NH voters choosing different paths on health care
CONCORD, N.H. (AP) — New Hampshire's top gubernatorial candidates propose taking the state down starkly different paths on providing health care to its poorest uninsured residents.
Democrat Maggie Hassan says she would accept an option under the federal health care overhaul to cover thousands of people by expanding Medicaid. Hassan has repeatedly stressed the advantage of extending coverage to people who can't afford it. She says expanding Medicaid will inject $1 billion into New Hampshire's economy by 2020 while providing health coverage to people who have none.
"Without it, we will have fewer and fewer resources to make sure people in New Hampshire get medical care, and that hurts all of us," she said Friday.
Republican Ovide Lamontagne says he would reject such an option and instead try to get the federal government to give money to let New Hampshire design its own solution to the problem. Lamontagne has argued for a waiver or block grant to create a pool of high-risk people that is a market-driven, private health insurance exchange. He would use the money that would pay for expanding Medicaid to fund it.
Both paths promise uncertain results. There is no guarantee that Lamontagne could negotiate with the federal government, and the costs and benefits of expanding Medicaid as Hassan proposes are only rough estimates.
The state Department Health and Human Services hopes a new study due before the election will better estimate how much it would cost New Hampshire to expand Medicaid, Deputy Medicaid Director Lisabritt Solsky said. In Medicaid, a state determines eligibility and what services are covered. The federal government reimburses a percentage of the state's spending.
Under the federal health care law, people under age 65 will qualify for Medicaid if they earn up to 138 percent of the federal poverty guideline. For a single adult, that means about $15,000 a year. The federal government will pay 100 percent of the cost to insure these newly eligible enrollees for three years beginning in 2014. Eventually, the federal government's share of the cost begins to shrink annually until it is 90 percent in 2020, and the state pays the rest.
Estimates on the number of uninsured residents who would enroll in an expanded version of Medicaid range from 36,000 to 55,000, said Tom Bunnell, director of the Institute of Health, Law and Ethics at the University of New Hampshire law school. Childless adults will make up a large portion of those newly eligible for Medicaid.
Some of the other estimated 125,000 uninsured residents earn too much money to qualify for Medicaid and could be covered by a policy through a yet-to-be created federal health insurance exchange, Bunnell said.
New Hampshire's effort to provide care to its uninsured poor will be affected even if the state does not expand Medicaid.
The federal government will continue to pay half of the state's cost for those who are eligible for Medicaid now but not enrolled. Lamontagne argues that many of those people, who will face a tax penalty under the federal law if they don't get health insurance, will enroll in Medicaid regardless of whether New Hampshire expands its program. He says this so-called "woodwork effect" will drive up the state's costs.
Former Health and Human Services Commissioner John Stephen, who helped Rhode Island negotiate a global Medicaid waiver under the Bush administration, argues that could cost New Hampshire tens of millions of dollars.
"They're not covered and by law they have to be," said Stephen.
Lamontagne says people qualifying for Medicaid under both the existing rules and an expanded Medicaid program would have the option under his plan to buy a policy from the new exchange or enroll in Medicaid. Those who buy a policy through the exchange would be given a voucher from the state, he said.
"We're dealing with concepts as opposed to the nuts and bolts of how it would work," he said Friday.
Lamontagne said he would gather health care providers, insurers and others to put together a plan that would work.
No one knows how many people fit into the "woodwork" category or who might enroll, but Bunnell believes those numbers will be low since eligibility is so limited under New Hampshire's current program.
Bunnell also points to earlier studies that indicate the state would save money from program changes in enough other areas to offset the federal law's costs with expansion that includes adding people who qualify for the lower federal reimbursement rate.
The federal government also will begin phasing out aid to hospitals to help cover their costs of caring for the poor starting in 2014. The state qualifies now for up to $160 million a year in aid matched with a like amount of state money. The law assumes hospitals would have fewer poor people using emergency rooms for basic care if they are covered by Medicaid or buy insurance through an exchange.
Health and Human Services Commissioner Nicholas Toumpas says the decision whether to expand Medicaid rests with the next governor and Legislature.
House Speaker William O'Brien, R-Mont Vernon, wants no part of expansion.
"We cannot allow this federal law to hijack our state finances with unfunded mandates," said O'Brien in announcing this month that he is sponsoring legislation to block expansion.