The New Hampshire House of Representatives voted down a bill that would have rolled back the state’s Medicaid expansion.
Rep. Neal Kurk (R–Weare) introduced House Bill 1813 in December 2017. The House Committee on Health, Human Services, and Elderly Affairs instead approved a plan on March 6 to extend the state’s Medicaid expansion another two-and-a-half years.
HB 1813 would have required the New Hampshire Department of Health and Human Services to reduce the eligibility requirement for Medicare and Medicaid from 138 percent of the federal poverty level to 100 percent.
More Enrollees, Higher Costs
Charles Katebi, a state government relations manager at The Heartland Institute, which publishes Health Care News, says Medicaid expansion has been a failure in every way.
“Medicaid expansion has been disastrous from a taxpayer’s perspective and from the perspective of patients,” Katebi said. “Policymakers really didn’t know how many people would enroll. There were a lot of people already eligible for Medicaid even before Medicaid expansion eligibility changed, and the education and outreach about the expansion brought in a lot more.
“Federal funding covers 90 percent of the cost of the Medicaid expansion population, but if somebody was already eligible for Medicaid prior to expansion, the state has to pick up 50 percent of the costs,” Katebi said. “Those costs weren’t picked up by the federal government; they were picked up by the states.”
Dying on Waiting Lists
Katebi says entitlement programs siphon resources from other government programs, causing undue suffering to people in need of those other services.
“If autopilot programs keep growing, they are going to crowd out all the other things states do,” Katebi said. “As Medicaid spending has grown, funding for primary education, secondary education, and higher education, as a percentage of state budgets, has fallen, as has funding for road maintenance and law enforcement.
“From a patient’s perspective, when these able-bodied people go into the program, they take money and resources from the people that Medicaid is really for: the elderly, children with illnesses, adults with illnesses,” Katebi said. “Those people have seen wait times go up, and people have died on those waiting lists.”
Calls for More State Control
Devon Herrick, a policy advisor for The Heartland Institute, says the federal matching-funds system allows lawmakers to view Medicaid as an economic development program that uses other states’ taxpayers’ money to pay for hospitals, doctors, and health care workers, in addition to being a cheap way to help poor people. States should have more control over the program, plus the responsibility that goes with it, Herrick says.
“Under current law, states cannot tailor benefits in a way that is affordable for taxpayers and meets the needs of Medicaid beneficiaries,” Herrick said. “The cost of expensive specialty drugs could be used to care for many more beneficiaries. Yet, federal law does not allow states to limit costly medications to those who are not expected to fare well and care for those mostly likely to benefit.
“States should have the right to establish limited benefit plans, with cost-sharing, nominal premiums, work requirements, and the ability to kick off those beneficiaries who do not follow the rules,” Herrick said. “Medicaid should be a leg up, not an economic development program. What might help is giving the poor more responsibility for their care. States like Indiana use a type of health savings account with deposits for healthy behaviors.”