SURVEY: Was NH right to expand Medicaid eligibility, using private insurance wherever possible?

Was NH right to expand Medicaid eligibility, using private insurance wherever possible?

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Mark Fernald
- Peterborough

Mon, 10/14/2013 - 11:47am

Funding Obamacare is not just about money, or regulations, or freedom.  It’s about life.  Consider the story of a woman I will call Alice (not her real name). She came to my office several years ago seeking help processing health insurance claims. Not what you might ordinarily expect a law firm to do, but we dug into the task.

Alice’s husband had left her about four years before, when she was nearly 60. Their divorce agreement obligated her ex-husband to maintain the health insurance coverage that he and Alice had during their marriage, but only during the 36-month period Alice was eligible under federal law.

When I met with Alice, I learned that she was diabetic. Like many with that disease, she had poor circulation, which had led to an infection, and the recent amputation of one of her legs. I also learned that her health insurance had just run out.

I was able to help Alice with her immediate problem — most of her medical bills had been incurred before her health insurance expired, and the claims were eventually paid. But I couldn’t touch her larger problem.

She was a 62-year-old woman with huge medical problems and no health insurance. Because of her pre-existing conditions, no health insurer would sell her a policy at any price. She did not qualify for Medicaid because she was not poor enough. She was three years shy of Medicare eligibility. Another infection was either going to leave her dead, or bankrupt.

I lost touch with Alice. Maybe she reached Medicare age, and the security of health insurance. Maybe she became a statistic — several years ago, a study by Harvard Medical School concluded that 45,000 deaths each year are due to lack of health insurance.

There are countless other Alices who need health care, and they had no hope of affording health insurance in the marketplace that existed before Obamacare.

Today, people like Alice cannot be denied health insurance due to a pre-existing condition. Obamacare swept away all those pre-existing condition clauses.

Starting Jan. 1, 2014, people like Alice will be eligible for help with health insurance premiums, with the amount of assistance depending on the person’s income.

If a person faces a severe medical condition, such as cancer, a life-threatening infection, or heart disease, there are no lifetime limits on health insurance benefits.

The people who want to defund Obamacare are the same people who made Obamacare a central issue in the 2012 campaign. Then the people spoke. The Republicans lost the presidential campaign, lost seats in the House, and lost seats in the Senate. Republicans can’t repeal Obamacare through the legislative process, so they are throwing a tantrum, threatening to shut down the government if they don’t get their way. The Democrats say “we won’t negotiate” — a logical stance, as any concession would only encourage more blackmail.

All the political theater boils down to this: Are we, as a nation, going to help people like Alice obtain affordable healthcare? Now that Obamacare has answered that question, Democrats say there is no going back.

Mark Fernald was the 2002 Democratic nominee for governor. He can be reached at mark@markfernald.com

Andrew Hosmer
- Laconia

Tue, 06/04/2013 - 10:07pm

Last week, the New Hampshire Senate Finance Committee rejected expanding Medicaid in New Hampshire and instead opted to delay and study.  This politically motivated decision is fiscally short-sighted and will hurt our healthcare system and our entire economy.

The Medicaid program is a partnership between the federal government and the states. It primarily covers poor children, senior citizens, expecting mothers, and people with disabilities. Today, New Hampshire covers about 132,000 people, and the costs are split 50-50 between the state and the feds.

However, under the Affordable Care Act (ACA), states now have the option to extend Medicaid to working adults with annual incomes up to $15,856. And instead of splitting the costs evenly for this new group, the federal government will pay 100% from 2014-2016, and then after 2020 it will pay 90%.

According to nonpartisan studies from the Lewin Group and New Hampshire Fiscal Policy Institute, the economic impact of this extended coverage is overwhelmingly positive.  It’s estimated that over the next 7 years, New Hampshire will receive $2.5 billion in federal funds, New Hampshire’s hospitals will save $400 million, and the economic spinoff will create upwards of 5,000 jobs and $2.8 billion in gross state product.

And how much will this cost New Hampshire? Zero, once managed care in Medicaid is implemented in the coming year.

So where’s the opposition coming from?  Despite the huge benefits, some have argued that there is still a risk for New Hampshire, since the federal government might somehow renege on its promise.  The history of Medicaid is contrary to this fear, as the federal government has never failed to fully fund Medicaid in more than 45 years.  Also, if they ever do, New Hampshire can pull out at any time.

Others say that it makes financial sense to stop and study for a year.  This is unnecessary as expansion has been studied by nonpartisan groups and their conclusions are quite similar. In fact, delaying a year costs us $340 million, drives up costs for businesses, and leaves tens of thousands of people in New Hampshire without coverage.

Putting politics aside and even beyond the clear economic and fiscal benefits, extending Medicaid coverage is important for our entire healthcare system.  Our current system, with skyrocketing insurance costs, increasing demands for charity care, declining Medicaid reimbursement rates and an inadequate understanding of mental health issues, is broken and in need of immediate, substantive reform.  Expanding Medicaid, regardless of how one feels about the ACA, is an opportunity to address and begin reforming our healthcare system.

Even fiscally conservative governors from across the country, including Chris Christie (R-NJ), Jan Brewer (R-AR), John Kasich (R–OH) and Rick Scott (R-FL), support Medicaid expansion, because it just makes so much sense for their states, and they are willing to look past the short-term politics.  If New Hampshire doesn’t take advantage of expansion, our hard earned tax dollars will go to subsidizing healthcare in these other states.  How ironic that NH’s healthcare system is struggling, yet Granite Staters will be paying for other states’ healthcare.  If this happens, New Hampshire will be 50th out of 50 states in the return of federal tax dollars to the state—the biggest “donor state” in the whole country.

The human cost is also staggering.   Medicaid expansion would cover 58,000 hard-working New Hampshire taxpayers (including 1,500 veterans and 800 of their spouses).  These people are our neighbors, people we see at church, ball games and the grocery store -- people who work multiple jobs trying to keep a roof over their head and food on the table.

When I campaigned for the State senate I remember well how many people told me they were tired of hyper-partisan politics.  I promised that I would remember those conversations and put them into action when elected.  This doesn’t have to be a partisan issue: we have a genuine opportunity to work together as pragmatic problem solvers.  It’s rare that a real, genuine solution is open to us.  Let’s grab it. Let’s put Granite Staters first and do what’s best for our healthcare providers, our business community, our economy and the hard working taxpayers of New Hampshire.

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