We applaud the N.H. Legislature and Gov. Maggie Hassan for reauthorizing the N.H. Patient Protection Program — also known as Medicaid expansion — for another two years. It was a necessary move that not only aids tens of thousands of Granite Staters who otherwise could not afford health insurance, but will also bolster the state’s economy in several ways.
We can’t help but wonder whether the extension would have occurred if not for the attention being paid these days to the calamitous opioid addiction crisis. One of the benefits of the program is that it provides access to both mental health counseling and addiction treatment among a population very much at risk. As of 2014, opioid overdoses were claiming more than a life a day in the Granite State, and that rate has continued to grow. The N.H. Patient Protection Program has made it possible for 1,700 people to access substance-abuse services.
There are other benefits, to be sure. So many, in fact, that we find the entrenched opposition to the program among some lawmakers positively dumbfounding.
To begin with, nearly 50,000 residents have gained health insurance over the past two years through the program. That means many of those people now have access to care that could save their lives. Better, many who might have otherwise put off seeking care until they were in crisis mode can now get less costly preventive care. And those who had been seeking care but were unable to pay for it now can, which means hospitals are absorbing less in “uncompensated care” and the rest of us are paying less to subsidize that cost.
That savings alone is so great that hospitals, along with insurers, have agreed to foot the state’s portion of the program’s cost for the next two years, and are still making out better. Think about the economic effects of that. The state’s hospitals saved more than $142 million in 2015 through this reduction in uncompensated care.
Now add the federal dollars accompanying the expansion — hundreds of millions of dollars over the next two years — the corresponding increase in health-sector jobs, and the productivity increase attributable to having workers actually working, rather than taking time off because they’re sick, having foregone medical treatment because they had no insurance.
A recent study by the Robert Wood Johnson Foundation found states that have expanded Medicaid services under the Affordable Care Act have seen these benefits and more. Their Medicaid spending grew at half the rate of non-expanding states, and fewer hospitals closed, especially in rural areas.
And all that doesn’t even take into consideration that it’s simply the right thing to do. No one should suffer in declining health for want of the means to be treated.
Yet the legislation very nearly was sidetracked by efforts to link the program to forced work requirements. In hammering out a bill that legislative conservatives could stomach, Senate Majority Leader Jeb Bradley and others included the requirement that anyone in the program be able to show they work or volunteer at least 30 hours per week.
A month ago, House Speaker Shawn Jasper had to vote to break a 181–181 tie to include a severability clause so the bill could move forward. Without such a clause, the program could be killed if the federal government finds the work requirement onerous. No such work-requirement rider has yet been allowed.
Fortunately, that now won’t derail the program.
A second compromise Bradley and company made in devising the legislation was to convince insurers and hospitals to pay most of the state’s share of the cost. Under the Affordable Care Act, the federal government has borne the cost of expanding Medicaid for the first two years. But the state now becomes responsible for just 5 percent of the cost, and will eventually have to pay as much as 10 percent.
Insurers and providers are willing to foot that bill for now because of the huge gains they’re seeing from the program already. But how they’ll pay still needs to be worked out, and they may balk at some point.
Which leads us to this: Everyone was all smiles Tuesday when Hassan signed the legislation into effect. But the fact remains that two years after implementing Medicaid expansion, lawmakers had to strong-arm private businesses and nonprofit hospitals into taking on the bulk of the cost, and still only managed to push the reauthorization through in a sustainable manner by a single vote.
Two years from now, we’ll have a different governor and many new legislators. But the need for access to health care will not have evaporated. Planning for that day should begin now, not when the Legislature convenes in 2018
