Recently the N.H. Senate turned its back on about 58,000 citizens who, for the most part, can't afford health insurance. In essence, the Republican leadership wanted to rush all the eligible people into marketplace insurance within a year, and if things didn't' go as planned, they'd lose their insurance, the program would end and everybody would be left with nothing.
During the debates on expanding Medicaid, all we heard was the same talking points we've been hearing since the Affordable Care Act became law three years ago. It was all about Obamacare and how everybody should be afraid of it. No talk about how Medicaid expansion fits into the picture; just talk about disasters and train wrecks and how Governor Hassan was proposing an income tax. That doesn't sound like trying to find a way to ensure success.
Medicaid Expansion is part of the Affordable Care Act's plan to make affordable health insurance available to everybody. But Medicaid, like Medicare, has been the law since 1965, when it was passed by the 89th Congress. My dad, Ollie Huot, was a member of that Congress and he proudly supported the bill. I think we can agree that Medicare has made a big difference in the quality of life of senior citizens and Medicaid has saved a lot of poor people from unnecessary suffering.
Up to now, Medicaid has been extended only to certain kinds of poor people, like children, the disabled, and women with breast and cervical cancer. Now we want to be able to cover everybody under 65 (when they become eligible for Medicare) who can't afford it. Like those who purchase insurance through the marketplace, preventive services will be included, because, as we all know, medical care doesn't cost much unless you're sick or injured.
It isn't just the poor who are suffering because of last week's decision. If you pay taxes and want to see who else took it on the chin, go to your bathroom and look in the mirror! Health care costs the taxpayers of New Hampshire a lot of money. I'll give you one example; prisoners. Prisoners in our state prisons (and county houses of correction), get sick and have to go to the hospital. If you're behind bars you can't hold a job, so you can't afford health insurance. Thing is, Medicaid, up to now, does not cover persons 19 to 65 who are not disabled or otherwise eligible. Most of our prisoners don't qualify so 100 percent of the hospital and medical costs for these folks come right out of the general fund (or your county treasury!). So if you go to Dunkin' Donuts and pay the rooms and meals tax, or have a beer when you get home from work, you're paying 100 percent of those medical expenses.
And if you think it doesn't make any difference if we expand Medicaid now or five years from now, think again. The reason Governor Hassan and the House and Senate Democrats wanted to get the program running now, and held a special session of the Legislature, is that the federal government is going to pay 100 percent of the cost of expanded Medicaid for three years; but the three years starts January 1, 2014, not when you decide you'd like to start.
Medicaid Expansion isn't just going to help those who can't afford medical insurance and don't qualify for Medicaid. Had we voted to start putting the program to work January 1, 2014, over the next eight years nearly $2.5 billion of the money you pay the federal government in taxes would come back to New Hampshire and the drain on the general fund would decrease by almost $47 million. On top of that, our local hospitals, which have to provide care in their emergency departments for the people who can't afford either health insurance or medical care, is estimated to go down by some $82.3 million a year. Might that have an impact on the cost of medical care for everybody?
Finally, the cost of just about everything goes up every year. That includes the cost of providing government services. Not new services, but the same ones we've been getting for many years. The money we save with Medicaid expansion is going to keep us from having to find more money just for the things we have now. For example, I read last Saturday that audits by the Legislative Budget Assistant found the Department of Corrections' halfway houses and the Department of Education's management of school aid deficient. Both departments agreed, and said that although they are working to make things better, increased costs are preventing them from bringing the agencies back up to snuff.
We need to think hard about the decisions made by the Senate, but for it to mean much, we're going to have to do it pretty soon.
(David O. Huot, a Democrat, represents Laconia in the N.H. House. He is a member of the House Finance Committee.)