Debate on Medicaid Expansion Centers on Who Will End Up Paying

Feb 17, 2016

Dozens of people filled the House Finance Committee room Wednesday to hear testimony on whether to continue the state’s Medicaid expansion program. Many of those who spoke said they support the program, but some argued its costs will fall to people with private health insurance. Related: NHPR's primer on Medicaid expansion

Two years ago, New Hampshire expanded eligibility for its Medicaid program as part of the federal Affordable Care Act. The expanded program now provides insurance to around 48,000 state residents. 

But this program is set to expire by the end of the year if lawmakers don't vote to continue it. A bill working its way through the State House now would continue that expansion until 2018 - at no cost to the state. But some lawmakers question whether having hospitals and insurance companies foot a big part of the bill will cause private insurance premiums to rise.

Speakers from the state’s hospitals and insurance providers said they can't guarantee that. But, they argued, without the expanded Medicaid program, the privately insured will almost certainly see premium increases.

Matt Veno of Harvard Pilgrim Healthcare told lawmakers this program saves money by, for instance, expanding primary care access, which prevents costly chronic diseases from developing.

"It also keeps (low-income people) out of emergency rooms and hospital inpatient units where they are getting much more costly care which falls on the burden of the state and those who pay premiums," Veno testified.

And Alex Walker, vice president of the Catholic Medical Center, argued if the state doesn’t continue with the program it will lose out on roughly $800 million of federal money. 

“The fact that the hospital and the insurance companies are stepping up to take care of the gap that will exist is fiscally responsible – failing to approve the reauthorization is not fiscally responsible,” Walker told the committee.

The N.H. Municipal Association also testified in support of the bill, stressing that the expanded Medicaid program has also saved money at the local level. 

Last year, the costs of providing health care to uninsured patients went down more than $100 million statewide. The House Finance Committee plans to work on the bill early next month before it returns to the House floor.