IF YOU WERE planning a vacation you couldn’t finance it by, say, not paying your grocery bills.

Yet, for too long, New Hampshire’s budget has been “balanced” in no small part by not paying the care bills for the state’s Medicaid clients. This has led to New England’s largest gap between Medicare care costs and state payments, and contributes to the daily net exodus of thousands of health care workers who cross the border into better-paying Massachusetts. It explains why we entered the COVID-19 pandemic with such a critical shortage of staff, which has led to staffing crises in long-term care settings experiencing outbreaks from community transmission of the highly-contagious respiratory virus.

With legislators again talking about further cutting business taxes, it is necessary, as even the Business Industry Association (BIA) has noted, to consider any impact upon Medicaid payments. To its credit, a legislative priority of the BIA is “appropriately funding the Medicaid program to avoid cost shifting to employers and employees.” In New Hampshire it is the licensed nursing assistant in a nursing home, or the personal care aide in someone’s home, who finds herself forced into poverty because Medicaid was shortchanged to pay for the tax cut du jour. Most Medicaid care costs are wages, after all.

During the COVID-19 pandemic it would be especially egregious to siphon more funding from wage costs for these essential workers — heroes all — in order to provide tax cuts the business community is hardly clamoring for.

Those who oppose broad-based taxes and sign “The Pledge” also somehow close their eyes to the fact that we have the nation’s third-highest property tax burden, and it is county property taxes used to fund what would otherwise be the state’s Medicaid responsibility for long-term care.

In the last budget members of both parties came together to provide increases in Medicaid rates for all Medicaid providers in a way that did not play favorites and that recognized the value of each sector. Thanks heavens they did this, and that Governor Chris Sununu signed that budget, because we would be truly sunk had that not occurred. At the time the funding increase was a modest down payment following years of funding neglect. During the pandemic it has become a slender reed for drowning providers to hold on to.

An enhancement, under the Families First Coronavirus Response Act, to the federal participation in the Medicaid program has helped our state pay for the increase in citizens turning to Medicaid for health care coverage amidst economic hardship. This will last during the public health emergency. Optimally, in the long run, Congress and the Biden administration will take on more federal responsibility for Medicaid costs — especially in long-term care. Our society is aging, and the elderly have suffered heartbreaking tragedy amidst this pandemic. But until that day happens the states, including the Granite State with the nation’s second-oldest population, must step up to their responsibilities to protect our most vulnerable citizens.

Although partisans can debate the specifics, Gov. Sununu, with a healthy assist in funding brought in by our congressional delegation, has done an able job of responding to the unprecedented, existential crisis COVID-19 created for our fragile long-term care system. It would be incongruous to now falter in our commitment with state budget decisions to be made for the next two years.

Bedford resident Brendan Williams is the president/CEO of the New Hampshire Health Care Association. He lives in Bedford.

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