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NH officials told: Do not expand Medicaid

State House Bureau

August 13. 2013 10:41PM

CONCORD — The commission studying the possible expansion of Medicaid eligibility under the Affordable Care Act heard two sides of the issue Tuesday.

While one expert told the nine-member commission that she sees no reason a state would want to expand Medicaid eligibility, others said it would save money over time through preventative care and the decline in the use of expensive emergency room services.

Christie Herrera of the Foundation for Government Accountability and former Health and Human Services Task Force director for the American Legislative Exchange Council, gave the commission five reasons why New Hampshire should not expand Medicaid.

She said it would drive up the federal deficit, people with private insurance will join the state-federal health insurance plan, any future federal cuts in the program could double New Hampshire’s obligation, the program will keep growing and others states that have expanded Medicaid have seen costs escalate.

“In my opinion, I don’t think there is one good reason to expand Medicaid,” Herrera said. “I would work to make private insurance more affordable or stand pat on Medicaid.”

But Lynda Flowers, senior policy advisor for AARP, said expanding Medicaid to include adults, particularly those between 45 and 64 years old would reduce future costs by keeping that population healthy longer.

The mid years are usually when chronic diseases such as diabetes or high blood pressure start to affect people, she said, and if they are treated early, future costs are less.

“There are people in your state that are not accessing critical health services,” Flowers said. “If they are not treated, they come into Medicare with chronic health needs and that is very costly.”

Steve Norton of the NH Center for the Study of Public Policy Studies said the commission should first determine what goals it wants to meet before deciding whether to expand Medicaid.

Does the state want to maximize access to health care and health outcomes, or minimize the roll of state government and the federal dollars flowing to the state, Norton asked, or does it want to minimize state dollars while maximizing federal dollars, health coverage, and the use of private insurers? He said without setting goals, it is difficult to decide on what models would be best for the state and in deciding if better health for citizens and the community outweighs the money spent on the program.

But he warned commissioners they should be cautious of all the numbers opponents and proponents use to make their case.

Deb Fournier of the N.H. Fiscal Policy Institute presented several options for the state that would be cost effective, including paying the premiums for the private insurance coverage someone already has, although they are eligible to be on Medicaid.

“Under current law, the state can help low-income workers pay their premiums if they already have insurance through their employers,” Fournier said. “The Health Insurance Premium Program already exists and can be expanded to cover some of the new people who’d be added to Medicaid as long as it is voluntary.”

A public hearing for the public and other stakeholders will be held Aug. 27.

The commission has an Oct. 15 deadline to issue its recommendations.

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