N.H. Medicaid expansion hurts the disabled, poor

Increased costs of the program are causing cuts to other critical services


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A decade ago, working at the Department of Health and Human Services, we saw a long-term fiscal train wreck coming with the explosive growth in Medicaid. At the time, the long-run projections for cost increases in the program would both put pressure to cut other critical services, like education and public safety, and would likely need massive tax hikes to sustain.

At the time, DHHS implemented a Medicaid reform effort that overhauled service delivery and brought growth under control, allowing the program to continue to deliver important services to children and the disabled across New Hampshire.

Sadly, the trend in Medicaid growth has returned. According to the National Association of State Budget Officers, Medicaid in New Hampshire grew from 24 percent of the state budget in 2012 to 27 percent in 2014. This growth is crowding out funding for colleges and universities, more police on our highways or even having a functional court system, ensuring that all our residents have access to justice.

According to a report by the Urban Institute, 82.4 percent of Medicaid expansion beneficiaries are able-bodied, childless adults, and the majority of beneficiaries are millennials.

Given that, one has to wonder why anyone would be looking to sell more tickets onto the Titanic. Yet this is precisely a major discussion in Concord now, as the Medicaid expansion is set to sunset at the end of 2016.

A good place to start is asking who exactly we are talking about covering. According to a report by the Urban Institute, 82.4 percent of Medicaid expansion beneficiaries are able-bodied, childless adults, and the majority of beneficiaries are millennials.

In fact, Governor Hassan has suggested that the program is a mechanism to help keep young people here. Apparently, the governor feels having good welfare benefits, and not good jobs, is the key to keeping the next generation from leaving the Granite State.

She couldn’t be more wrong. Giving healthy adults without kids an incentive to join the workforce should be part of New Hampshire’s economic growth strategy, instead of an incentive to avoid work.

However, there is an even greater reason to end Medicaid expansion. In January, DHHS announced that it was $82 million over budget, mainly due to costs from Obamacare, partly because of the cost of Medicaid expansion, and partly because of the “woodwork effect” resulting from Governor Hassan’s commitment to advertise the services of Obamacare far and wide – an effort that the state Legislature rejected, but the governor used a legally dubious loophole to spend your tax dollars on marketing “free” health care.

How did the agency move to resolve this big hole? The first step was $44 million in cuts in other areas. While the $7 million reduction to nursing homes received the biggest news, these cuts came from across the department. They involved cutbacks to seniors, children, the mentally ill and the developmentally disabled. Programs that saw their budget cut include family planning, the Ryan White Care Act funding for those with HIV and funds for sheltering the homeless.

In a press release, the governor called these cuts “responsible” and “difficult, but necessary.” In other words, the governor has chosen to sell seniors, children and the disabled down the river in order to provide a welfare program to healthy, childless adults.

At a public policy level, leaders typically put the necessities of the truly needy before those for whom a service would be “nice.” However, Medicaid expansion turns this notion on its head as its proponents engage in their Ahab-like quest to implement Obamacare in New Hampshire. Children, seniors and the disabled are the victims who are paying the price for their ideology, and that price will go up as the price tag for Medicaid expansion does.

Greg Moore is state director for Americans for Prosperity.

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