Editorial: Expanding Medicaid: good for economy, good for the uninsured

Last modified: 6/6/2013 1:06:57 AM
The state Senate is scheduled to vote tomorrow on whether New Hampshire should join the 23 states that have decided to accept federal money to expand access to Medicaid. Nine of those states have Republican governors, among them staunch conservatives like Jan Brewer of Arizona and Rick Scott of Florida. That’s made it hard for opponents to make the case against expansion, but that hasn’t stopped Senate Majority Leader Jeb Bradley from trying. In a histrionic piece published yesterday in the New Hampshire Union Leader, Bradley stops just short of predicting the collapse of civilization if more poor people are given access to health care. The full Senate should see the prophesies of doom for the overblown fears they are and vote to expand Medicaid. It’s the right thing to do for the state’s economy and the moral thing to do for the uninsured. It also has the potential, over the long haul, to save taxpayers and employers money.

As evidence against expansion, Bradley cites a New England Journal of Medicine study about the impact of Oregon’s decision to provide 10,000 uninsured low-income adults with Medicaid using a lottery. The result? Though they received significantly more health care, “Medicaid coverage generated no significant improvements in measured physical health outcomes in the first two years,” the study’s authors said.

That was the part Bradley quoted. What he didn’t say is that the study found that the recipients received more health care services, had a higher rate of detection of diabetes than the uninsured, a diagnosis that should save money in the long run, and reported suffering less depression and reduced financial strain. These are outcomes that may increase well-being and allow them to use fewer health care services.

Two years isn’t enough time to accurately measure success or failure. The savings from things like early diagnosis and preventive care take years or decades to realize. The poor have a harder time navigating health insurance systems, understanding health care information, following treatment regimens, eating a proper diet, and monitoring things like blood sugar or blood pressure levels. They, more than most, would benefit from insurance that doesn’t just pay the bills, as Oregon’s Medicaid program did, but manages their care, something virtually every state that opts to expand Medicaid, including Oregon, plans to do.

New Hampshire will manage the care of its Medicaid population too, if the Legislature and the state’s large hospitals ever settle their dispute over taxes, a dispute that should be decided in favor of the hospitals. Managing care – making sure, for instance, that a patient with prescribed medication uses it properly – should dramatically reduce the need for costly emergency room visits and long-term hospital stays for conditions that worsened for lack of care.

Bradley is also beating the drums of fiscal doom and gloom to rally opponents. The nation’s debt is $17 trillion and growing, and the burden of Medicare and Social Security is unsustainable, Bradley warns. There’s no way the government will make good on its pledge to pay 90 percent of the cost of the expansion, he says.

“Given this frightening federal situation, is it reasonable for New Hampshire legislators to assume Washington can keep its promise?” Bradley asks.

We’re sorry the senator is frightened. He shouldn’t be. The nation’s debt, while troubling, hasn’t put the United States on a path with Greece or Spain. The deficit, which topped $1 trillion in each of the past four years thanks to the recession and stimulus spending, is falling like a rock as the economy improves. The health of Medicare, the nation’s biggest fiscal problem, has been improving. Expanding Medicaid is not just the right thing to do, it will also make the state’s economy better, not worse.

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