Myth-Busting New Hampshire’s Medicaid Expansion

Published April 15, 2016

New Hampshire Gov. Maggie Hassan signed into law on April 5 House Bill 1696 to modify and renew through 2018 the state’s Medicaid expansion program under the Affordable Care Act (ACA), which state lawmakers first adopted in 2014.

Although the law is scarcely a week old, the people of New Hampshire are less than seven months away from influencing whether their elected officials renew Medicaid expansion through 2020.

Why so soon? Most of the New Hampshire lawmakers who will decide Medicaid expansion next time around will hold their offices as a result of the general election on Nov. 8, just seven months from now.

State lawmakers will vote in the spring of 2018 either to allow the Medicaid expansion program to sunset at the end of the year, as HB 1696 prescribes, or renew the program again through 2020. In that year alone, New Hampshire will spend $47 million to extend Medicaid coverage to 50,500 newly eligible enrollees, according to HB 1696’s fiscal note. If the program attracts more enrollees than projected, as other states’ Medicaid expansion programs have, New Hampshire will pay even more.

As the people of New Hampshire prepare to elect candidates to represent their values and interests in the General Court, voters should consider three popular Medicaid expansion myths, misconceptions and rebuttals.

One myth is Medicaid expansion empowers states. In fact, the federal share of Medicaid expansion makes states more dependent on the federal government. In 2020, the federal share for New Hampshire will be $509 million. New Hampshire will grow more beholden to the federal government as it grows more dependent on federal money. Like the ACA itself, this federal overreach will further upset the balance of power between federal and state governments, known as federalism.

The Founding Fathers, in contrast to the majority of current New Hampshire lawmakers, saw value in limiting the federal government’s reach into matters the 10th Amendment reserves to the states, such as providing for the health and welfare of their citizens.

A second myth is popular among alarmists: If New Hampshire doesn’t renew its Medicaid expansion program, other states with Medicaid expansion programs will get billions of New Hampshire dollars in the form of federal shares.

The truth is, if New Hampshire allows its Medicaid expansion program to sunset, the federal share it was receiving would not go to other states. It would go unspent. “There is no magic pot of Obamacare money” in Washington, D.C., waiting to be distributed to other states, Nicolas Horton, a senior research fellow at the Foundation for Government Accountability, told Health Care News in March. “All of the money the federal government is spending on Obamacare’s Medicaid expansion is being added to the national debt.”

The national debt will reach close to $20 trillion when President Barack Obama leaves office on Jan. 20, 2017. The money New Hampshire currently receives in the form of the federal share never was New Hampshire’s, except in the sense New Hampshire shares the national debt. Whether people realize it or not, this debt belongs to every present-day American and countless Americans yet to be born into debt they did not create.

To say New Hampshire’s money could go toward expanding Medicaid in another state is misleading, because the money is not New Hampshire’s and technically does not exist.

A third myth is HB 1696’s addition of work requirements protects the program from abuse by newly eligible, able-bodied Medicaid recipients.

The Republican-controlled New Hampshire House of Representatives left HB 1696’s work requirements vulnerable to removal by the federal Centers for Medicare and Medicaid Services (CMS). A split in the House prompted Speaker Shawn Jasper to break a 181–181 tie on March 9 in favor of including a severability clause for work requirements in the bill. The adopted amendment, offered by state Rep. Karen Umberger, ensures the Medicaid expansion program will remain in effect even if CMS holds the legislation’s work requirements invalid.

On its face, the law’s inclusion of work requirements offers politicians a convenient cop-out when constituents challenge their representatives’ support of Medicaid expansion. Wise voters will recognize that a lawmaker’s consent to severing work requirements is, by definition, a vote not to require work.

The decision whether to renew New Hampshire’s Medicaid expansion program through 2020 rests not merely with lawmakers in the General Court in 2018, but with voters at the ballot box in November.

New Hampshire’s latest Medicaid expansion law increases the state’s dependence on Washington, D.C., spends money the country doesn’t have and which never belonged to New Hampshire, and does not truly require able-bodied recipients to work.

Proponent lawmakers, like Medicaid expansion myths, deserve busting.

[Originally published at the New Hampshire Union Leader]