Editorial: Lawmakers must find a way to agree on Medicaid expansion

Last modified: 1/5/2014 12:29:01 AM
On Tuesday, six New Hampshire state senators, Republicans Chuck Morse, Jeb Bradley and Bob Odell, and Democrats Sylvia Larsen, Lou D’Allesandro and Peggy Gilmour, will meet to negotiate over whether, when and how to expand Medicaid access to cover an additional 50,000 low-income residents. No issue facing the Legislature is more important. The decision is crucial to the economy of New Hampshire, the well-being of its residents, the health of its hospitals and the price those already insured will pay in premiums.

It is imperative that these senators, as well as the governor and both houses of the Legislature, find a way to get to yes. Not expanding Medicaid means denying basic health care to tens of thousands of citizens while turning down federal money that does enormous good. It would relegate New Hampshire, which not long ago was a leader in job creation and the health of its citizens, to second-tier status or worse.

To put what’s at stake in perspective, the state desperately needs $250 million to finish widening Interstate 93 and millions more to keep conditions on deteriorating roads and bridges from getting worse. At the moment, there’s no agreement on how or whether to raise a sum that pales in comparison to the loss the state will suffer if Medicaid is not expanded.

Under the Affordable Care Act, the federal government will pay 100 percent of the cost of providing coverage to the near-poor for the first three years and then gradually reduce that support to 90 percent of the added cost. Senate Republicans, led by Morse, the mysteriously intractable new Senate president, have so far thwarted the expansion of Medicaid for what can only be seen as ideological reasons.

Both sides are willing to seek a waiver that would allow New Hampshire to require that, after an initial period on traditional Medicaid, recipients of expanded Medicaid use a federal subsidy to purchase coverage from a managed care plan, but they can’t agree on a timetable. Morse says the transition period can’t be more than one year. The House, Gov. Maggie Hassan and insurance industry experts say that deadline would be impossible to meet for a host of reasons, and they’re right.

As is, with every day lost in 2014, New Hampshire forgoes roughly $550,000 in federal money that would be used to provide care for the poor and, by doing so, create jobs in the health care industry and elsewhere. The size of the loss depends on how many eligible recipients would have enrolled in expanded Medicaid, but by 2016 it will grow to more than $1 million per day. The total loss would not be the $250 million the state needs to widen I-93, but $2.5 billion, 10 times that.

The expansion of Medicaid, like the imposition of Obamacare itself, is a massive undertaking. Problems were inevitable and will inevitably be overcome in time. At present, only one provider, Anthem, has enrolled in the health insurance exchange where the recipients of expanded Medicaid would shop for a plan. But if Morse and his fellow Republicans can agree on a slightly longer transition period, the poor and everyone else will have more options when they shop for insurance.

Several other providers, notably the Massachusetts-based Harvard Pilgrim Healthcare and Minuteman Health, have announced plans to compete for New Hampshire customers in 2015. They may be joined by one or more of the three managed care companies serving the state’s existing Medicaid population. Some or all will allow members to receive care at hospitals not included in Anthem’s network for exchange customers. Among those excluded is Concord Hospital.

Two of the potential competitors on the exchange, Minuteman Health and Wellsense, are nonprofits. Minuteman, in fact, is a cooperative whose mission calls for returning savings achieved through better care to members in the form of lower premiums. The result could be lower costs and improved care for all, but it won’t happen unless Senate Republicans compromise.

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