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Editorial: A moral and financial argument to expand Medicaid

Last modified: 8/19/2013 12:12:22 AM
Rep. Neal Kurk of Weare, a force in the Legislature who leads by the power of his arguments, cut to the chase in the debate over whether New Hampshire should join the 23 states that have agreed to expand Medicaid. Expanding Medicaid, in short, means accepting federal money under the 2010 Affordable Care Act to do what New Hampshire has never done: offer coverage to all adults up to 138 percent of the federal poverty level.

Speaking last week on New Hampshire Public Radio’s The Exchange, Kurk said that the people of New Hampshire are of two opinions about doing so. One “believes the state has an obligation to care for poor people and provide them with all sorts of entitlements. . . . There is another group that feels that it’s not the role of government to provide services to everyone. Simply because you are poor is not a reason for you to be entitled, in this case, to health care. The idea is almost an immoral kind of decision. . . . This is a country that believes in personal responsibility. Unless there is something . . . wrong with you, your obligation is to work your way up into the system, ” Kurk said.

Leave aside, for now, the fact that many people, and more than a few nations, believe that human beings have a moral right to health care. That right, in the United States, is recognized in a limited way by laws that require hospitals to provide emergency care to all, whether they can pay for it or not.

Forget for the moment that Kurk’s Horatio Alger belief that anyone who isn’t in some way disabled can and should work hard and improve their lot enough to afford health insurance is unfounded. That view reflects a profound misunderstanding of the realities, economic and otherwise, faced by the middle class, let alone the poor. The days when most jobs came with good quality, affordable health insurance coverage are over.

Kurk sits on a nine-member commission charged with issuing by Oct. 15 a recommendation on whether the state should or should not expand Medicaid and, if it does, with what if any qualifications. In a more straightforward way than any other member, Kurk questions whether it’s the government’s role to provide health insurance for those who can’t afford it. Questions of morality aside, we believe the answer is yes, because doing so benefits all of us.

Children who fail to learn because they are hungry, ill or in pain from a lack of dental care are more likely to become dependent on society for help. Feed them, heal them and provide preventive health care, and they are far more likely to succeed and repay society by paying more in taxes.

The same is true for many adults who, though they work, do not earn enough to buy ever more costly health insurance.

The economic argument for expanding Medicaid is strong. What the uninsured poor don’t get is regular preventive health care that keeps them at work and out of hospitals. Instead, they get expensive treatment in emergency rooms and enormously expensive hospital stays for chronic conditions that were allowed to deteriorate.

The cost of that care is shifted to employers and the insured in the form of higher health care premiums and state subsidies to hospitals.

Providing health coverage increases low-income citizens’ ability to exercise personal responsibility by doing more of what it takes to stay healthy and on the job instead of in a hospital or on disability payments. It allows them to contribute to the local economy rather than be a drain on it. It lowers the cost of health care for all, which is why those on the commission who don’t believe that the poor have a moral right to health care should nonetheless vote to expand Medicaid.


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