Top GOP state senator says Medicaid expansion is ‘a gamble’ that N.H. may not want to take

By BEN LEUBSDORF Monitor staff
Saturday, May 18, 2013
(Published in print: Saturday, May 18, 2013)

The top Republican in the GOP-controlled Senate yesterday indicated he may oppose expanding New Hampshire’s Medicaid program under President Obama’s 2010 health care reform law – an expansion that’s supported by the Democratic-controlled House and Gov. Maggie Hassan, also a Democrat.

The federal government has promised to pay the entire cost of the expansion for the first three years, and at least 90 percent in future years. But Senate President Peter Bragdon, a Milford Republican and one of the Senate Finance Committee’s six members, said the federal government hasn’t kept other promises, such as funding for special education.

“I hope you can understand my concern that a lot of promises (are) floating around out there, but when we’re talking billions and billions of dollars, I don’t know if that’s a gamble I want to take,” Bragdon said during a hearing yesterday on budget issues involving Medicaid and the Department of Health and Human Services.

No decision’s been made yet on Medicaid expansion by the Senate, though the House included the expansion in the budget it passed last month.

“I don’t think that anyone here’s saying they won’t consider it,” said Sen. Chuck Morse, a Salem Republican and chairman of the Senate Finance Committee.

Expanding Medicaid, the joint state-federal health care program for low-income residents, is part of the sweeping health care reform law known as Obamacare. The U.S. Supreme Court’s June 2012 ruling that upheld most of the law as constitutional also gave states the choice of opting in or opting out of the Medicaid expansion.

According to the Kaiser Family Foundation, 28 governors, including Hassan, support Medicaid expansion in their states, while 20 are opposed and two are undecided.

Bragdon pointed out yesterday that even if federal dollars pay most of the expansion cost, the state would still spend more on Medicaid in future years. But other provisions of the health care law will result in lower state costs, he said, and the managed care system being implemented now will also save the state money.

But Katie Dunn, the head of New Hampshire’s Medicaid program, said implementing managed care and expansion together would have additional benefits, including lower uncompensated care costs at hospitals and increased revenue from the state’s Medicaid Enhancement Tax.

An estimated 22,000 residents would gain health coverage who otherwise would remain uninsured, she said. And the state can opt out of the Medicaid expansion at a future point, she said, though that could create problems with managed care since the contracts awarded to three companies in May 2012 to run the system assume Medicaid would be expanded.

Senate Minority Leader Sylvia Larsen, a Concord Democrat and member of the Finance Committee, also said expanding Medicaid would bring an estimated $2 billion into the state economy over the coming years.

“Is there any financial reason why we wouldn’t do this?” she said.

As senators assemble their version of the next state budget, DHHS Commissioner Nick Toumpas urged them to consider Medicaid expansion, managed care, uncompensated care payments and the Medicaid Enhancement Tax as an interconnected system.

“While each one of these are separate topics, the fact of the matter is that they are interrelated with each other,” Toumpas said.

The Finance Committee is expected to put in long hours next week as it works on the state budget for the biennium that begins July 1. The full Senate will vote on the budget by June 6, teeing up final negotiations with the House, and Hassan, over a final plan.

(Ben Leubsdorf can be reached at 369-3307 or or on Twitter @BenLeubsdorf.)

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