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My Turn: Medicaid expansion will help psychiatric patients, and the rest of us

I don’t understand the decision to delay Medicaid expansion in New Hampshire.

Every day I review the emergency care provided to people in the capital region – our friends, neighbors and fellow citizens – who end up in the emergency room seeking care for problems because they don’t have the insurance or resources for basic or preventative health services. People without routine health care resort to emergency rooms for help when a once easily treatable issue becomes a critical health problem – untreated depression, for instance, leads to a suicidal crisis; a lethal overdose requires emergency treatment and Intensive Care Unit monitoring; or substance abuse requires medically supervised withdrawal.

I see these same people seeking help upon discharge who want ongoing care but are uninsured and unable to afford the follow-up service to support recovery and maintain health.

Medicaid expansion promises 50,000 people in New Hampshire access to essential health care.

Emergency room care is ultra-expensive! It aims to stabilize trauma: heart attacks, broken bones, gun shots and car accidents. It is not appropriate, efficient or an adequate substitute for the attention that a caring and professional clinician provides.

We know about the problems in New Hampshire: the use of emergency rooms to house people in psychiatric crisis, people who end up waiting for weeks due to lack of resources and proper care in a proper setting. We have seen the escalation in aggressive behavior, horrific assaults on care providers and life-altering consequences.

The inappropriate use of emergency rooms, whether for primary health care or psychiatric intervention to the uninsured, is a well-established driver of health care costs. Hospitals and community health care agencies provide millions of dollars in uncompensated critical “charity” care annually. The cost of charity care is largely shifted onto people who have insurance, employers and taxpayers. This is a hidden tax collected though sky-high insurance premiums, excessive co-pays, and multi-thousand dollar deductibles that have become commonplace for those of us fortunate to have insurance.

Why do we leave millions of New Hampshire taxpayer dollars in Washington? The federal government will pay New Hampshire 100 percent of the cost for Medicaid expansion initially and guarantees to cover 90 percent of our costs from 2020 on. Fears that the feds might leave New Hampshire holding the bag are unfounded; New Hampshire can drop out of expansion anytime!

Fifty thousand people and families with insurance will contribute to our local economy. Isn’t that better than 50,000 lives at increased risk for disabling illness, financial ruin and bankruptcy? Common sense and decades of research shows us that with access to care people are healthier, and it costs less to treat healthy people when they do need care. Expansion will save the state money and reduce costs for everyone. It was a key assumption in the state’s balanced budget; the longer it is delayed, the more it costs the residents of New Hampshire.

Medicaid expansion would help the New Hampshire economy. Fifty thousand more people accessing health care means more good-paying New Hampshire jobs: laboratory technicians, receptionists, clinicians, social workers, doctors and nurse practitioners. It would restore health care jobs lost in recent years. Fifty thousand more healthy people participating in the New Hampshire economy means less unemployment, disability, welfare and poverty.

Medicaid expansion will go a long way to help New Hampshire residents gain access to basic health care services and avoid the complications and progression of untreated illness. Medicaid expansion, by reducing the numbers of uninsured people, will improve care, reduce waste, stimulate local economies, restore necessary services, help turn the tide of rising health care cost and save money and lives.

Please help your legislators understand the importance of supporting Medicaid expansion now.

(Karl Boisvert is director of acute care services for Riverbend Community Mental Health Inc. in Concord.)

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