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Maria Ryan: Throwing more onto Medicaid would be a mistake for NH

October 13. 2013 8:51PM

Most people would agree that providing health insurance coverage to more Granite Staters is a worthwhile goal, the benefits of which we all would share. Given that medical costs play a major factor in financial hardships for families, this is an area where we can and must do better.

New Hampshire is ranked the third healthiest state to live in and is ranked eighth for the percentage of people without insurance (11 percent). Considering our relative wealth as the state with the lowest poverty rate in the country, increasing access to health care for those most in need should be an achievable goal.

One option is to increase the number of people eligible for the existing Medicaid program. We must be cautious in pursuing this option, however. Hard-working families who are Medicaid eligible today may become disqualified if they earn higher incomes due to income limits, creating a disincentive to work. Before adding more people, we need to make reforms so we all have collective ownership in the cost of health care and encourage families to get out of poverty.

While supporters of Medicaid expansion often like to gloss over any cost concerns, these are not insignificant. In the midst of a government shutdown and with a federal deficit approaching $17 trillion, New Hampshire cannot and should not depend upon federal funding promises. Medicaid is the state’s largest expense today and is a constant funding challenge. Any reduction of the promised 90 percent federal funding levels would likely require an income tax or other broad-based taxes. Can we really afford to trust the federal government when the stakes for our state are so high and other options are available?

Gov. Maggie Hassan attempted to expand Medicaid earlier in the year, but Senate Republicans wisely urged more review through a study commission. Now that study commission is considering Medicaid expansion and is on the brink of making its recommendations, which are scheduled for tomorrow.

Commission members looked at the possibility of moving those who would be eligible for Medicaid onto the health care exchange where private insurance is sold. Insurance Department officials were quick to say that move would not be allowable due to a lack of choice. How is it permissible that hard-working families earning more than 100 percent of the federal poverty level ($23,550 per year for a family of four) and looking to purchase health insurance through exchanges created by the Affordable Care Act will have fewer choices than those who qualify for Medicaid?

Taxpayers paying for their own health insurance should not have fewer choices than those receiving a government-funded benefit. This is not acceptable, and we can do better. New Hampshire should pursue a waiver from the federal government to allow such an option.

New Hampshire should consider ways that help everyone have ownership of the cost of care, their health, and that ultimately help foster healthy and cost-conscious choices. Co-pays and deductibles are just one way to do this, but wellness programs and work requirements are all options that can help foster personal responsibility while also curbing health care costs and improving health.

President Obama famously said that if Americans liked their doctor they would be able to keep him or her. Yet prior to the go-live date for exchanges and amid several delays, Granite Staters were already being denied their doctor in some instances and are facing fewer choices in health care. This includes the exclusion of Cottage Hospital from the Anthem provider network — the only insurance carrier now available to Granite Staters on the exchange. This means that individuals in rural areas who already face transportation barriers will have a hard time finding care in their network. The explanation for the network reduction was to help curb 40 percent increases in health care premiums as a result of Obamacare.

Given the botched rollout of the Affordable Care Act, can we really have confidence in expanding an already existing government program? Proponents of Medicaid expansion want to sign up immediately based on the false promise of free federal dollars. Rather than running towards acceptance, New Hampshire should continue to cautiously review ways of providing greater access to health care in a way that makes the most sense.

We can do so in a way that’s innovative and will more than likely come from reforming, not expanding, an existing government-run health care program. We can and should develop a New Hampshire solution, not a one-size-fits-all Washington solution. That’s the right choice for patients, hospitals and taxpayers.

Maria Ryan is CEO of Cottage Hospital in Woodsville.

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