Arizona lawmakers testify on potential New Hampshire Medicaid expansion
Members of the commission studying whether New Hampshire should expand its Medicaid program heard a tale of two Arizonas yesterday from members of that state’s legislature.
When Arizona expanded its Medicaid program in 2000, the state spent $8 billion, four times the number originally anticipated, and patients continued to use the inefficient emergency care system for nonemergency care, said Arizona state Sen. Kelli Ward, an ER doctor who opposed expansion. In 2011, Arizone Republican Gov. Jan Brewer forced the legislature to expand the program further under the Affordable Care Act, Ward said.
That was different than the picture painted for her by a fellow Republican, state Rep. Heather Carter. Arizona had to freeze Medicaid enrollment in 2011 when non-general fund revenue streams were no longer enough to cover the costs, Carter said. Then, the Affordable Care Act offered an opportunity to reopen the program to more people and save the state $136 million in fiscal year 2015 by increasing the federal government’s share of the cost, she said.
New Hampshire’s nine-member commission is slated to make a recommendation by Oct. 15 on whether New Hampshire should extend Medicaid to 49,000 poor adults under the federal health care reform law. If New Hampshire did expand Medicaid starting Jan. 1, the state would collect an additional $2.44 billion in federal aid and spend $45.8 million less from the state’s general fund between 2014 and 2021.
Starting in 2021, the state would see additional general-fund costs estimated at $21.7 million a year under the expanded Medicaid program.
Before Arizona’s initial Medicaid expansion, estimates projected the cost would be $2 billion; the actual cost was about $8.4 billion, Ward said.
After 366,000 people joined the Arizona state Medicaid program, the rate of people without insurance did not decrease, showing that most new enrollees had dropped or lost private insurance, she said.
“There’s very little to entice this population to be accountable for how they use this health care,” Ward said, adding that in her role as an emergency room physician, she sees frequent abuse by patients seeking expensive emergency care for nonurgent conditions.
Ward faced her toughest questions yesterday from the two doctors on New Hampshire’s panel considering expansion, Democratic Rep. Tom Sherman, a gastroenterologist and state representative from Rye, and Travis Harker, a family doctor at the Concord Family Health Center and president of the New Hampshire Medical Society.
Sherman previously worked in Virginia and Massachusetts and said he was surprised to hear Ward’s anecdotes about patients abusing the emergency room system once they were eligible for Medicaid coverage.
“We had the experience where they were pretty respectful of ours. I guess that’s a difference between the population in Arizona and in these states,” he said.
Harker asked whether Ward believes any tax dollars should be used to fund health insurance.
“I’m for the free market, for people providing insurance for themselves unless they are unable,” she said.
Carter spent most of her testimony explaining the history of the Arizona program’s 2000 expansion and 2011 enrollment freeze.
The unexpected number of people who enrolled in expanded Medicaid in Arizona may have been a result of the disproportionately hard hit to the state’s economy during the recession, Carter said.
She defended the more-recent expansion as “the most fiscally responsible decision we could make,” she said.
“If we did nothing, we would not see that savings, and we would break the bank within three years,” she said.
In fiscal year 2015, the state is due to collect $1.5 billion from the federal government, at which time the federal government will also pay a higher portion of the cost for Medicaid recipients. That means Arizona will spend $136 million less from its general fund for the program, Carter said.
Arizona legislators wrote into the expansion law that if the federal funding falls below 80 percent of the cost for the expansion program, or if the federal law is repealed, the state expansion program is automatically repealed, she said.
Ward and Carter are expected to be among the last people to testify before the commission before members begin debating.
The panel scheduled eight meetings over the next five weeks to finish hearing testimony and discuss its report. A vote on the expansion could happen before the end of the month to ensure commissioners have sufficient time to review and critique a draft of the official report, which will be written by Maine-based accounting and consulting firm BerryDunn.
The meetings, each of which is scheduled for 12:30 to 4:30 p.m., are set for Sept. 10, 17, 18, 24, and Oct. 1, 2, 8 and 9.
A proposal from BerryDunn suggested the final report will be available Oct. 14.
(Sarah Palermo can be reached at 369-3322 or
firstname.lastname@example.org or on Twitter @SPalermoNews.)