Editorial: Medicaid deal is welcome news – finally!

The debate about expanding Medicaid has become so politicized, so partisan, so full of jargon and shorthand, that it’s worth taking a step back and remembering exactly where this idea came from, what it intended to accomplish, and why the stakes are so high – in New Hampshire and across the country.

Medicaid expansion is part of the Affordable Care Act. The federal reform law originally sought to help poor and middle-income people gain access to health care through two parallel methods. First, the feds would require the 50 states to expand their Medicaid health insurance programs for the poor. Programs which primarily covered children and their parents with incomes well below the poverty level would grow to also cover single adults and those with income levels above the poverty line. Those with slightly higher incomes would be eligible for federal subsidies to buy private insurance policies on the new health care exchanges.

Trouble is, the U.S. Supreme Court said the federal government couldn’t force the states to expand Medicaid, and some have refused. As a result, in many states the new health law will help middle-income people but shut out needier residents, a shameful, bizzaro-world outcome, to say the least.

To date, New Hampshire has been among those states. But state Senate leaders announced last week that they’d come to terms on a bipartisan deal to use the federal money available to help poor residents buy private insurance policies. So far, details have not been released. Once they are, the plan will need the support of the full Republican Senate, the full Democratic House, the governor and, not inconsequentially, the federal government. But in broad strokes, the breakthrough is welcome news indeed.

The new deal would help 50,000 residents obtain insurance. That population specifically includes 19- to 64-year-old women and men who earn up to $15,856 a year. That’s too much money to qualify for Medicaid as the law currently allows and too little to qualify for the federal health insurance subsidies.

The deal would give this group access to a full range of medical care, including, notably, mental health and substance abuse services – care that will not only improve the lives of individuals and their families but also the safety and economic well-being of the state as a whole. Not a week goes by that the consequences of inadequate or nonexistent treatment don’t make headlines in New Hampshire: crime fueled by drug addiction; recidivism among prison inmates who get no help with the addictions that drove them to crime in the first place; unusually high rates of alcohol use and binge-drinking among teenagers; hospital emergency rooms dangerously clogged with patients experiencing mental health crises. Pro-active treatment could go a long way toward reducing such serious problems.

Because the proposal was forged in part by the Senate’s Republican leaders, there is reason to hope that it will meet with swift approval; Democrats, after all, have been eager to pass such legislation for months. But it remains too early to cross this legislation off the state’s to-do list. In Arkansas, which pioneered the approach New Hampshire is considering, Republican support has waned, and the state may well reverse course. And in New Hampshire, a conservative group called the Republican Liberty Caucus is urging politicians to sign its anti-Obamacare pledge, which includes opposition to expanding Medicaid through the use of federal money, “regardless of how those funds are allocated.” Part of the group’s rationale: “Obamacare is the gateway drug to full socialism.”

Please. Granting poor residents access to health care is good public policy: good for individuals, good for the economy. The federal subsidy for this effort is remarkably generous. New Hampshire lawmakers should ignore the overwrought rhetoric, put aside silly pledges and election-year strategies and finally do the right thing.