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On Thursday, New Hampshire legislators are scheduled to vote on a proposal to expand Medicaid under the Affordable Care Act. Conservative Republicans in several state governments have led the charge to opt out of implementing Medicaid expansion due to the increased costs state budgets will be forced to adopt. However, the New Hampshire GOP establishment has crafted a plan that invites crony capitalism and will force New Hampshire to adopt revenue-increasing mechanisms, such as a state income tax, to pay for the implementation of Medicaid expansion. The people of the Live Free or Die state need to rise up and let their legislators know that this is unacceptable.
Republicans, who have the majority in New Hampshire’s state senate, have the ability to stop the expansion of Medicaid in their state. Yet they would rather expand a broken entitlement program under their own terms than strive for actual health insurance reform. The problems with the Medicaid are well documented. The program is very expensive; in 2010 total federal and state spending on Medicaid surpassed $400 billion. To reduce costs, states have a history of limiting reimbursements for healthcare providers and limiting services to patients, which ultimately lessens the quality of care provided to Medicaid patients. To be sure, Medicaid is far inferior to private insurance.
The senate Republicans’ Medicaid bill (S.S. SB1) would use federal funding under ObamaCare to expand Medicaid coverage to people making less than 138% of the poverty line for 1-2 years. Afterwards, the program then distributes that money to a small number of private insurers in the healthcare exchange.
Far from a true free-market solution, as Republicans in New Hampshire are calling it, this plan is literally just implementing Obamacare’s Medicaid expansion and then rolling those people over into Obamacare’s exchanges. This plan comes from the same Republicans whose party platform declares that the GOP will “Oppose the implementation of Obamacare in New Hampshire.”
Proponents of expansion claim that the federal government is going to foot the bill, pumping $2.5 billion in federal funds into New Hampshire over the next seven years. This is only nominally true.
Starting in 2014, the federal government has promised to pick up 100 percent of the benefit costs for the newly eligible population for three years. Afterwards, this enhanced federal funding is scheduled to decline to 90 percent in 2020. But, as Budget Chairman Paul Ryan has pointed out: “The notion that the federal government is going to keep matching Medicaid spending at this level is a notion that is just a faulty premise. It’s going to get cut.”
Earlier this year, Rep. Ryan told the Chicago Tribune: “The fastest thing that’s going to go when we’re cutting spending in Washington is a 100 or 90 percent match rate for Medicaid. There’s no way. It doesn’t matter if Republicans are running Congress or Democrats are running Congress. There’s no way we’re going to keep those match rates like that.” Democrats in Congress are already in favor of trading the 2% across-the-board sequester cuts for targeted spending cuts, and these unsustainable match rates are easy targets. New Hampshire, like other state governments, cannot count on the Federal government to fund these Medicaid expansions.
So what happens when the federal funds dry up? The Republican bill has a sunset provision in 2016, but will these representatives vote to repeal the expansion of an entitlement in an election year? It’s more likely that New Hampshire will be forced to seek new revenue mechanisms to close the budget shortfall Medicaid expansion will create. "By necessity," Aaron Day, Chairman of the Republican Liberty Caucus, notes: “NH will have to implement a state income tax to cover the new costs.”
If you live in New Hampshire, contact your state representatives and demand that they vote against expanding Medicaid. The Republican Liberty Caucus of New Hampshire has listed the names and phone numbers of New Hampshire state senators here. Call them and tell them to stand with true conservatives against an ever-growing government!