NH News
5:00 am
Mon September 10, 2012

Medicaid Expansion Divides Candidates in Governor's Race

When the Supreme Court ruled on the Affordable Care Act, it said states must be given a choice about expanding their Medicaid programs.

Option A: Keep things as they are.

Option B: Enroll more people, and the Federal government will help you pay for their care.

Democrat Jackie Cilley likes that second option. She says that if New Hampshire doesn’t grow its Medicaid rolls, poor people will continue to slip through the cracks, and that Republican lawmakers in Concord would bear the blame.

"If you have watched what’s gone on in our legislature in the last two years, they have attempted in every way possible to walk away from those most vulnerable," says Cilley.

Her rival in tomorrow’s primary, Maggie Hassan, also likes Option B.

"I am committed to using federal money to expand health care coverage for the people in our state," says Hassan. "But we need to do it in a way that is right for New Hampshire."

The former state senator says an expansion makes good economic sense, but she’s cautious. Hassan wants to see more Federal money for the program.

Medicaid already costs the state about $700 million annually. That’s 26 % of the budget.

Republican candidate Kevin Smith says the state just can’t afford to spend more on the program.

"One of the things I’ve said is that I would oppose the expansion of Medicaid, and not because it’s an ideological position but because there is no way for the state to pay for it."

The Federal government will cover the tab for expanded coverage through 2017. By 2020, states will have to shoulder 10% of the costs.

Smith argues that even with a seemingly good deal on the table for states, their partner down in D.C. doesn’t have a good track record with this sort of thing.

"The Federal government can’t even meet its obligation for fully funding special ed for the last 30 years," says Smith. "On top of that, they’ve racked up a $15 trillion debt. And now they are telling us that they are going to pay for every state’s Medicaid expansion? I’m not buying it."

Ovide Lamontagne is Smith’s main opponent for the Republican nomination. He agrees on this issue.

"I think most people in New Hampshire understand we are better suited if the policy makers in New Hampshire chart a new course for health care reform. Not the people in Washington who have a very different view than we do about what’s good for us."

Negative reaction to the Affordable Care Act helped usher many republicans into office in 2010. But two years later, it’s a different atmosphere.

"Top three issues in this election are jobs, jobs and jobs," says Wayne Lesperance, professor of Political Science at New England College

Lesperance notes that the candidates, and the voters, don’t seem all that interested in the complicated world of health policy.

Frank McDougall of Dartmouth-Hitchcock lives in that world.  D-H is the state’s largest provider of services for Medicaid patients, and supports the expansion. He agrees that pocketbook issues should be the focus.

"One of the best things for health care is a job," says McDougall. "And there are all kinds of statistics that show that. So helping the economy rebound and getting people as close to full employment as we can is very much aligned with the goals of Dartmouth-Hitchcock."

Of course, a huge government program like Medicaid does directly impact New Hampshire’s economy. Expanded care will require expanded state spending, which has to be paid for somehow.

But less coverage could mean more people using the emergency room, meaning higher premiums for everyone else.

It’s a choice New Hampshire will eventually have to make. That process starts with tomorrow’s primary.