GOP Lawmakers Asking Health Providers to Help Foot the Bill for Medicaid Expansion

Jan 11, 2016

Credit Sara Plourde for NHPR

Republican leaders in the New Hampshire House and Senate say they’re willing to consider reauthorizing the state’s Medicaid expansion after its sunset date at the end of 2016 — as long as they can find someone to help foot the costs.

On Monday’s edition of The Exchange, House Speaker Shawn Jasper said it doesn’t seem politically feasible to expect him to pass a plan that requires more public spending.

“There are certainly a large bloc of members of the House on the Republican side who just think it’s a program that should go away, that we shouldn’t have it at all. I disagree, but I do believe that it should not be a responsibility of the taxpayers of the state of New Hampshire to come up with that funding,” Jasper said. “So there’s the issue that we’re working on. Because I know that if I said all right we’re going to have a new tax and come up with this money, I wouldn’t be able to get that through the House.”

An alternative, as outlined by Jasper and Senate President Chuck Morse, is to ask other parties with a stake in the expansion — hospitals, insurance providers and the like — to chip in. Morse said lawmakers have already been engaged in discussions around this kind of a deal for months.

A cohort of New Hampshire Republican lawmakers struck a deal with Gov. Maggie Hassan and Democrats to pass Medicaid expansion — technically, the New Hampshire Health Protection Program — in 2014. The plan expands insurance coverage for adults who earn up to 138 percent of the federal poverty level.

Right now, the federal government covers expansion costs in full for New Hampshire. But federal funding is set to start declining in 2017 — so state lawmakers have to figure out whether to continue with the program beyond that point and, if so, how to pay for it.

Looking at 2018 as an example, Morse said New Hampshire’s expecting the federal government to contribute about $460 million toward the program, and the state would have to come up with $20-25 million to cover the rest of the costs.

Hassan and Democratic lawmakers have been pushing heavily in favor of reauthorization, arguing that it’s a worthwhile investment that has helped thousands of people to access healthcare.

State Sen. Jeff Woodburn, also speaking on The Exchange, said there are concerns with “this attitude that somehow we can do anything to expand Medicaid, so long as we don’t have to pay anything.”

“I think the Democrats believe that wise and prudent use of our taxpayer dollars is important, but so are investments — investments like the gas tax, that is making great roads, our roads much better, our bridges much safer, and is important to the economic development of our entire state,” Woodburn said.

In an interview with NHPR last week, former Department of Health and Human Services Commissioner Nick Toumpas said nearly 46,000 people were enrolled in the program. Morse, on Monday, said the program’s on track to enroll about 58,000 in total.

Beyond the pursuit of another funding source, Morse and Jasper said they’ll be looking to gather evidence on how much the Medicaid expansion is benefiting taxpayers in general — for example, by sizing up how much it’s saving in costs that would otherwise go into uncompensated care for people who go to the emergency room because they don’t see a doctor regularly.

“We said when we put the sunset in, the reason we’re putting it in was to make sure that we delivered higher quality healthcare in New Hampshire, and, two, we didn’t let the federal government back off on their promise,” Morse said.

The full conversation, on Medicaid expansion and other policy priorities for the legislative session, can be found here or by listening to the audio below.