About Medicaid Expansion:
Part IV in a Series

Today we reach the final part of our four-part series on the Affordable Care Act with an explanation of Medicaid expansion. The reason we saved this for last is it’s the one part of the ACA that isn’t decided yet, though it should be soon.

About the ACA: A Four-Part Series

Part I: What’s Changed Thanks to the ACA
Part II: What’s Coming Next Under the ACA
Part III: Getting Covered Under the ACA

Medicaid, as you may know, is a joint state-federal health care program that covers certain low-income adults. The ACA required states to expand Medicaid, but the Supreme Court shot that bit down, giving states the option to decide whether to expand. Here in New Hampshire, our legislators are still trying to decide what to do.

Since expansion here is still a big question mark, we’ll try to answer some of the questions you may have, starting with the money.

Who’s paying for this?

Because the expansion was originally required, the federal government offered to cover the full cost of expansion for the first three years, from 2014 to 2017. After that, states would have to chip in a bit each year, reaching a max of 10 percent in 2020 and beyond. An independent study by the Lewin Group found that would mean $2.5 billion in federal funding would come back to N.H., while the state would spend a total of $18.4 million. Consider, too, that because it’s federal funds, we’re sending money to Washington already — if we reject expansion, our money stays there or gets redistributed to other states.

Who would benefit?

The federal guidelines required that expansion cover all adults aged 19-64 (those younger are covered by CHIP, those older are covered by Medicare) who earn up to 138% of the poverty level ($15,400 for a single person, $32,000 for a family of four). That independent study we just mentioned estimated that would mean an additional 58,000 Granite Staters would have access to affordable, quality health care. If you already have good health coverage, you’ll benefit, too. This is because when hospitals treat uninsured people, someone has to pay for it — that someone is insured people. Expansion would cut this uncompensated care and save Granite State households $92 million between 2014 and 2020. That comes down to $145 in savings per household every year.

What happens if we do nothing?

In a fiscal sense, N.H. wouldn’t see a dime of that $2.5 billion, and uninsured people would continue seeking the most expensive, unmanaged treatment with the costs being passed down to us. In the human sense, we would deny 58,000 of the lowest income N.H. residents access to quality, affordable health care. Some in that group of 58,000 would be eligible to save on insurance bought through the Marketplace, but the vast majority of that group (69 percent, to be precise) would fall into what’s known as the “coverage canyon.” Basically, these people wouldn’t qualify for Medicaid and make too little to qualify for savings in the Marketplace.

What are we doing about this?

As we mentioned earlier, our legislators are still trying to decide what to do — we’re one of eight states that has yet to decide.

During this year’s legislative session, Gov. Hassan proposed the full Medicaid expansion in her budget, which the House approved. The Senate rejected expansion, asking instead for a delay and more study of the issue. This came to a head when it came time to finalize the budget in June, and the sides eventually decided to study expansion but without the delay the Senate wanted. The compromise spelled out that a commission would be appointed to study expansion and file a report by next Tuesday, Oct. 15. A special session of the legislature is expected to vote on the issue.

That brings us to this week, when the study commission tentatively approved a plan to expand coverage that would maximize the use of private insurance. The plan would require getting a waiver from the federal government, and it’s not clear that would happen. The commission decided that if New Hampshire did not receive the waiver, the state would not expand Medicaid at all.

What’s next?

The study commission will meet Tuesday to vote on the final report. If the commission accepts the report, legislation will still need to be drafted before the legislature can vote on possible expansion.


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