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Editorial: With no Medicaid deal, needy residents continue to wait

On Saturday, a pair of last-minute deals among United Nations climate-change negotiators created the broad outline of a system for pledging emissions reductions, a step toward reversing potentially calamitous global warming. Separately, on Sunday, world leaders negotiated an interim nuclear agreement with Iran after three decades of standoff.

Big problems and potentially big progress.

In that context, the inability of New Hampshire political leaders to come to agreement last week on a proposal to extend health care coverage to some of the state’s neediest residents is all the more discouraging.

At issue was a remarkably generous deal by the federal government: expand the eligibility of the New Hampshire Medicaid program to cover another 50,000 residents, and the feds would pick up 100 percent of the cost for the first three years. After that, the federal share would drop to 90 percent.

As has happened elsewhere, Democrats liked the deal, Republicans didn’t. Wary of federal promises, the GOP-led Senate came up with a plan to use the federal money not to expand Medicaid but rather to subsidize those residents’ enrollment in private insurance through the Affordable Care Act health insurance exchange. Democratic negotiators balked at the Republicans’ insistence on implementing the private option sooner than they felt was practical to give additional insurers time to join the sole insurer on the marketplace.

In end, the GOP couldn’t even muster enough support for its own legislation in the Senate, as a handful of members seemed unmoved by the plight of residents too poor for the insurance offered though the exchange but not quite needy enough for the state’s existing Medicaid program.

And so, after fruitless negotiations during a special session of the Legislature, lawmakers left Concord last week just as they had last summer – with no plan to help their vulnerable constituents and a promise to keep talking.

The roots of this mess were created last year when the U.S. Supreme Court struck down the ACA’s mandatory expansion of Medicaid, making it a state-by-state decision. Many states have since simply said no; some, like New Hampshire, are still dithering.

As a result, millions of Americans – the ones federal lawmakers no doubt had in mind when they voted for Obamacare back in 2010 – are ineligible for help: They don’t qualify for Medicaid, and they can’t get a big enough subsidy to afford to buy private insurance on the exchanges. Equally nonsensical: People who initially qualify them for subsidies on the exchanges could – if their income fell because they lost a job – end up with no coverage at all.

Surely the federal legislation could have been made more simple. The folly of setting up two classes of consumers – those eligible for the exchanges and those eligible for expanded Medicaid – is clear now that states are resisting the Medicaid expansion. Ultimately, this may be a problem for Congress to help solve, but it’s hard to hold out much hope there.

In the meantime, New Hampshire lawmakers should take a deep breath, put aside their partisan rhetoric and keep working. In an Associated Press news story published in the Sunday Monitor, legislative leaders sounded optimistic that with a little more time they could reach an accord. Senate Republican Leader Jeb Bradley noted that without such an agreement, hospitals would simply continue to shift the cost of providing care to poor adults onto small businesses and people buying individual insurance.

He’s right. And he should use just that argument to convince the holdouts in his party to do the right thing.

Legacy Comments13

Wait for what??? Thanks to the great President Reagan and the Republicans ..... The Emergency Medical Treatment and Active Labor Act (EMTALA) is a U.S. Act of Congress passed in 1986 as part of the Consolidated Omnibus Budget Reconciliation Act (COBRA). It requires hospitals to provide care to anyone needing emergency healthcare treatment regardless of citizenship, legal status or ability to pay.... that would be the same Republican Party that ended slavery and passed the civil rights Acct.

Yes, the EMTALA was a good thing, but surely it was not meant to replace regular care at a doctor's office. You must know that a trip to the ER costs many, many times more than a trip to the doctor's office? And that an ounce of prevention is worth a pound of cure? Sending poor folk to the doctor's office for their more minor issues, and getting them treatment before they become acute, is far more fiscally responsible than having them treated at the ER and admitted for something at a course of antibiotics would have taken care of a month earlier. Most efficient way to bring down medical costs overall would be to eliminate insurance companies, and allow all citizens to have treatment when they need it, at a pcp or clinic, with or without a low co-pay. The paperwork reduction alone (for single payer) would be staggering and save providers much time and money.

Readers should notice that Field never ever produces a source for his radical claims - he cant - they dont exist.

Sail, nothing Field produced on this would satisfy you. Remember your credo and rant : All you kids/ Americans get off my lawn, your nothing but a bunch of moochers and takers!

I think that is a bit extreme.

XCSkier - why are all liberals outrageously serious....if you did not know that comment was in jest then you need to take a bunch of chill pills

But he does hold the self appointed moral high ground for what that is worth. Oh, it is not worth much. They complain that "we all pay" for emergency room care for those in need and it is sooooo expensive. If that is the case then why is it costing millions of Americans MORE under Obamacare??? They don't have an answer for that.

Here you go... See here: http://www.flickr.com/photos/68758107@N00/3578806098/in/set-72157618878040587/lightbox/ And here: http://www.nakedcapitalism.com/2013/11/obamacare-tina-medical-ethics-and-the-health-care-economist.html And here: http://theincidentaleconomist.com/wordpress/life-expectancy-and-health-care-spending/

naked capitalism......not a valid source or site. In fact I read some of the over the top, hysterical posts by leftists there, not surprising that you would quote that site. Wordpress and flickr are blogs not dependable information.

Ok, I will take this one. A visit to the doctors office costs $85 and generally a blood test or urine test for "minor" issues costs between $45 to $250. Let's go with twice a year and for the full monty plus a $25 prescription. $85 $250 $25=$360 X 2=$720 and throw in an extra $100 for good measure. So, $820 X $50,000=$4,100,000. For anything more serious they could still use the EMTALA. Now how much are they claiming Medicaid will cost to provide care for those 50,000 (is that an estimate?) people and how many will take advantage of that care? Puts a different spin on it, doesn't it?

Sorry, that is $41,000,000 not $4,100,000 but still a far cry from $500,000,000

I have to take issue with your characterization of this as a "remarkably generous deal by the federal government". The federal government can't offer a deal; they don't have any money! All they can do is take it from someone else, in this case, our children.

"The roots of this mess were created last year when the U.S. Supreme Court struck down the ACA’s mandatory expansion of Medicaid, making it a state-by-state decision.".....I'd say the roots of this mess were created when the SCOTUS upheld Obamacare as a tax and constitutional.

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