Under the 2012 Affordable Care Act the federal government will provide states with money to expand Medicaid eligibility. Expanding Medicaid in New Hampshire to include anyone under age 65 who earns up to 138 percent of federal poverty guidelines is estimated to add 59,000 people to the program. The federal government has promised to pay 100 percent of the cost in the first three years and 90 percent until 2020, which would mean $2.5 billion in the next seven years for New Hampshire. Governor Maggie Hassan has convened a nine member Medicaid Expansion Commission to report their recommendations by October 15, 2013.
Rejecting Medicaid expansion will not only result in lost dollars but it will also cause unnecessary hardships for some of our most vulnerable citizens.
I was an emergency medicine physician for 20 years . Poor uninsured people use hospital emergency departments for medical care because they usually aren’t welcome elsewhere. If we can keep any uninsured people out of the emergency department we will be saving hundreds of thousands of dollars a year. Not only is this delivery of care costly and inefficient, the rest of us pay for these costs in the form of uncompensated care, impacting hospital and private health insurance premiums. The planned Medicaid expansion to 59,000 Granite Staters will help end their reliance on emergency departments, improve their health, and will boost our state’s economy. Participating in the Medicaid expansion will provide savings to the state budget by reducing free or charity care estimated to be in the amount of $85-175 million.
There is no clear link between health insurance and better health but we do know that people on Medicaid end up with significantly better mental health. They get something crucial to long-term health that the uninsured don’t have peace of mind. Just ask anybody who has had to face medical bills without insurance. This is good fiscal policy, given the enormous costs that mental health problems pose on society by reducing productivity, increasing the incidence of violence and self-destructive behavior.
Medicaid virtually wipes out crippling medical expenses among the poor. Medicaid improves mental health and provides economic security to some of the most vulnerable people in the state. Financial protection is the reason most Americans who can afford health insurance buy it. If insurance against devastating medical costs is a good thing for us middle-class types, it’s a good thing for poor people too. The links between insurance, medicine and health may be impressively mysterious, but staving off medical bankruptcies among low-income Americans is no small policy achievement.
The primary purpose of health insurance is to protect one financially in event of a catastrophic medical shock. Almost any cost is catastrophic if you’re poor. Lower-income people who receive Medicaid at least have economic security against medical expenses that might otherwise cause them to lose what little income they have.
We are the richest nation in the history of the world. We can surely afford to give every American the basic security that comes with access to health care. I sincerely hope that the Commission’s recommendations and the vote of our legislatures will see expansion of Medicaid in New Hampshire as a win- win for everybody.
Sylvia R. Kennedy, M.D.