Editorial: May spirit of compromise take hold
Expanding access to Medicaid is so important to the economy of the state and the health of its low-income adult residents that how a state senator votes on the issue should be a key factor in the 2014 elections. News late yesterday of a potential compromise is encouraging, but even a deal among leaders will amount to nothing if the full Senate won’t go along with it.
The Senate’s initial position, if left unchanged, would cost New Hampshire up to $340 million in lost federal aid in 2014 alone. That’s money the state would never get back. More importantly, roughly 60,000 poor residents would go without insurance that gives them the ability to receive preventive health care and the peace of mind that comes with knowing that an illness won’t mean financial ruin.
If all 13 Republicans in the Senate hang together in their ideological opposition to accepting federal funds to insure the poor, one or more of them will deserve to be, metaphorically speaking, hung separately at the polls. We’re thinking particularly of senators whose reputations are those of bipartisan moderates with sound fiscal judgment. In central New Hampshire, that means Sens. David Boutin of Hooksett, Bob Odell of Lempster and Jeanie Forrester of Meredith.
There seems to be little more than distrust of the federal government behind the Senate’s opposition to expansion. Senate President Peter Bragdon, Finance Committee Chairman Chuck Morse and their fellow Republicans fear that once the honeymoon period is over and the federal government stops paying 100 percent of the cost of the expansion, it will reduce its contribution below its promised 90 percent share.
That fear is unrealistic. The Medicaid program has been around for a generation and it has yet to reduce its commitment to participating states. Nor is a study commission of the sort the Senate proposed as a stalling tactic likely to assuage anyone’s fears.
The harm in not accepting the federal offer to expand Medicaid goes beyond the loss of direct revenue. It would hurt hospitals that would have been compensated for the care they provide those who can’t pay. It would mean lost insurance or premium taxes to the state. And it would unravel the state’s much-delayed plan to move to managed care for Medicaid enrollees.
Fortunately, a path to compromise appears to be emerging. Given the uncertainty typical of last-minute negotiations, such as the one legislative leaders are engaged in now, the path could yet take unforeseen turns. Any of several outcomes could be far better than letting the money go.
The bill accepting the expansion could, for example, automatically sunset if the federal contribution falls below the 90 percent level set for 2020 and beyond, because the rules allow states to opt in and out of the expanded program.
Alternately, New Hampshire could accept the federal offer to pay 100 percent of the tab for the first three years with the proviso that lawmakers reconsider participation in the program in year four. At that point, the Legislature would have not a study that estimated the impacts of expansion, but real world experience.
The upcoming decision on Medicaid expansion will be one of the most important in each senator’s career. That’s how much is at stake. A senator who votes against expansion in some form will be handing ammunition to his or her opponent in 2014.