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N.H. study commission weighs pros, cons of Medicaid expansion

Last modified: 8/16/2013 9:57:19 AM
Should New Hampshire expand its Medicaid program? The commission studying that policy question yesterday heard a lot of reasons for why it should, and a bunch of reasons for why it shouldn’t.

“There are both positives and negatives, and I can very easily come up with five reasons why we want to and five reasons why we don’t. . . . That’s easy for me to do,” said Steve Norton, executive director of the New Hampshire Center for Public Policy Studies. “Weighing those is the difficult part. That requires value judgments.”

The commission, which faces an Oct. 15 deadline to issue a recommendation, heard yesterday from Norton and other policy experts as it weighs the pros and cons of accepting federal money to expand the Medicaid program to cover adults who earn up to 138 percent of the federal poverty level.

Under the 2010 health care reform law championed by President Obama, the federal government will pay 100 percent of the expansion’s cost for three years, starting Jan. 1, and at least 90 percent in future years.

Deb Fournier, policy analyst at the New Hampshire Fiscal Policy Institute, told the commission that expanding Medicaid would add about 60,000 mostly uninsured people to the program and also provide a boost to the state’s economy.

Among those getting help would be uninsured “mid-life adults,” aged 45 to 64 and including many people with chronic conditions such as hypertension and diabetes, said Lynda Flowers, a senior strategic policy adviser on the health team at AARP’s Public Policy Institute.

Sooner, she said, would be better than later.

“States that expand early tend to reap the most benefits because as you know, in the early years, the federal government will be covering 100 percent of the cost of this program. And it’s during those years, especially in the states that like to put these people into managed care, that you can really leverage contract requirements to get these people’s health status improved . . . so that hopefully, over time, they will be costing you less when the states have to start putting in some federal matching dollars,” Flowers said.

On the other hand, Christie Herrera, vice president of policy at the Florida-based Foundation for Government Accountability, highlighted various reasons for New Hampshire not to expand Medicaid, including the potential for federal budget cuts that would result in less aid than expected, the potential for increased federal deficit spending that would increase the national debt and the mixed records for Medicaid expansion experiments in Maine and Arizona.

“You’ve given us five reasons not to expand Medicaid,” said Rep. Neal Kurk, a Weare Republican and commission member. “How about giving us five good reasons to expand Medicaid?”

Herrera replied, “In my opinion, I don’t think there is one good reason to expand Medicaid. I believe that we should make higher quality private health insurance more affordable and accessible, rather than put people on a Medicaid program.”

Norton offered words of caution. It’s hard to gauge how expansion would affect state finances, he said, though it appears the state’s costs would be minimal through 2018 and increase starting in 2019.

Those numbers, he said, can be weighed against broader costs and benefits of expansion, including reduced charity care costs for hospitals, low-income workers being “crowded out” of private insurance and improved access to health care services for poor people.

The effects of expansion will take time to measure, Norton said, and will vary considerably from region to region. Much depends on how the expansion is designed, he said.

New Hampshire is one of six states still debating Medicaid expansion, according to the Kaiser Family Foundation. Twenty-three states have decided to move forward with expansion, and 21 states have decided against it.

Gov. Maggie Hassan, a Democrat, supports Medicaid expansion, as does the Democratic-controlled House. The Republican-controlled Senate in June blocked expansion from being part of the state budget, instead proposing the study commission that began its work last month.

Five of the commission’s nine voting members were appointed by Democrats, versus four appointed by Republicans. Hassan has said she expects the Legislature will hold a special session on Medicaid expansion once the panel issues its report.

The commission next meets Aug. 27, when it will take public testimony.

(Ben Leubsdorf can be reached at 369-3307 or bleubsdorf@cmonitor.com or on Twitter @BenLeubsdorf.)


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