up in the night crying and in pain, Ahnen said.
"That's a pretty lousy place to be," he said. "What does it feel like as
a parent to deal with that sort of thing?"
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