, Kingston, NH

June 27, 2013

My Opinion: June 27, 2013

By NH State Rep. L. Mike Kappler
Carriage Towne News

---- — RAYMOND — Real food for thought. With the House and Senate a odds on the 2013-14 budget, if it isn’t passed by both chambers by June 30, what happens? If this happens, a temporary measure called a “Continuing Resolution” must be passed by both chambers. This has happened a few times since WWII, most recently in 2003. This would allow the state to continue spending money at the 2012 level, usually up to three months, while debates continue, and the new 2013-14 budget is passed.

Medicaid Expansion, where did this come from? The Affordable Care Act (ACA) (Obamacare) which debuted in January 2013. The ACA program is a massive overhaul of insurance laws, designing health “exchanges”, and getting involved in the providers end of Medicaid. A very scary move.

With much debate nationwide about the cost and how effective Medicaid Expansion really is, is the one size fits all program proposed by the Governor the right way to go? Many states are holding off and studying the expansion more, and I believe New Hampshire should too. In New Hampshire, to date, no options to the plan have been explored. What are we waiting for? A bipartisan commission proposed by the Senate Finance Committee, and is in the Senate version of the 2013-14 budget bill, would be a good start, and I hope it survives the Committee of Conference, and the final voting.

Medicaid is already running 27% of our current General Fund, at $1.4B a year, and I believe we need to carefully consider our options, prior to just jumping on-board the ACA program. If we started the expansion, got it established, soon it would be costing the state about $50M a year, and yes, that’s provided the federal match is still coming in. The feds have already failed to make good on the IDEA Special Education Funding, and other programs, costing NH taxpayers millions. It is estimated that for each new enrollee under the expansion program, it will cost NH taxpayers about $15K.

How would this expansion effect the availability of care? Given the state’s already low Medicaid reimbursement rates, some providers have already stopped accepting new Medicaid patients. Providers have been unable to guarantee they would have the ability to take on the thousands of new patients expected to seek care under a new program. With thousands more new patients seeking care under the expanded program, this will just cause more providers to pull out, that would be a problem not only for the new ones, but also for the existing patients.

(Editor’s Note: NH State Representative Mike Kappler can be reached at