Time to expand Medicaid is now

Earlier this year legislators decided to delay Medicaid expansion, in order to study it further. Now, the Commission to Study Expansion of Medicaid Eligibility has made its final report, recommending expansion effective Jan. 1, 2014, and a special session of the Legislature has been called to begin Nov. 7, when our representatives will decide whether to move forward with the commission’s proposals. If the Legislature approves the expansion, about 50,000 more low-income folks in the state would become eligible for Medicaid.

The Medicaid expansion question arose in 2012 when the U.S. Supreme Court ruled the Affordable Care Act’s mandate to states to expand their Medicaid programs unconstitutional. Here in New Hampshire, many Republicans have worried what expansion would mean for costs to the state down the line, while Democrats have lauded the federal dollars that expansion would bring, not to mention the additional low-income residents it would insure.

From 2014 through 2016, expansion would be 100 percent funded under the Affordable Care Act. After that, it would be funded at 90 percent with federal dollars. It is estimated that the state would bring in $2.5 billion from the federal government in the next seven years with Medicaid expansion, and would spend less than $86 million.

Under the commission’s plan, the state’s Medicaid expansion program would be called the New Hampshire Access to Health Program. According to the commission’s final report, “Adults not already eligible for Medicaid aged 19 to 64 with income up to 138 percent of the Federal Poverty Level will be covered.” So those earning about $15,850 or less would be eligible, or families of four with an income of less than $32,500.

But there’s a caveat in the commission’s plan in the event that the federal government pulls back on funding: “Any decrease in percentage of federal support of NHAHP as outlined in the Affordable Care Act would trigger a requirement that the General Court reauthorize NHAHP within six months from the receipt of such notification. Failure to reauthorize would result in automatic discontinuation of the NHAHP at the end of that six-month period.”

Nine people participated in the commission as voting members, three from the Senate, three members from the House of Representatives and three from the public, and among them were Republicans and Democrats. Sen. Peggy Gilmour, D-Hollis, who served on the commission, has said the commission’s report represents a bipartisan compromise. But from Republican quarters, we’ve heard more needs to be done to protect the state against unfunded mandates and to incorporate private insurance alternatives.

We hope the full Legislature will work to improve what the commission spent more than 50 hours developing, but not at the expense of further delays.

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