CONCORD, N.H. -- A bill to ban New Hampshire from expanding its Medicaid program as part of the federal health overhaul law attracted scant support at a public hearing Tuesday. Instead, opponents dominated the debate, arguing that expansion would help struggling families, hospitals and the state’s economy.
New Hampshire’s current program covers low-income children, pregnant women, parents with children, elders and people with disabilities. The state is deciding whether to expand eligibility to include anyone under age 65 who earns up to 138 percent of federal poverty guidelines, which is about $15,000 for a single adult, but a bill before the House Health, Human Services and Elderly Affairs Committee would block the state from taking that step.
Former House Speaker William O’Brien, R-Mont Vernon, told the committee that expanding Medicaid is unaffordable, unnecessary and amounts to an effort by the federal government to hijack state finances. The federal government has a long history of walking away from its promise to pay for special education, he said, and will do the same with Medicaid.
"New Hampshire will end up holding the financial bag," he said.
Speaking on behalf of House Republican leaders, Rep. John Hunt agreed, saying now is not the time to expand Medicaid.
"When we’re more flush, when the economy has turned around, we can absolutely look at this," he said.
But opponents of the bill argued that New Hampshire should act now to take advantage of the federal funding being offered.
A report commissioned by the state health department estimates that expanding Medicaid would boost enrollment by about 58,000 people by 2020, and together with the federal law’s other provisions, would reduce the number of uninsured residents from roughly 170,000 to 71,000. The report estimates that expansion could cost the state $85 million during that time period, but the state would get $2.5 billion in federal funding.
If the state doesn’t expand its program, "New Hampshire taxpayers -- all of us -- will be paying for and subsidizing Medicaid expansion in other states," said Tom Bunnell, a policy analyst with New Hampshire Voices for Health.
Others focused on the human cost, saying expanding Medicaid would help hard-working, young adults who make other people’s lives more comfortable but can’t afford insurance themselves. Dr. Travis Harker, a family physician in Concord, described a patient who works as a home health aide, helping senior citizens remain in their homes, but who lacks insurance and struggles with diabetes and chronic kidney stones.
"She’s one hospital admission away from unemployment and potentially becoming bankrupt," said Harker, president of the New Hampshire Medical Society.
Mike Lessard of Dover told the committee he was speaking up for his brother, whom he described as a hard worker who can’t afford insurance.
"What it basically comes down to is, Who do you represent when you walk into this building?" he said. "Do you represent people who cannot help themselves?"
Steve Ahnen, president of the New Hampshire Hospital Association, described uninsured patients who show up to emergency rooms with conditions that could have been prevented or cured had they received routine care in a doctor’s office. Hospitals have 40 percent increase in the amount of uncompensated care they provide since 2008, he said.
"We should be encouraging people to get the right care, at the right time and in the right place," he said. "Expanding eligibility under the Medicaid program is simply the right theing to do."
Alison Cuomo-Nason, who has spent most of her 31 years as a nurse working in emergency rooms, said she sees patients daily who are seeking help for the first time for issues that go back months and sometimes years. She described a young mother in her 20s who ended up being diagnosed with advanced cervical cancer.
"She just kept putting it off and putting it off because she was more worried about food and rent," she said.
Gov. Maggie Hassan, a Democrat, has expressed support for expanding Medicaid to help families and strengthen the state’s economy. She is expected to address the issue when presenting her budget proposal to lawmakers next week.