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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 or on Twitter @SPalermoNews.)

Legacy Comments9

Not only did Senator Morse praise Senator Stiles, he reportedly asked Democrats to turn down the partisan rhetoric. With his selective memory he fails to note that his Republican colleagues, Senator Sanborn and Representative Kurk (both sitting members of the Commission) have regularly used inaccurate and ideological criticisms to display an undisguised contempt for Medicaid Expansion. Sanborn’s fixation on the failures of a previous program in Maine remains steadfast in spite of facts that show the Maine program was a completely different endeavor in its funding, eligibility requirements, and management oversight. Representative Kurk invokes Romney-esque disdain for the disadvantaged in his simplistic suggestion that the poor remedy their own problems by taking “personal responsibility”. Most egregiously, these critics of the program are shockingly willing to abandon their cherished pose of “fiscal responsibility” by refusing $2.5 billion of federal funds already paid into the system by NH residents, just so they can once again punish the poor for being poor. Senator Morse can say whatever he wants, but we all know that this is just another cynical attempt to destroy ObamaCare, even if it hurts our most vulnerable citizens (who lack the political power with which to threaten his incumbency).

This is not intriguing, it's just bad economics and worse politics that in the end will cost us money (that by the way, we do not have). Stiles seems smarter than this. How disappointing.

Democrats always always focus on FREE Big Govt solutions that have taken our national debt from $10 Trillion to $17 TRILLION since the Obama & Democrats rule. Democrats should be voted out office in mass

Hmmmm.... think you better recheck the numbers. Start with the first budget actually prepared under Obama, which would be the one starting 10/1/2009. I never saw a thing from the right about deficits in the Bush years. Again, go look at the math, not to mention the war funding.

Right! Go look at the math, and then look at the history. Tax cuts & rising deficits from Saint Ronald Reagan and Geo. W Bush. A tax increase in the name of fiscal sanity and saving Social Security for future generations from Geo. H W Bush. It caused his base to rise up with their torches and pitchforks to boot him out of office. A large if transitory budget surplus under Bill Clinton. Let's look at 2 facts about Obama's time so far: falling deficits once the GW Bush near-depression started to turn around and federal government spending as a DECREASING percentage of GDP since 2010. But of course the usual subjects have no use for math or history.

Saint Ronald Reagan sold arms to Iran just after they had held our hostages for a year. Used the money for the Contras in So. America. For a conspiracy theory how about letting our hostages go and I will sell you arms and I will look good and get elected president.

Nellie, In Bush's last year in office his budget deficit was ` 400 Billion. Every year Obama has been in office the deficit has been over 1 Trillion.

Now for the truth, "Though the budget deficit for 2008 was a then-record $458.6 billion, the CBO issued a projection in January 2009, just days before Obama took office that the budget deficit would reach $1.2 trillion that year, before the cost of any new stimulus plan or other legislation was taken into account." So even before Obama took office, not much you can do about that, is there?

Nellie - Democrats and Obama have never ever passed a budget - FACT FACT FACT

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