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Another View -- Joseph Pepe: Not expanding Medicaid will cost New Hampshire

December 30. 2013 9:52PM

FIFTEEN MILLION dollars. Sounds like a lot of money. In fact, it’s the amount of federal money New Hampshire is passing up each month in 2014 that we don’t act to expand health coverage for 50,000 low-income, uninsured citizens.

Under the Affordable Care Act, the federal Medicaid program will pay the full cost of expanding coverage to people with incomes up to around $15,000 a year, or 133 percent of the poverty level. The federal government will pay the full cost for three years, and at least 90 percent of costs thereafter.

This may be the most important, ultimately solvable public policy issue facing New Hampshire legislators as we head into the 2014 legislative session. It has major ramifications for our economy, our businesses and our citizens.

Expanding health coverage is important for the uninsured, who often delay treatment only to end up in costly hospital emergency rooms when their untreated conditions worsen. It’s important for New Hampshire’s non-profit hospitals, who right now provide more than $500 million a year in free care for the uninsured — more than $29 million at CMC alone — an amount of free care that’s simply not sustainable for the future.

It’s important for the social fabric of our communities, ravaged by the effects of untreated mental health issues and substance abuse, which would be covered under expansion.

It’s important for the vast majority of our citizens and business who have or offer health insurance, but whose premiums are being driven up in part by cost shifting by medical providers to pay for those without insurance.

But most of our citizens and policymakers support some form of expansion. They recognize the important, positive public health and economic benefits that come from expanding health coverage under the federal Medicaid program.

While it’s not surprising that hospitals and health advocacy organizations support expansion, many took notice when the Business and Industry Association (BIA) of New Hampshire, New Hampshire’s statewide chamber of commerce, raised its voice and endorsed Medicaid expansion.

The BIA identifies the high cost of health insurance as one of the top concerns for business owners in New Hampshire. The group recognizes the connection between population health and the state’s economic prosperity, and that regular, preventive care costs less, will lead to less utilization of health care services and ultimately lower health insurance costs for businesses and individuals. Quite simply, it makes smart business sense to expand coverage under the federal Medicaid program.

So, just how is it that New Hampshire finds itself heading into 2014 without a resolution on this key issue and about to leave $15 million a month on the table?

This issue was debated thoroughly in the last session of the Legislature. A bipartisan commission met over the summer and made recommendations for a uniquely New Hampshire approach to expansion.

A special session of the Legislature convened in November, with policymakers from both sides of the aisle putting forth constructive proposals. Though the House and Senate couldn’t reach agreement on final wording, the differences between the two sides, though very real, are in fact, very small.

With a bipartisan majority of policymakers favoring some form of expansion, it would seem that all parties should be able to come together to reach an agreement that makes sense for New Hampshire.

Given the range of important, though complex, health care issues facing our state — restructuring of the Medicaid Enhancement Tax; improving reimbursement rates for providers; reforming our mental health system — expanding health coverage should be a relatively easy problem to solve.

With 2014 fast approaching, it’s encouraging to see lawmakers back at the table working on this issue. Let’s hope for speedy action and resolution early in the session. Fifteen million dollars a month is too much money to leave on the table.

Dr. Joseph Pepe is president and CEO of Catholic Medical Center Healthcare System.

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