Increasing medical access, in a free-market way
Medicaid expansion is a hot topic throughout our country. As of November 1, twenty-five states (and Washington, DC) have accepted federal money for expansion, while fifteen have decided not to at this time. New Hampshire is one of the last states to decide whether it will accept the money. If the state decides to do so, the next step will be to determine what mechanism to use to provide care to the approximate 54,000 residents who would qualify.
First, a little background: In a ruling on Obamacare, the Supreme Court said the federal government could not mandate that states expand Medicaid. However, if states accept federal money for Medicaid expansion, they would have to expand coverage to 138 percent of the Federal Poverty Level.
Next, consider how much money would come to our state, and how much New Hampshire taxpayers would be on the hook for expansion. The federal government proposes to pay 100 percent of the mandate for the next three years (2014, 2015, and 2016). Afterward, the state would be responsible for a percentage of this mandate; up to ten-percent starting in 2020. According to the NH Center for Public Policy Studies, this would cost state taxpayers about $40 million during this time, and at least $47 million per year starting in 2020.
I remain opposed to Medicaid expansion, primarily due to the impact on taxpayers. I am fundamentally opposed to direct taxation of New Hampshire residents to pay for this plan. The expansion does this, starting in 2017. This is a major concern for me, and for the voters of District 23. With a federal deficit approaching $17 trillion, New Hampshire would not be doing its due diligence if it depended on promises of federal funding. Medicaid is the state’s largest expense today and is a constant funding challenge. Any reduction of the promised federal funding levels would likely require an income tax or other broad-based taxes.
While I oppose Medicaid expansion, I support low-income New Hampshire families having access to affordable health insurance, but in a more effective way. I support a plan that provides access to private health insurance, rather than a government entitlement program. We do this by allowing those making less than 138 percent of the FPL – who would now be Medicaid eligible – access to private health insurance on the federal exchange with premium assistance. This is being done in Arkansas, and is a model that could be modified to meet New Hampshire’s needs. This would allow the Medicaid eligible to maintain insurance coverage through various income levels, rather than have disruption in care.
I also believe that any plan for affordable access to health insurance ensures that everyone have ownership in the cost of health care. Co-pays and deductibles are one way to do this, but wellness programs and work requirements are all options that can help foster personal responsibility while also curbing healthcare costs and improving overall health. Any New Hampshire solution should result in a sense of collective ownership in the cost of healthcare and encourage families to get out of poverty.
Finally, any proposal should sunset after three years, when the 100 percent federal funding coverage for the expansion population expires. Again, I am fundamentally opposed to New Hampshire taxpayers directly paying for the deficit the federal government built into the expansion. This sunset provision would give the state the opportunity to analyze the first three years of the program, determine if the federal government will work to address the funding gap, and see if other ACA provisions adversely affect expansion.
Russell Prescott (R-Kingston)
District 23, State Senate