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Sen. Andy Sanborn: On Medicaid expansion, we should look before we leap

We all know that if it sounds too good to be true, it probably is. The Senate Republicans also believe that taxpayers deserve to know how their tax dollars are being spent. Likewise, we have an obligation to carefully consider any new potential increase of government entitlements, which will affect both those being charged to pay for the program and the recipients. It is this thinking that led the Republican-controlled state Senate to defer making a rash decision of leaping into Medicaid expansion before carefully considering all options.

Due to the lack of any plan put forth by Gov. Maggie Hassan to consider how Medicaid expansion could be implemented, the Senate has taken it upon itself to do the work. Frankly, we did not say “yes” or “no.” We recognized that neither the governor nor the Democrat-controlled House has considered the policy implications. Voters expect the Legislature to consider policy changes and create a plan that is in the best interest of the state, and we plan to do just that.
So while the governor frets about the potential loss of free money and looks to find ways to circumvent the legislative process, the Senate is taking a measured view of Medicaid expansion. Despite the criticism from some that the Senate has killed expansion, the reality is that nothing could be further from the truth. The Senate budget is specific. We believe we should better understand and analyze the options, do the math, and then make a decision.
So, what is there to consider with Medicaid expansion? Actually, a lot.

Medicaid is a federal program to provide health care to lower-income individuals, families and persons with disabilities. Today, our state has on average 137,000 people receiving benefits, costing $1.4 billion a year, with half of it being paid by your state tax dollars and half paid by your federal tax dollars. In general, after paying for administrative costs, we are spending about $7,720 per person in the system. At this amount, New Hampshire has the 6th-highest costs in America to manage this care. For comparison, South Carolina spends $3,443 per person, California $3,962 and Florida $4,352. New York is second-highest at $8,589 per person.
If Medicaid expansion were to be implemented, it would benefit roughly 24,000 additional people at a cost of approximately $370 million more a year. This commitment comes with a “100 percent guarantee provision” by the President for three years, and then we are to expect a decrease in how much money the federal government sends to us. Knowing that the government is only sending back 50 cents on the dollar for the remainder of the program today, we should have concerns about future reimbursement levels.
In addition to the concern over lower future reimbursements, which would mean higher state taxes to offset that reduction, we should consider options for implementation. For example, we could specify that we would accept the funds via a block grant so New Hampshire could create a state-specific program and better monitor health outcomes of recipients. We could use the money to purchase insurance on the open market, or we could consider creating a voucher program. All of these options and more are worthy questions to be considered.
Knowing the challenges of a federal government that promises one thing only to renege later, today, 23 other states have declined to expand Medicaid and five states in addition to New Hampshire have also made the prudent decision to wait and fully consider this offer by the President rather than prematurely leap into the unknown.
Senate Republicans know you sent us to Concord to insure that government is spending your money as wisely and efficiently as possible. To do so requires careful consideration of all options and potential outcomes for any program. Concerns on the future finances of both our state and federal governments dictate that we need to create a plan to both take care of those in need and do it in a way that also protects the taxpayers who are paying for it. While the governor appears to like bigger government, we like better government.
Andy Sanborn is a Republican state senator from Bedford.

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