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Editorial: Extended Coverage; N.H. Lawmakers Should OK Medicaid Expansion

The New Hampshire Legislature convenes in special session today with the opportunity to do something truly special — provide an estimated 49,000 residents with health care coverage by expanding the Medicaid program. Whether it will seize that opportunity is uncertain, but there are signs that a bipartisan agreement is within reach. We urge lawmakers of both parties to keep their eye on the ball in the coming weeks and not lose sight of the fact that expanding Medicaid coverage will directly improve the lives of thousands of people and, by doing so, affirm that while the Granite State may be hard-headed, it is not hard-hearted.

Medicaid is the federal-state program that covers health care for the poor and disabled. About 130,000 New Hampshire residents are currently enrolled in Medicaid, to which the federal and state governments each contribute roughly 50 percent of the funding. At issue in the legislative session beginning today is a recommendation from a study commission to take advantage of a provision in the new federal Affordable Care Act to extend Medicaid coverage to adults who earn up to 138 percent of the poverty level. Lest you think that government-funded coverage is not needed for that segment of the population, consider that for a single adult, 138 percent of the poverty level amounts to earning about $16,000 a year.

Under the ACA, the federal government would pay the full cost of expanding the program for the first three years and at least 90 percent of the cost every year after. Democrats generally favor expansion, and Gov. Maggie Hassan has pointed out on numerous occasions that accepting the promised $2.5 billion in federal money will give the state economy a boost as well as help a large group of its hard-working residents.

Skeptical Republicans have cast doubt on whether the federal government will meet its financial obligation in the future if the state proceeds. Such fears are unfounded based on Medicaid’s funding history, but understandable. The Medicaid program is already an expensive component of the state budget, and on Dec. 1, New Hampshire will embark on a managed-care system for current Medicaid recipients in hopes of better controlling costs. So expansion must not be allowed to exacerbate a cost structure that is already unsustainable, says Senate President Chuck Morse, R-Salem.

Beyond that, Republican objectives appear to center on making greater use of the private health insurance market in any Medicaid expansion. For instance, those newly eligible for Medicaid could be required to accept insurance offered through their employer, if available, with the Medicaid benefit used to support that insurance in some fashion. That would require a federal waiver, which Republican lawmakers want to be secured before any expansion.

This is in keeping with the traditional Republican preference for the market over government, and it is not one that we share. In fact, one can plausibly argue that health insurers are part of the problem, not part of the solution, when it comes to the fractured American health care system. On the other hand, if concessions of that nature are what is required to attract Republican support for expansion, then Democrats should give them every consideration. It seems to us that going forward with an expanded program that attracts support of both parties is definitely preferable to the alternative — assuming that the alternative is not going forward at all.