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Editorial: N.H. Medicaid Expansion; State Shouldn’t Waste Opportunity

It’s hard to construct an argument in favor of New Hampshire accepting federal money to expand the state’s Medicaid program — because it’s difficult to grasp why anyone might oppose it. Are there people whose distrust of the federal government is so profound that they would have the state pass on the opportunity to significantly expand the number of people with health insurance? The answer, apparently, is yes — although it’s not clear whether enough lawmakers share that sentiment to actually block the state from making what should be an easy call.

As part of the Affordable Care Act, the state is being offered $2.5 billion over the next seven years to expand health insurance coverage through Medicaid, the state-federal program that now insures 132,000 New Hampshire residents, most of them low-income. If New Hampshire accepts the help, income limits would be raised to 138 percent of the federal poverty line —$15,856 for single adults — and an estimated 58,000 additional people would be covered, reducing New Hampshire’s uninsured population by about a third.

This expansion was not intended to be optional. When the Supreme Court upheld Obamacare as constitutional, however, it ruled that Congress lacked the authority to mandate Medicaid expansion. Under what is now an optional plan, the federal government will reimburse states for 100 percent of the cost of covering all newly eligible adults from 2014 to 2016, with the federal portion gradually being reduced to 90 percent by 2020.

Oddly, the Supreme Court has protected the right of states to block the federal government from extending health insurance to large numbers of their own residents. Why would they? In New Hampshire, the most common objection is that the federal government can’t be trusted to maintain that level of funding, and the state will end up getting stuck with the bill. They also warn that the state share may be a small percentage of the total cost, but it will still be significant, especially for a state budget in straitened circumstances.

Exactly how much of the expense will fall to New Hampshire depends on a number of factors. An analysis by the New Hampshire Fiscal Policy Institute estimates that the Medicaid expansion would cost the state $85 million over the next seven years, but that the planned implementation of a managed care system for Medicaid and several other changes in the offing would eliminate that cost and might even reduce the state’s overall spending.

Even if that forecast proved wrong and the state ended up paying the full $85 million — an average of about $12 million for each of the next seven years — it would be a relative bargain for extending coverage to so many New Hampshirites now exposed to the peril of living without protection. And let us not forget that expanding coverage also is likely to lower overall health spending: People with insurance can seek medical help when it’s needed, forestalling the development of more serious and expensive conditions, and they don’t have to resort to a high-priced trip to the local hospital’s emergency room when they absolutely need medical attention.

Might the federal government renege on its commitment sometime in the distant future? Perhaps, although expansion supporters rightly note that nothing in the nearly 50-year history of the Medicaid program suggests that the federal government can’t be trusted to meet its obligation.

The same can’t be said for the state of New Hampshire, of course, which has too often demonstrated a creative knack for diverting Medicaid money from its intended purpose into the general fund. Here’s a chance for the state to use Medicaid money appropriately — to help the working poor get the health care they need, when they need it.