State House Memo: Here’s why I voted for Medicaid expansion
For the past three months, I have had the honor of serving on the state’s bipartisan Commission to Study the Expansion of Medicaid Eligibility. Last, we agreed on a plan. I wanted to explain what we decided and why I voted for it.
First, why did we have this commission? Medicaid is a program that states and the federal government run together as a partnership. It gives health care coverage mostly to low-income children, but also to some senior citizens, pregnant women and people with disabilities.
Under the federal Affordable Care Act, our state is allowed to expand the program and offer health insurance coverage to low-income adults. These are individuals making up to about $16,000 – people like wait staff, janitors, hairstylists and landscapers. There are about 60,000, mostly working, taxpaying New Hampshire residents who would be eligible. Most have no health insurance. The deal is that the federal government will pay all the cost for the next three years, then slowly decrease its amount to 90 percent after seven years.
Earlier this year, the governor wanted to go ahead and accept the federal money to offer this coverage. The majority of the Senate wanted to study it and then decide. The two sides compromised on a short-term commission to study how to move forward.
Our commission worked hard. We met 16 times, heard more than 50 hours of testimony and had discussions with more than a dozen experts from New Hampshire and across the country. The public too weighed in, with more than 60 speakers. We considered thousands of pages of documents.
The process was fair and open. All views were heard. Experts included a balance of those who opposed expanding Medicaid and those who supported it.
What we ultimately learned is that the benefits of expanded Medicaid for New Hampshire are substantial. Expanding the program will bring in $2.4 billion in federal dollars, $340 million next year alone. It grows the economy by almost $400 million and creates 700 new jobs. It will save our state’s budget $45 million over the next seven years. And it will save consumers $100 million in what they pay for health care.
Having more people insured helps everyone, including those not on Medicaid. Currently, hospitals and health-care providers pay the bill when people have no insurance. That adds up to hundreds of millions of dollars, and it pushes everyone else’s health insurance premiums up in order to cover these uncompensated costs. If we get uninsured people covered by Medicaid instead, we will help bring premiums down for everyone else.
As a nurse, I know that access to insurance is good for people’s health. Preventive care, monitoring chronic conditions, and treatment in the most appropriate setting are the goals of health care. This rarely happens when people lack insurance.
Still, some concerns were raised, and a number of ideas on how to proceed came forth. Many on the commission wanted to emphasize keeping people in the private market for health insurance when possible. And we want to make sure we are taking an opportunity to reform traditional Medicaid and make it as efficient as possible. All of us wanted to make sure our state is protected financially.
How did the commission recommend addressing these concerns? First, we agreed to use Medicaid dollars to keep people who are newly eligible for Medicaid on private insurance if it is available from their employer. Then, we are going to give everyone else who is eligible an option in the future, as long as it is cost effective, to get onto a private insurance plan in the state marketplace, with Medicaid paying their out-of-pocket costs.
To achieve greater efficiency, we are already moving to a privatized Medicaid system. We are going to put new enrollees into coverage through these private companies. That should make things more efficient and keep costs down. And finally, we supported a so-called “circuit breaker” to protect our state financially. If the federal government doesn’t pay the share it has promised, we get out.
At the end of the day, we saw Republicans and Democrats working together and getting a bipartisan compromise on a uniquely New Hampshire plan. The plan passed on a 6-2 vote, and I was proud to support it.
The Legislature will go into a special session in November, and hopefully we can get this up and running. If we delay beyond Jan. 1, New Hampshire stands to lose about $1 million a day and all of the associated economic and health-care benefits. The commission worked hard to create a New Hampshire plan; Legislature should work together to agree.
(State Sen. Peggy Gilmour is a Democrat from Hollis.)