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Editorial: Time to Quit Balking and Expand Medicaid in N.H.

Sunday, January 12, 2014
Maybe the third time will be the charm, though luck has less to do with it than pluck. We’re talking about repeated attempts in a divided New Hampshire Legislature to expand Medicaid, a vital social program that provides health-care coverage for the poor and disabled. Gov. Maggie Hassan has declared expansion a priority, but the Republican-controlled Senate has twice blocked plans to enroll an estimated 58,000 additional adults. On Wednesday, the House passed a third Medicaid expansion bill, a variation of one taken up during last fall’s special session. It now heads to the Senate, where, as often as not, common sense goes to die.

In November, the Senate turned down a deal that was pretty much everything Republicans wanted in a Medicaid expansion bill, which is to say it was pretty much everything they sought in a bill they didn’t want. The proposal favored the private insurance market by directing federal funds not to the state’s existing Medicaid program but to insurers offering coverage through the new federal health-care exchange; newly eligible Medicaid beneficiaries would have received “premium assistance” to buy plans. Such an arrangement would have required a federal waiver and a lot of administrative preparation on the part of both government and private insurers. In the end, some GOP senators balked because they said waiting two years or so for the federal waiver would be too long.

Let’s insist on truth in balking. Some GOP senators objected mainly because, as a matter of philosophy, they reject the notion of extending benefits to more residents and fear the fiscal consequences of doing so. Thus, they were unwilling to take yes for an answer.

Medicaid expansion is good social policy, and it’s good fiscal policy. That’s especially the case in New Hampshire, which has a tradition of scrimping on Medicaid funding. The current program serves some 170,000 people, two-thirds of them children. Expansion would open it up to more of the state’s working poor — bus drivers, home health aides, waiters and waitresses. New enrollees would include adults, 19-65, who earn up to 138 percent of the federal poverty level, or about $16,000 a year. Yes, enlargement would have financial implications; but under the terms of the Affordable Care Act, the federal government would pick up most of the tab, paying in full for the first three years, which began Jan. 1, and at least 90 percent after that. For every day the state fails to expand Medicaid, it forfeits about half a million dollars, funding that would have helped tens of thousands at or near the poverty line obtain coverage. Those Republicans who were in such a hurry in November ought to think about that.

The current House proposal differs in one important particular from the bill the Senate rejected in November. It would make as many as 37,000 adults eligible for Medicaid’s existing managed-care program instead of requiring them to buy private insurance through the exchange. These are people living at or below the poverty level who aren’t eligible to receive subsidized coverage through the health-care exchanges without a federal waiver. The Affordable Care Act was written with the assumption that every state would expand Medicaid coverage to those making up to 138 percent of the federal poverty level, but the Supreme Court ruled that expansion was optional, thus opening a coverage gap for those making under the poverty level. The bill would help the lowest income group benefit from the coordination of care offered under Medicaid.

Predictably, Senate Republican Leader Jeb Bradley complained that the House was on a fast track to expand a social entitlement. First the bill was too slow. Now it’s too fast. But speed isn’t really the issue. The proposal to expand Medicaid has been debated and studied for almost a year now. For the sake of the state’s most vulnerable residents, senators should just get on with it.

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