Alternative to Medicaid expansion discussed; would cost state millions more
Members of the commission studying whether New Hampshire should expand the Medicaid program as authorized by the federal health care reform law got their first look at a uniquely New Hampshire option, presented by Avik Roy, a senior fellow at the Manhattan Institute and blogger for Forbes.
Calling the program “DirectCare New Hampshire,” Roy proposed a fully state-funded program, with no federal involvement, to take the place of expanded Medicaid.
Under the Affordable Care Act, the federal government would pay the full cost of enrolling almost 58,000 people into Medicaid for the first three years.
Roy’s alternative would cost the state $46 million to provide coverage for 11,500 people in 2014.
A report by The Lewin Group estimated that the new Medicaid enrollees will include about 22,300 people who do not already have insurance; that is the group on which Roy focused his proposal. (The Lewin report assumes 20,500 individuals will drop employer-sponsored insurance once they are eligible for Medicaid due to the expansion. Roy assumed an additional 11,620 will use the new insurance marketplaces for subsidized insurance.)
He then proposed that, since DirectCare would require enrollees to work, half of the people eligible for the program would decide to enroll instead in employer-sponsored coverage, leaving 11,150 uninsured people.
The annual premium cost for an individual would be about $412, plus a $5,950 deductible. The state would assume the rest of the costs, including a $100 monthly payment to a primary care provider.
Such a program would give the state control and flexibility, as opposed to working under the requirements of the federal Medicaid system, Roy said.
Roy drafted the proposal at the request of Sen. Nancy Stiles, a Hampton Republican and member of the Medicaid expansion commission.
“I ran into him couple of weeks ago, and he was talking about not taking Medicaid expansion and moving forward with a state plan and covering our citizens who need coverage a different way,” she said. “I thought it would be important if we heard that information and if we filter it through our discussion starting next week.
“We will definitely have to discuss the cost. I don’t know if it’s something we can move forward with quickly or if we should expand for the period of three years and then assess how that worked and have we provided better care, and look at how the programs compare.”
She said she would want to ensure that anyone who obtained coverage under the expanded Medicaid program would not lose it if the state left the expansion after the first three years.
When Stiles asked about whether the state could leave the expansion after three years, Roy called that a “highly risky move from a political capital standpoint.”
“Once the train has left the station, it’s hard to pull out the rug from under people, or even to make meaningful changes,” he said.
Senate President Chuck Morse, a Salem Republican, praised Stiles and Roy after Roy’s testimony.
“Today’s presentation detailed a real opportunity for a possible New Hampshire specific way forward on this complex issue,” he said in a statement. “Republican senators share the goal of reducing the number of uninsured in New Hampshire and improving health outcomes. I believe the proposal developed by Sen. Stiles and outlined today by Dr. Roy offers an intriguing concept for how we can do so through the private insurance marketplace. It deserves significant further study.”
Senate Minority Leader Sylvia Larsen, a Concord Democrat, said in a statement the proposal “would be a huge mistake for our state and a huge burden for low-income taxpayers.”
“It just makes no sense to make our state pay billions more to give taxpayers worse health coverage and cover fewer people,” she said.
The commission is scheduled to meet again Tuesday at 12:30 p.m. The group has until Oct. 15 to issue a report of its findings, but consultants helping prepare the document estimated yesterday that it would be ready Oct. 2.
(Sarah Palermo can be reached at 369-3322 or
firstname.lastname@example.org or on Twitter @SPalermoNews.)