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State Sen. Stiles, Mad Tailors, and Medicaid Expansion

By Gary Patton on September 19, 2013 in

The Tea Party is like a mad tailor who makes a suit that doesn’t fit you, but he insists that you must wear it.

In its quest for ideological purity, the Tea Party insists that societal problems be solved in the private sector, or, at worst, by local government. The difficulty is that problems come in all different shapes and sizes. One size doesn’t fit all. Some, indeed, are best handled by the private sector (e.g., the distribution of goods and services); some by local government (e.g., zoning, town planning, fire protection); some by state government (e.g., maintenance of state highways) and, shock and surprise, some by the federal government (e.g., maintaining the military, administering Medicaid and Medicare).

What, Medicaid and Medicare! Yes, their sheer size provides an overwhelming advantage in negotiations with health providers and drug companies. They can get the best deal. So, it should not come as a bombshell that the Medicaid Expansion plan currently offered New Hampshire by the federal government is clearly the best one available.

$2.4 billion is available under the Affordable Care Act to help poor working families in New Hampshire afford health coverage. The federal government has pledged to pay 100 percent of the cost of expanding Medicaid in the first three years and at least 90 percent thereafter.

The planned Medicaid expansion to 58,000 Granite Staters will help end their reliance on expensive emergency room care (which you and I pay for), improve their health, and, perhaps most surprising, it will boost our state’s economy.

According to the non-partisan New Hampshire Fiscal Policy Institute, “if New Hampshire takes the federal money, it will enjoy a number of economic benefits as well. It will gain an average of 5,100 new jobs; the state will enjoy a $2.8 billion increase in gross state product; personal income will increase by more than $2 billion; and household spending on health care will drop by almost $100 million statewide.”

Who can be against it? Every Republican in the State Senate voted against it. But another vote is coming up in October, so their mistake can be corrected.

Instead of Medicaid Expansion, the GOP has proposed an alternative plan that would delight the insane tailor (and the Tea Party). It conforms to the idea of local control, but is, otherwise, a truly dreadful proposal.

Look inside this ill-fitting plan and you will see a label prominently displayed which reads “Courtesy of State Sen. Nancy Stiles.” Dr. Avik Roy, a senior fellow at the Manhattan Institute, testified before the special 9-member commission studying possible extension of the state’s Medicaid program. Stiles is a member of this commission. According to New Hampshire Public Radio (9/10/13), “(Roy) is proposing a plan he co-developed with Senator Nancy Stiles (R-Hampton) called Direct Care New Hampshire.”

Republican Senate President Chuck Morse issued a press release (9/10/13) in which he stated, “I believe the proposal developed by Sen. Stiles and outlined today by Dr. Roy offers an intriguing concept for how we can do so through the private insurance marketplace.”

Well, just what’s so bad about the Stiles/Roy proposal? The New Hampshire Fiscal Policy Institute (9/10/13) nicely summarizes its weaknesses. The proposal would:

* “increase (NH) spending over the next 7 years from $20 million to approximately $320 million.
* forego $2.4 billion in federal aid that would come into the state’s economy.
* cover 80 percent fewer people.
* leave 70 percent of the low-income uninsured without coverage.
* offer participants bare bone benefits that could expose them to the individual mandate penalty.
* offer providers Medicaid reimbursement rates lower than current levels; and,
* force participants to face cost-sharing requirements that could amount to as much as 40 percent of their gross annual pay. A deductible of the size included in the Roy proposal may well drive people away from seeking the care they need.”

Wouldn’t it just be simpler for Stiles and her Republican colleagues simply to accept that Medicaid Expansion is one of those times when a federal solution is okay. Do we all have to walk around with ill-fitting medical plans because state senate Republicans won’t stop being rigid political ideologues and instead face the facts?

http://bluehampshire.com/2013/09/19/state-sen-stiles-mad-tailors-and-medicaid-expansion/