State House Memo: Medicaid expansion is important to North Country

Last modified: 6/5/2013 1:01:29 AM
e_SSLqA half a million dollars,” says the young man and nods toward the shiny, red fire engine parked in one of the two bays of the Stark Fire Department. Nearby hungry customers are bowed over a hearty breakfast to raise money for the local fire-safety operation.

“Nice,” I say, and wonder how a town with just 516 residents can afford such a luxury in such tough times. Assuming all this, a more senior member of the department explains that the town applied for a federal grant and lo and behold got it. Stark is proud of its fire engine and ideologically content with taking from the federal dole.

New Hampshire likes federal money too – with a full 30 cents of every dollar of state revenue coming from the federal government. If we weren’t such a wealthy state, we could grab more. The logic has been that it’s better to pick the pocket of the federal government than that of local taxpayers. Republican legislative leaders are breaking from this tradition and want to take a stand on principle by refusing big federal bucks to expand Medicaid to cover low-wage workers. A few years ago, the state notably found a way to peel Medicaid money from poor people to fill a persistent budget gap.

Medicaid provides health care services to low-income and some disabled people. It is managed by the states, and New Hampshire is one of the few states to continue to use a so-called “fee for service” model, meaning each procedure has a set price established and has the distinction of having the lowest provider reimbursement rate in the country.

This leaves the providers – in most case the hospitals – short. Typically, the state pays about 50 cents on every Medicaid billed dollar. But short is better than nothing, which is what providers get when a patient is without coverage – so expanding Medicaid is very popular with the state’s financially ailing and overstressed hospitals, especially those in the North Country with a high rate of uninsured and poor.

If Medicaid is expanded, an estimated 5,000 people in the North Country, mostly people holding low-paying jobs (from service workers to school para-professionals) who can’t afford health insurance or much preventive care, will get basic coverage. And they will presumably catch problems and seek treatment sooner and use health care more efficiently and not use the most expensive portal to health care – the emergency room. Now, when forced by accident or illness to get care, they burden our local hospitals and eventually the cost of all of our insurance premiums. Another benefit with expanding Medicaid is that it rewards and encourages work. It puts work on par with welfare – and who could be against that?

Senate President Peter Bragdon said this is a “risky gamble” because the feds might back out and leave the state hanging. It’s a logic lost on Republican governors around the country who see a deal they can’t refuse. Saying no to federal money doesn’t reduce the federal deficit – it only shifts money away from our residents, hospitals and local economy. By extending Medicaid, we leverage federal money to solve local problems.

(State Sen. Jeff Woodburn is a Democrat from Dalton.)

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