MANCHESTER — Although it upheld most of the Patient Protection and Affordable Care Act, Thursday’s U.S. Supreme Court ruling appears to open the door to states to reconsider whether or not to join the expansion of Medicaid, state officials and legal experts said.
"It appears that there may be some flexibility with regard to whether to participate in the Medicaid expansion and there may be some policy decisions that may still need to be made," Suzanne Gorman, senior assistant attorney general in the civil bureau, said.
“Many people are going to sleep better tonight because they have certainty the law is going to continue to move forward,” New Hampshire Medical Society President Dr. Travis Harker, said in a conference call hosted by New Hampshire Voices for Health. “People who struggled before will have access to our system.”
The federal threat
The Affordable Care Act requires state programs to provide Medicaid coverage by 2014 to adults with incomes up to 133 percent of the federal poverty level, but the court found its threat of withholding all Medicaid funds from states that don’t comply was overreaching.
John M. Greabe, professor of constitutional law at University of New Hampshire School of Law, said the portion of the nearly 200-page opinion covering the Medicaid expansion was a compromise struck among the justices, with seven supporting it and two against.
“Only three justices actually think this is what the law should be, but because those three are sort of smack dab in the middle, it ends up being presented as the position of the court with seven justices on board,” Greabe said.
And reopening the Medicaid expansion question will make it a subject of debate in the fall elections for both state and federal office, he said.
$7,500 a year per person
Previous estimates have put the number of new Medicaid enrollees under the Affordable Care Act in New Hampshire in a range of 30,000 to 50,000.
House Speaker William O’Brien, R-Mont Vernon, said Thursday each new Medicaid enrollee costs the state about $7,500 a year on average.
“There are a number of areas that are going to cost the taxpayers of New Hampshire millions of dollars in additional state costs,” he said. “We look at such things as the maintenance of effort requirements that the court didn’t deal with, the expansion of eligibility.
“We’re questioning how this is going to be implemented,” O’Brien said.
The law says states can’t offer less in Medicaid benefits than they did in February 2010, he noted.
O’Brien said he fears the Medicaid expansion may drive folks off private insurance plans — such as COBRA plans — and onto Medicaid eligibility rolls.
“Obamacare in essence hijacks state governments to provide through their local taxpayer resources a substantial amount of health care coverage,” O’Brien said.
Who will pay?
In a conference call, Voices for Health consultant Tom Bunnell said, “With respect to the Medicaid expansion, we expect New Hampshire public officials and other stakeholders will work together to make sure the most vulnerable members of the community will receive coverage.”
Bunnell, director of the Institute for Health, Law and Ethics at the University of New Hampshire School of Law, said if states opt out of the Medicaid expansion, they’ll miss out on the opportunity to get matching federal funds.
But O’Brien said the law will phase out support for that expansion after a period of 10 to 20 years.
Mary Vallier Kaplan, interim president of the Endowment for Health, said if the state doesn’t join the Medicaid expansion, it may not necessarily save any money.
“These people get sick,” she said. “They most likely will present themselves at our emergency rooms, which are one of the most costly ways of solving the problem of the moment.
“If they don’t have Medicaid, the hospital will see them, and it (the costs) will get redistributed back through the system just as they are now,” Kaplan said.
DHHS Commissioner Nicholas Toumpas issued the following statement: “It is the law and while we have a number of challenges before us, we also see there are opportunities. We are committed to staying focused on the people we serve,” Toumpas said.
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