Should New Hampshire expand Medicaid?

Considering the multi-pronged benefits, the answer is most assuredly ‘yes’

The primary goal of the Affordable Care Act is to reduce the number of people without health insurance. One strategy to reach that goal is an expansion of Medicaid, so that more people will qualify.

In its recent decision, the U.S. Supreme Court ruled that Congress cannot force states to expand Medicaid because states will pick up some of the cost of the expansion.

Many New Hampshire Republicans, including gubernatorial candidates Ovide Lamontagne and Kevin Smith, and House Speaker William O’Brien, have lined up to oppose any expansion of Medicaid. If this becomes the law in New Hampshire, it will be the triumph of ideology over common sense, and New Hampshire will have lost an opportunity to improve the health of its citizens, lower the cost of private health insurance, and boost the state’s economy.

Our state budget would not work without money from Washington. Federal funds make up 30 percent of the budget, while state tax revenues make up 34 percent. User fees, licenses, court fines and other non-tax revenue make up the rest.

In the past, politicians from both sides of the aisle have worked to take full advantage of federal dollars when crafting the state budget. Federal money usually comes with strings attached — some state dollars have to be contributed in order to qualify for the federal funds. Typically, the state and federal dollars are in approximately equal proportions, but sometimes one state dollar can leverage two or more federal dollars.

The ACA calls for Medicaid eligibility to be expanded to 133 percent of the federal poverty level. This means a family of four with household income up to $30,657 would qualify. Under current New Hampshire law, a poor family is eligible for Medicaid only if its income is less than 68 percent of the federal poverty level ($15,674).

The federal government will pay 100 percent of the cost of the Medicaid expansion for the first three years, 95 percent in the next three years, and 90 percent in the following three years.

Medicaid expansion would have three major benefits for New Hampshire.

First, it is estimated that 20,000 people would become insured, and better access to health care means healthier citizens.

A recent study that compared states that have already expanded Medicaid (Maine, New York and Arizona) with neighboring states that have not expanded Medicaid (New Hampshire, Pennsylvania, Nevada and New Mexico) found that deaths dropped over 6 percent among those who gained Medicaid coverage.

We also should consider the benefits to New Hampshire businesses. Healthier workers are more productive and take less sick time.

Second, the cost of private health insurance will decrease as cost-shifting is reduced. Caring for the uninsured is not free. Those costs are included in the cost structure of hospitals, and passed on to those with private health insurance.

Third, tens of millions of dollars of new federal money will be pumped into New Hampshire’s economy. Currently, New Hampshire gets back only 68 cents of each dollar in federal taxes paid by New Hampshire citizens. Accepting the Medicaid expansion money will help change that number. The economic impact of new Medicaid money will be equivalent to the opening of a major new employer, with the benefits spread throughout the state and its 26 hospitals.

The debate over Medicaid expansion comes down to this: Should New Hampshire spend about $5 million a year from 2018-2020, and $10 million a year thereafter, in order to receive about $90 million in federal dollars, if the new money will decrease the number of uninsured, improve the health of New Hampshire citizens, reduce costs for employers, decrease the cost of private health insurance, and boost our state’s economy?

To ask the question, you know the answer is “yes.” And you wonder how Ovide Lamontagne, Kevin Smith, Speaker O’Brien could possibly say “no.”

Mark Fernald, a state senator from 1998 to 2002 and the Democratic nominee for governor in 2002, can be reached at

Categories: Opinion