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Editorial: Improved but Not Expanded; Mixed News on N.H. Medicaid

Baffled and disappointed as we are by the New Hampshire Legislature’s failure to expand Medicaid, we’ll accentuate the positive by making note of legislative leaders’ avowed desire to strike a deal in the near future and also of a substantial improvement to current Medicaid benefits.

The Legislature met in special session last week to consider extending Medicaid to about 50,000 people who aren’t in an eligible category or who earn enough money to disqualify them from the joint state-federal health insurance program, but not enough to afford coverage on their own. As part of the Affordable Care Act, the federal government has offered to pay the entire cost of expanding coverage to people who earn up to 138 percent of the poverty level — about $16,000 for a single adult — for the first three years, with the state gradually assuming 10 percent of the additional cost. Democratic Gov. Maggie Hassan and the Democratic-controlled House enthusiastically supported the expansion, but the Republican-controlled Senate sent the measure to a study committee.

Here’s what’s baffling. The bipartisan study committee also endorsed the expansion, and Senate Democrats accommodated the majority’s wishes by agreeing to require newly eligible Medicaid recipients to purchase coverage on the private market through the insurance exchange established under the Affordable Health Care Act — yet Senate Republicans still balked. Why? They wanted the move to the private market to occur within a year, while Democrats insisted that that simply wouldn’t be enough time because a federal waiver was required. Yes, it’s odd that Senate Republicans would demonstrate that much faith in the efficiency of the federal bureaucracy, but what’s truly puzzling is that Senate Republicans would regard the time frame as so important as to be worth denying thousands of people health coverage. Democrats had already yielded on the principle that the newly insured get private coverage. So why was making that happen in a year rather than two so important, particularly after Democrats made a convincing case that one year wasn’t realistic?

We were happy to learn, however, that senators from both parties, including Senate Republican Leader Jeb Bradley, expressed confidence after the special session that they could eventually hammer out a deal. It probably will have to wait until the Legislature gathers in January, meaning that implementation wouldn’t occur until 2015 and that the state would miss out on one of the three years of full federal funding — but two-thirds of a loaf is better than none.

What won’t need legislative approval is the state’s expansion of Medicaid benefits to include treatment for those who abuse alcohol and other substances. New Hampshire Medicaid now covers detox treatment, but not longer-term therapy such as counseling and residential care. Thanks in part to the advocacy of Hassan, New Hampshire will no longer keep company with Mississippi, Louisiana and Arkansas as the remaining states that don’t cover such services.

It’s little wonder that virtually every other state has recognized the importance of substance abuse treatment. The condition is notoriously difficult to overcome, and addiction is a powerful agent for spreading misery not just to the addict but also to family members and others. Given how often substance abuse adds to the challenges of people already suffering from mental illness and the role it often plays in sending people released from the corrections system back into it, it’s not surprising that offering a full complement of treatments is regarded by many as key. Nor is it surprising that substance abuse treatment is also viewed as a wise investment, returning from $1.45 to $7 for each dollar invested in reduced expenses on such things as prisons and social services.

But mostly it’s an investment in people’s lives — and the sooner the Senate can figure out how to make it, along with other Medicaid benefits, available to a greater number of low-income residents, the better.