Medicaid expansion's benefits extolled before House Finance Committee
CONCORD - State Sen. Sylvia Larsen called last week's 18-5 Senate vote in favor of Medicaid expansion the "culmination of a long bipartisan process," as she urged the House to follow suit and approve a plan to extend the federally funded health insurance program to 50,000 or more low-income New Hampshire residents.
In testimony on Monday before the House Finance Committee, the Concord Democrat used the word "bipartisan" at least four times, calling the Senate compromise similar to bills previously passed in the House.
"More than 50,000 people, mostly hard-working, tax-paying, low-income residents of New Hampshire will get coverage," she said. "Hospitals will face less uncompensated care; and $600 million in federal funds will flow to the state, which will help grow our economy and jobs."
Senate Bill 413, the subject of the hearing, creates a 2 1/2-year pilot program that would address the question of how to provide health insurance for residents who do not qualify for Medicaid under current guidelines, but also do not qualify for subsidies on the insurance exchange at healthcare.gov because the Affordable Care Act assumed that states would expand Medicaid as the law requires.
The Supreme Court struck down that requirement, and some states have chosen not to expand Medicaid, leaving millions of Americans in what has been called "the doughnut hole" of health care coverage.
Under SB 413, New Hampshire residents in the doughnut hole would be broken into two groups - those who have jobs where qualified health insurance is offered (about 12,000) and those who do not (about 38,000).
Those with the potential for coverage at work would get state subsidies to pay the premiums to private insurers, while the rest would go into the state's Medicaid program pending federal approval of a waiver that would allow them to be covered by private insurers, with the state using federal Medicaid money to pay the bills.
If the waiver is denied, the legislation calls for the expansion to be terminated.
Representatives of the state's hospital association, business and industry association and advocates for the disabled spoke in favor of the legislation.
"There will be continual legislative review," said Larsen. "We can repeal laws if we find them unaffordable."
Republican Rep. Neal Kurk of Weare asked Larsen if expanding government-funded health insurance to those earning up to 138 percent of the federal poverty level would rob them of their ambition.
"Are we providing a disincentive for people to achieve the American dream?" he said.
She replied that most of the population affected by expansion consists of the working poor. "I don't believe this will disincent their work ethic," she said.
Opponents also worried about spiraling costs, and the fact that the federal share of the program will go from 100 percent to 90 percent in three years.
"When (not if) the federal government reduces its commitment, Medicaid expansion will draw resources from many other things we value," said Bedford Republican Laurie Sanborn, the House GOP policy leader.
She said House Republicans would like the bill killed, but failing that, she urged the committee to establish safeguards that would limit or cap the state's exposure to future expenses.
"We have a hard enough time saying 'no' now to this program," she said. "I think it's going to be very hard to say 'no' later when people are already signed up."
Belmont Republican Rep. Michael Sylvia suggested lawmakers were shirking their responsibilities by passing a bill that does not address the issue beyond two and a half years.
“This is a good bill for politicians,” he said. “We get the good stuff right away, and the consequences come down the road. We leave others with the hard decisions.”
Commissioner of Health and Human Services Nick Toumpas described the process his department will use to implement the Medicaid expansion, which he described as “a significant step forward for innovation in our health care delivery system in New Hampshire.”
Toumpas said HHS will spend about $6.4 million more on Medicaid administration if the program is expanded, but will not need any additional state appropriations. “The General Fund will not be adversely affected,” he said.
Henry Lipman, senior vice president at LRG Healthcare and vice chair of the state Hospital Association, told the committee that Medicaid expansion would “go along way to making care available to people in a sensible fashion.”
New Hampshire gets the lowest federal match for Medicaid in the country, he said, and hospitals bear an unfair burden in providing care to the state’s low-income population.
“The structure of financing Medicaid in New Hampshire is broken and further exacerbates the cost of health care in the state,” he said.
Lipman said Medicaid does not come close to covering all of a hospital’s actual costs in providing services, but it’s better than no coverage at all.
“We get seven cents on the dollar from the uninsured,” he said.
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