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Rep. Thomas Sherman: Why New Hampshire needs to expand Medicaid coverage

June 04. 2013 6:38PM

Medicaid is a partnership between the federal government and the states that started in 1965. In New Hampshire, we split funding with the federal government 50-50, and its administration is through our own Department of Health and Human Services. Medicaid currently covers pregnant women, children and the elderly poor as well as the disabled.

Medicaid expansion would extend these benefits to New Hampshire residents ages 19 to 64 with annual incomes of up to just under $16,000 (138 percent of the federal poverty level). In New Hampshire, expansion is likely to provide coverage to 58,000 uninsured residents. For the first three years of the program, the cost of this expanded coverage would be borne by the federal government. Thereafter its share would gradually decrease to a level of 90 percent by 2020. It would stay at 90 percent unless Congress passes a new law.

National studies show that the uninsured have a higher mortality risk solely on the basis of insurance status. While they are three times less likely to seek care, often delaying treatment, when they actually did get care, 70 percent fully deplete their savings and 50 percent struggle to pay for basic needs like food and rent.

The vast majority of recipients of Medicaid under this expansion will be the uninsured working poor. Additionally, Medicaid expansion will provide critical funding to the care of the mentally ill and for those suffering from substance and alcohol dependency. As a doctor, I see uninsured patients with hepatitis C, Crohn’s disease and other gastrointestinal disorders. They have curable or controllable diseases. Without insurance, they cannot afford even the most basic of care, relying on emergency rooms as their primary care contact, living in a state of chronic illness and costing all of us much more in the long run.

The impact of Medicaid expansion on the State of New Hampshire has been carefully studied by the Lewen Group, a nonpartisan firm contracted by the state Department of Health and Human Services. This independent study showed that over the next seven years this program would bring in an estimated $2.5 billion of federal aid at no net cost to the state. There would appear to be an additional benefit to the state by creating jobs and providing financial means for addressing critical shortfalls in our health care system.

Given all of these benefits, attempts to block expansion were defeated in the House of Representatives. The House and Gov. Maggie Hassan support its implementation, which is slated for 2014. However, expansion has met a roadblock in the Senate. Several senators are asking for a “block grant,” but no block grant is being offered. What is being offered is federal funding for a program that is administered here by the State of New Hampshire. These are our federal tax dollars, already earmarked for Medicaid expansion, and they will go to another state if we do not use them.

Some state senators are worried about the reliability of the funds, but the source of the federal dollars is the same agency with which we have had a strong financial relationship over the last 40 years. There has been no failure to meet financial obligations on the part of the federal government in the history of Medicaid for the State of New Hampshire. If we find that expansion is not all we hoped it would be for the state, we have a documented right to withdraw from the program without penalty.

Medicaid expansion addresses many of the current, active and critical needs of our uninsured population without increasing the financial burden to New Hampshire residents. We know that the uninsured have a higher mortality rate than the insured population, and we know that medical illness is a leading cause of lost productivity and financial insolvency in this group. Medicaid expansion brings funding that will underwrite implementation of critical programs and creation of jobs in our state. Furthermore, a Rand Corp. study just released projects a sharp increase in health care related costs to states that do not participate in expansion. We therefore cannot afford either to delay or to fail to implement Medicaid expansion.

Our state senators are voting on a budget that excludes Medicaid expansion this Thursday. If you agree with me that Medicaid expansion is critical not only for the health of the uninsured but for the long-term financial health of New Hampshire, please call them and ask them to reject any further delay and to support its implementation.

Thomas M. Sherman is a medical doctor and a Democratic state representative from Rye.

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