Published DateTo the editor,
Expanding Medicaid in 2014 is still being debated across the nation this year as state legislatures work toward adjournment. While the Affordable Care Act passed by Congress in 2010 — the ACA, or "Obamacare" — required expansion of Medicaid, the 2012 Supreme Court decision upholding the law made what was mandatory, optional: states can now choose whether or not to participate in Medicaid expansion. In New Hampshire, that decision is currently before the 24-member State Senate, which is scheduled to vote on its version of the two-year state operating budget on June 6th.
Even though the federal government will pay states 100 percent of the costs of Medicaid from 2014 until 2016, and 90 percent until 2020, some have chosen not to participate: as of last week, 28 states had opted for expansion of Medicaid, others have opted out, and some, like New Hampshire, are still undecided. Both Democratic and Republican governors, including some of the country's most conservative, support expansion; Governor Maggie Hassan's budget, passed by the N.H. House of Representatives, includes it.
The N.H. Community Behavioral Health Association, representing the state's 10 community mental health centers, has joined with other health care providers, consumers, advocates, and businesses to urge the Senate to pass a budget that includes expansion of Medicaid. Our centers have testified before the Senate Finance Committee to that effect, and our association issued a position paper last month (available at http://www.nhcbha.org/) that outlines the primary reasons for our support as:
It will improve access to mental health care;
It will help address issues of parity in coverage;
It will help stabilize the community-based mental health delivery system in New Hampshire;
It will help address cost-shifting to other payers;
There are additional reasons that others have explained more convincingly than we are prepared to. These include: expanding Medicaid will help the state's economy by creating jobs, and because a healthy workforce is good for business. It will help New Hampshire's housing and retail markets because when people have health coverage, they can afford to buy food, clothing, and other essentials, and they can pay their rent. It will help cut state and county corrections systems' costs by providing coverage to current and former prison inmates, thereby lowering recidivism rates and decreasing incarceration. It will help hospitals, community health centers, and the community mental health centers with the huge burden of uncompensated care.
The NHCBHA's primary focus this year has been to advocate for funding the state's Ten-Year Mental Health Plan, which will start to restore the community mental health system. Turning the near-collapse of the system around won't happen in one state budget cycle, but funding the Ten-Year Plan at the level proposed by the governor and passed by the House will begin to rebuild the system. We are grateful to the governor and the House, and are hopeful that the Senate will support funding mental health services at the same level.
Press reports about adults and children waiting in hospital emergency rooms for psychiatric care, sometimes for days at a time, brought public and political awareness of the crisis in mental health to the forefront in New Hampshire this year. There were 50 adults and children waiting in ERs across the state on a single day recently, and just last week, there were five people waiting in ERs on a single day in Genesis Behavioral Health's catchment area alone. The tragedy is that when they did receive care, it was probably not what they needed. Added to that is the potential tragedy that takes place every day when patients, families, and hospital staff are literally put in physical danger because hospital emergency departments are not equipped to provide either appropriate psychiatric care or adequate security.
We wish there was a picture of the uninsured in New Hampshire as clear and compelling as the one of the mental health crisis in our hospital ERs. A large part of our adult impoverished population receives no access to primary health care, oral health care, or mental health care, and they also wind up in hospital emergency rooms. These are the people who are waiting on you at the coffee shop, grocery store, or barber shop, who are mowing your lawn or rotating your tires, who have no other place to go when they are in pain from a toothache, the flu, or in a mental health crisis. Medicaid expansion will help ease that pain and for that reason more than any other, it is the right thing for New Hampshire to do. NHCBHA urges the Senate to pass a state budget that includes our state in Medicaid expansion.
Genesis Behavioral Health