CONCORD — The potential costs of expanding the state’s Medicaid program is one of several concerns raised by Republican legislative leaders about the Affordable Care Act.
But those on the other side say the potential costs need to be balanced against the economic benefits of the act and Medicaid expansion before decisions are made in what has become a politically-charged atmosphere.
Numerous studies and reviews have been done on the possible effects of the federal health care reform act on the state’s Medicaid program — the latest by former Health and Human Services Commissioner and Republican gubernatorial candidate John Stephen — showing a range of impacts from several hundred million dollars to over $1.7 billion over a seven- to 10-year period.
From lawmakers to advocates to government officials, all agree there are three main issues: the proposal to expand Medicaid, the state and federal health insurance program for the poor, disabled and elderly, to those earning up to 138 percent of the federal poverty level; people currently eligible but not on the Medicaid program who will become eligible once the individual mandate to have health insurance kicks in, and the phasing out of the Disproportionate Share Hospital program that reimburses hospitals for the uncompensated services they provide to the poor and uninsured.
The U.S. Supreme Court caught many by surprise when it ruled earlier this year states could not be forced to expand Medicaid coverage to those earning up to 138 percent of the federal poverty level, while it upheld the individual mandate requiring everyone to have health insurance.
The court’s decision forced state elected leaders and officials to have to decide fairly quickly whether to join in the expansion and spurred additional discussions about the value and cost of the act.
Here in New Hampshire state Senate Majority Leader Jeb Bradley, R-Wolfeboro, and House Speaker William O’Brien, R-Mont Vernon, both say lawmakers need much more information at this critical juncture.
State Health and Human Services Commissioner Nicholas Toupmas believes policy makers, the public and his department need an independent analysis that provides a more detailed look at the costs and the benefits of expanding Medicaid eligibility and its implications.
He said he is not in a position of advocating for one side or the other.
“Our role is to provide information to the policy makers that they need to have, that is the responsible thing,” Toumpas said. “They can take action as they see fit.”
He wants an outside analysis done with input from key lawmakers of the areas that need to be addressed.
Tom Bunnell, consultant to New Hampshire Voices for Health, a group promoting access to affordable health care, said a detailed “drilling down” will be good for the discussion.
“It is our hope and desire that policymakers will look not just look at the potential costs for New Hampshire but the overall economic benefits,” Bunnell said. “There is a bigger picture here and we hope (policymakers) take a pragmatic look.”
O’Brien has already said he opposes the state’s expansion of Medicaid eligibility.
“I’m very concerned about the effects on state finances,” he said. “It’s not too harsh to say the full implementation of the Affordable Care Act is a hijacking of our state’s finances.” He said the act amounts to the “government take -over of health care for low- and moderate-income people and then dumping them unto the state Medicaid system.”
He said the federal government has not lived up to its promises in the past, using the Individuals with Disabilities Education Act as an example. O’Brien said the federal government promised to pay 45 percent of the cost but has never paid more than 20 percent in New Hampshire, and he does not believe it will pay its full share for Medicaid expansion.
Bradley, who backs Toumpas’s request for an independent analysis, asked Stephen of the Stephen Group to update his analysis of the effects of the Affordable Care Act on New Hampshire after the Supreme Court’s decision letting states decide if they want to expand Medicaid eligibility and upholding the individual mandate requirement.
“I need more information about expected costs and expected benefits before someone in my position says ‘Yes’ to proceed with expansion,” said Bradley. “I don’t know how rationally we move forward.” In his analysis, Stephen projects the costs to be $365 million to $1.76 billion over the next decade.
“That’s a pretty significant impact to our state,” Stephen said.
Stephen’s estimate of the cost of expanding Medicaid eligibility for approximately 50,000 new recipients is $53.8 million over 10 years, which is in line with a number of studies done by groups ranging from the Kaiser Family Foundation to the Heritage Foundation.
But Bunnell also notes, the state is projected to see an influx of between $1.2 billion and $2.3 billion of federal money to pay for the expansion, and that will have a positive economic impact.
Full Article: http://www.unionleader.com/article/20120806/NEWS06/708069970.
