Editorial: With no Medicaid deal, needy residents continue to wait

Last modified: 11/29/2013 2:02:31 PM
On Saturday, a pair of last-minute deals among United Nations climate-change negotiators created the broad outline of a system for pledging emissions reductions, a step toward reversing potentially calamitous global warming. Separately, on Sunday, world leaders negotiated an interim nuclear agreement with Iran after three decades of standoff.

Big problems and potentially big progress.

In that context, the inability of New Hampshire political leaders to come to agreement last week on a proposal to extend health care coverage to some of the state’s neediest residents is all the more discouraging.

At issue was a remarkably generous deal by the federal government: expand the eligibility of the New Hampshire Medicaid program to cover another 50,000 residents, and the feds would pick up 100 percent of the cost for the first three years. After that, the federal share would drop to 90 percent.

As has happened elsewhere, Democrats liked the deal, Republicans didn’t. Wary of federal promises, the GOP-led Senate came up with a plan to use the federal money not to expand Medicaid but rather to subsidize those residents’ enrollment in private insurance through the Affordable Care Act health insurance exchange. Democratic negotiators balked at the Republicans’ insistence on implementing the private option sooner than they felt was practical to give additional insurers time to join the sole insurer on the marketplace.

In end, the GOP couldn’t even muster enough support for its own legislation in the Senate, as a handful of members seemed unmoved by the plight of residents too poor for the insurance offered though the exchange but not quite needy enough for the state’s existing Medicaid program.

And so, after fruitless negotiations during a special session of the Legislature, lawmakers left Concord last week just as they had last summer – with no plan to help their vulnerable constituents and a promise to keep talking.

The roots of this mess were created last year when the U.S. Supreme Court struck down the ACA’s mandatory expansion of Medicaid, making it a state-by-state decision. Many states have since simply said no; some, like New Hampshire, are still dithering.

As a result, millions of Americans – the ones federal lawmakers no doubt had in mind when they voted for Obamacare back in 2010 – are ineligible for help: They don’t qualify for Medicaid, and they can’t get a big enough subsidy to afford to buy private insurance on the exchanges. Equally nonsensical: People who initially qualify them for subsidies on the exchanges could – if their income fell because they lost a job – end up with no coverage at all.

Surely the federal legislation could have been made more simple. The folly of setting up two classes of consumers – those eligible for the exchanges and those eligible for expanded Medicaid – is clear now that states are resisting the Medicaid expansion. Ultimately, this may be a problem for Congress to help solve, but it’s hard to hold out much hope there.

In the meantime, New Hampshire lawmakers should take a deep breath, put aside their partisan rhetoric and keep working. In an Associated Press news story published in the Sunday Monitor, legislative leaders sounded optimistic that with a little more time they could reach an accord. Senate Republican Leader Jeb Bradley noted that without such an agreement, hospitals would simply continue to shift the cost of providing care to poor adults onto small businesses and people buying individual insurance.

He’s right. And he should use just that argument to convince the holdouts in his party to do the right thing.


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