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Editorial: Expanding Medicaid is a good deal

Gov. John Lynch held a wide-ranging discussion with the Monitor editorial board this week and, in classic Lynch fashion, shined a businessman’s light on decisions facing the state. One of those decisions is whether to take the federal government up on its offer to expand Medicaid enrollment to anyone with an income below 133 percent of the federal poverty level. The feds are offering to foot the whole bill for expanded coverage for the first three years and then gradually reduce their share to 90 percent in 2020.

It’s a deal that lawmakers should take, Lynch said. We agree. For just $133 per person per year, according to a state Health and Human Services Department estimate, as many as 60,000 uninsured New Hampshire residents could get health coverage. Some estimates place the cost to the state much higher, but much depends on how many of those eligible for expanded Medicaid coverage take advantage of it.

It’s theoretically possible, as opponents of expansion fear, that a future Congress could reduce or eliminate the federal contribution to Medicaid. Politically, however, once the program is up and running in a majority of states, that would be difficult if not impossible.

Expanding Medicaid to provide low-income residents with not just access to care when they’re injured or ill, but also with routine health care that may prevent illness, is the moral thing to do. Like Lynch, Gov.-elect Maggie Hassan favors the expansion. But expanding Medicaid is also a sound financial decision, in part because if New Hampshire doesn’t, the state will lose about $1.1 billion in federal payments that would stimulate the economy, create jobs, and slow the increase in health insurance premiums.

Currently, about one in 10 New Hampshire residents is covered by Medicaid. Most of them are children and indigent elderly residents in nursing homes. Expanding Medicaid would add tens of thousands of adults with incomes too low to afford even federally-subsidized insurance to the Medicaid rolls. Right now, many of those adults go to the emergency room when they need care. Not only is the cost of care in that setting inordinately expensive, but hospitals are rarely paid for delivering it. The loss is enormous; more than $100 million per year for Dartmouth-Hitchcock Medical Center alone. The bill for uncompensated care must either be written off or passed on to insured patients and their employers in the form of higher premiums. If Medicaid is expanded, hospitals will see their losses from uncompensated care shrink dramatically, as will the need to shift costs to the insured.

Savings will come simply from removing the financial barrier that keeps low-income people from seeking medical care until they’re really ill and treatment is costly. More money will be saved because when more of the poor have access to care whose cost is borne largely by the federal government, state spending on public health services should shrink. The switch to managed care for most of the state’s Medicaid population is also expected to reduce health care spending. That transition, and the savings that should result, will be threatened if Medicaid isn’t expanded, since the companies offering coverage were figuring the bigger insurance pool into their calculations.

It’s possible that the combined savings from expanding Medicaid could exceed the state’s share of the cost of the expansion. Lawmakers would be foolish not to do the right thing by low-income residents and expand coverage, especially when doing so has the potential to save money and lives.

Legacy Comments5

The entire health reform package was focused on increasing eligibility and did not address costs. Why are we not able to have interstate competition to obtain health insurance? Why does NH only have two health insurance companies? Why can I buy the same BC-BS coverage in California for half of what I pay in NH? What is magical about 133% of poverty level and is that poverty level a real number that takes into consideration the other benefits the recepient might receive? Those of us that still work and still pay taxes are tired of those who think they are entitled to everything and don't work to earn it. Where is the reward for hard work when our money goes to deadbeats?

One has to only look at what this article says. Expanding Medicaid does not produce revenue. Someone has to pay for those costs. Taxes need to go up. And guess what, that means that taxes go up for everybody who works, and that means middle class folks. Nobody is adressing the issue of how the govt is cutting the costs given to health care providers for these patients. Some health care places are starting to refuse to accept medicare and medicaid patients because the govt is cutting how much they pay them. Already happening. Fine to be covered by medicare and medicaid, but when health care services stop accepting folks on those programs, where do you get your health care? We see it with places being picky about what insurance they accept. They dump the insurance companies who do not pay the prices for services for ones that pay a higher price for that service. I go to the Doc and see a sign that says we no longer accept this particular insurance. With the govt paying, they have to ration how much they pay for services to make sure the program works. Mark my words you will see many health care places dump medicaire and medicaid patients.

Its a great deal. There are self-centered conservatives who oppose this sort of aid, tarring it "socialism," but taking care of the elderly and infirm is one of the most important things government can do. Most families do not have the resources to care for an elderly relative with dimentia or other condition who needs 24 hour care, and Medicaid is a lifesaver for them. Certainly, we need to be ever vigilant to keep costs in check and to continually look for efficiencies and ways to cut health care costs, but throwing our elderly on the rubbish heap is not an option. A society that does not collectively care for its weakest and most helpless members is not a society worth preserving.

The problem is that too many conservatives, especially many of the same usual suspects who makes daily posts on this site live, in a perpetual state of cognitive disconnect. They rail about "socialized" medicine, but see no issue in receiving Medicare, Tri-Care or V.A. medical care. Frankly, I think it is simply an issue of these types of people who say "I have mine and the heck with you."

The Conservatives actually seem to love socialized medicine - in China. Guys like Romney avoid paying employee health care insurance premiums here, along with all US payroll taxes on Medicare, Medicaid, and Social Security, by outsourcing our jobs to China, where none of those burdens are placed on employers. Their love of socialized medicine in China allows them to make big profits by undercutting the prices of products made in America. Then they really love their huge huge Reagan and Bush top bracket double whammy tax cut entitlements. I think voters are beginning to become immune to gas caused by the Republican magic beans. If this continues we may be able to help solve our job outsourcing and deficit problems by socializing health care here.

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