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.