The Medicare and Medicaid programs have benefited the lives of Americans since the law creating them was signed in the Harry S. Truman Presidential Library in 1965, with Truman and his wife, Bess, receiving the first Medicare enrollment cards.
Today New Hampshire ranks fourth nationally in the percentage of its population, roughly 25%, enrolled in Medicare, and well over one-tenth of the population is on Medicaid. Medicaid was significantly expanded under the 2009 Affordable Care Act for those states choosing to participate, and it’s a credit to the farsightedness of New Hampshire politicians that this expansion, which we call Granite Advantage, was embraced on a bipartisan basis here.
Yet there are challenges for Medicaid. The federal budget reconciliation law enacted last year effectively punishes states like ours that expanded Medicaid by reducing, over time, federal funding that comes in through a hospital financing mechanism. That will hit our state budget in 2028. The law, as implemented through a proposed federal rule, also creates work requirements for the Medicaid expansion population that would be unfeasible for many recipients, potentially compelling the medically frail and those with rare diseases to work despite the law itself recognizing work-related limitations.
As major Catholic organizations wrote in response to this proposed rule, “coverage losses would harm patients, increase uncompensated care burdens for hospitals, and undermine the shared goal of promoting health, stability, and economic opportunity.” The rule must be pared back to not exceed the law it implements.
I have no doubt that our Department of Health and Human Services will do its best to take on the unfunded duties piled on by this federal law and implement it as compassionately as possible. As Gov. Kelly Ayotte, with deserved pride, said in her State of the State Address this year, “We funded one of the strongest Medicaid programs in the country despite a difficult budget environment: protecting services and maintaining New Hampshire’s eligibility levels, which are tops in New England.”
Regrettably, eight states are already going further than the federal law and rushing to kick people off Medicaid even though states, under the law, are allowed through 2027 to accept a recipient’s word that he or she is too sick to work.
This is part of a pattern where some demagogically seek to undermine our vital safety net programs by claiming they are rife with “waste, fraud, and abuse.” It is a shame, because the programs were enacted into law in 1965 on a bipartisan congressional vote. And Medicaid is overwhelmingly popular. Tony Fabrizio, pollster for President Trump’s 2024 presidential campaign, has found that around 20% of those voting for Trump were on Medicaid, and another 20% had family members on Medicaid.
To be sure, where fraud is uncovered, as it was in Minnesota, it should be punished. But we cannot allow anecdotes and exaggerated generalizations to subsume the larger good occurring. As Doctor Mehmet Oz, the administrator of the U.S. Centers for Medicare and Medicaid Services, has acknowledged, “the majority of Medicaid providers are honest, hardworking, and dedicated to rendering high-quality care to beneficiaries.”
Medicaid’s biggest problem is not fraud, it’s financing. Despite efforts by legislators and Ayotte to improve funding, Medicaid reimbursement rates for nursing homes fall short of care costs even as more aging Granite Staters seek admission. That’s in no small part because states are left to fend for themselves as there is no national vision for long-term care, despite high-profile reports urging one that have been issued going back to 1990.
Faced with an age wave of care needs, we cannot afford attacks upon, and reduced federal commitment to, Medicaid. Instead, states need a sustained federal commitment to bolstering the program. It is hard to imagine a more urgent midterm election issue to press our congressional candidates on.
Brendan Williams is the president & CEO of the New Hampshire Health Care Association.