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Editorial: N.H. Medicaid Option; A Chance to Help the Working Poor

Although it handily passed the New Hampshire House, the proposed expansion of the Medicaid program may not glide as effortlessly through the Republican-controlled state Senate. The first indication of trouble came last week when the Senate president expressed skepticism about the federal government’s likelihood of sustaining a high level of funding, leaving the state with a huge financial obligation.

“I hope you can understand my concern that a lot of promises (are) floating around out there, but when we’re talking billions and billions of dollars, I don’t know if that’s a gamble I want to take,” said Sen. Peter Bragdon, R-Milford, during a hearing on the proposal.

Actually, we don’t understand his concern.

For starters, it’s not billions and billions; it’s millions and millions, which is still a lot of money, but a clear indication that whatever concern Bragdon might have about the proposal has been blown out of proportion either by sloppy math or unwarranted anxiety.

The Medicaid expansion was initially an integral component of the Affordable Care Act, also known as Obamacare, but was made optional when the U.S. Supreme Court ruled that the federal government couldn’t compel states to expand the joint federal and state health insurance program for the poor. Under the federal government’s offer, if New Hampshire loosens eligibility requirements for Medicaid, the cost of covering the newly eligible will be covered entirely by Washington from 2014 to 2016, with the federal government’s financial share decreasing to 90 percent by 2020.

More specifically, New Hampshire would receive $2.5 billion over the next seven years. With the income limit raised to 138 percent of the federal poverty line — $15,856 for single adults — an estimated 58,000 additional New Hampshire residents would receive Medicaid coverage. Of those, about 22,000 would remain otherwise uninsured.

In other words, if the New Hampshire Legislature says yes, a sizeable portion of New Hampshire’s working poor will gain access to affordable health care.

The state’s financial exposure is uncertain, but modest under any scenario. An analysis by the New Hampshire Fiscal Policy Institute found the Medicaid expansion might cost the state $85 million over the next seven years, but that that amount could be greatly reduced depending on how successful the new managed care system proves to be. Moreover, because the Medicaid expansion will provide access to health care that thousands of working New Hampshire residents don’t now have, it will reduce overall health care costs because those people won’t wait until their health problems reach a crisis, an unnecessarily expensive course of action. It will also mean less cost-shifting; health care providers won’t be forced to incorporate the cost of providing uncompensated care into the bills of those who do have insurance.

The fear that the federal government might renege on its commitment to continue picking up the vast majority of the cost into the future seems odd on a couple of levels. The federal government actually has an admirable record of meeting its financial commitments for health care programs. In fact, New Hampshire, which has not been shy about diverting federal money intended for health programs to other purposes, would do well to emulate Washington in this regard. And why single out health care? If the federal government is so untrustworthy, aren’t there a number of other state programs that receive federal aid that might suddenly lose that financial support?

Bragdon’s concerns are hypothetical and exaggerated. On the other hand, the offered federal aid is real, and the benefit it will deliver to the thousands of New Hampshire residents who now cannot afford decent health care is just as concrete.