Jonathan P. Baird

Soon our New Hampshire Legislature will be voting on the matter of Medicaid expansion. While I know the Legislature agonized over the decision and could not decide it last session, I must say I do not see it as a hard call. The benefits to the state are too great to pass on this deal.
In a state obsessed with saving general fund dollars, this is like the ultimate business deal for New Hampshire. The state can insure a huge group of the uninsured for three years at no cost in state dollars. After three years, the state would never pay less than 10% of the cost. In my opinion, that is great value obtained at a bargain price.
In so much of the media coverage, I do not think there has been adequate appreciation for the value of insuring the uninsured. It is estimated that 50,000 New Hampshire residents will obtain affordable health care through the Medicaid expansion.
Maybe it is obvious to say but having quality health insurance is a big deal and can afford some peace of mind. When you walk through most medical facilities, it is like the cash register starts ringing. All too often, if the patient lacks insurance, there is little or no access to health care. The only options are the emergency room, charity care if any exists in a particular locale, or going without health care.
Millions of people in our country and tens of thousands of people in New Hampshire are simply going without. They are rolling the dice, hoping for the best, and not going to the doctor when they are sick. They do not have the money to pay out of pocket and they do not want to incur the cost.
Medical debt acts as a major disincentive to seeking health care. Unaffordable medical bills and inadequate income are a toxic brew. I would not deny that underinsured people, not just the uninsured, might avoid health care. If you already have significant unpaid medical bills, the idea of going to the doctor and adding to an existing debt is unpalatable.
The choice not to go to the doctor may work out in some situations. If the problem is less serious, the cost might only be the discomfort of enduring pain or some increased anxiety and depression. However, the choice not to go to the doctor can also result in some catastrophic outcomes.
The cancer diagnosed too late, the stomachache mistaken for food poisoning which was a ruptured appendix, the undiagnosed heart disease – these are examples of what can happen when symptoms are ignored because people are so worried about hospital expense they avoid care. Delay in seeking care can also be the difference between a serious problem and a total nightmare.
Families USA has studied the consequences of going without coverage. In a report entitled “Dying for Coverage” released in June 2012, they estimate that between 2005-2010, 134,120 people between the ages of 25 and 64 died prematurely due to a lack of health insurance. They say there were 339 such deaths in New Hampshire during that time period. Families USA based their estimate on a methodology devised by the Institute of Medicine.
Some of the findings Families USA mentions:

— the uninsured are less likely to have a usual source of care outside of the emergency room > — the uninsured often go without screenings and preventive care
— the uninsured often delay or forego needed medical care
— uninsured Americans are sicker and die earlier than those who have insurance
— the uninsured pay more for medical care than the insured
I think it is unconscionable in a country as wealthy as the United States that we allow so many to remain uninsured. I personally think health care should be a right of every American. It is not some kind of privilege. Access to health care should not depend on a person’s income.
Just to be clear, I am not an uncritical supporter of Obamacare. I personally would have preferred a universal single payer, Medicare-for-all type system. That did not happen though. Obamacare with its Medicaid expansion is a positive step forward since so many more will obtain coverage.
One can only marvel at the reactions of the opponents of Medicaid expansion and Obamacare. To say they have been over the top does not do justice. Leading the charge was former New Hampshire House Speaker Bill O’Brien who claimed Obamacare is as bad as the Fugitive Slave Act of 1850. That law let slaveowners get their runaway slaves back!
Then there is Texas Governor Rick Perry who called Obamacare “a criminal act”. And not to be outdone Congresswoman Michele Bachmann who compared Obamacare to crack cocaine and said it will kill people. Bill O”Reilly just said Obamacare is “a vicious motorcycle gang threatening your daughter”. You really cannot make this stuff up and there is plenty more where it came from. Opponents have spent far more time demonizing than offering any credible alternative plan.
Obamacare was extensively debated; it passed Congress, was signed by the President and it was upheld by our very conservative U.S. Supreme Court. The Court gave states an option on Medicaid expansion. I would also note that the President ran, in part, on his health care policies and he was reelected. The hyperbolic overreaction to a law that is barely out of the starting gate is a form of political hysteria. Calling a new law a train wreck before it has gone into effect is both unfair and premature.
Part of the reason for the hysteria may be fear that, once implemented, the program will be successful. As Texas Senator Ted Cruz put it on Fox News, he worries that people will become hooked on Obamacare. I do believe there is a recognition that it would be much harder to repeal the program once many Americans have benefitted from it. There is a similar history with opposition to Social Security and Medicare when those programs were starting up. Once those programs got off the ground, they became extremely popular with the American people. There is a similar fear from opponents that that will happen again with Obamacare.
Our Medicaid expansion commission has initially voted this last week to support the expansion. The Commission is now drafting a final report with recommendations specific to New Hampshire. The Commission will vote on the final report on Tuesday. The Commission worked hard to develop a plan that reflects New Hampshire tradition and values. Once the report is produced it will have to be translated into legislation and then it must go through the legislative process.

Even if legislators were required to reconsider this voluntary program after three years, that could still be reasonable. At least there would be a body of experience to evaluate whether the Medicaid expansion should continue. I think our Medicaid expansion commission deserves credit for its bi-partisanship. At a time when partisan fever is running wild, it is positive that both Democrats and Republicans in our state could work cooperatively to craft a Medicaid expansion that serves our citizens.