N.H. cannot afford to opt out of Medicaid expansion

In the wake of the Supreme Court decision upholding the Affordable Care Act, Executive Council candidate Bill Duncan points to two upcoming decisions that will have a major impact on health care in New Hampshire — and the role of the Executive Council in the process. With his permission, I've reproduced his op-ed from the Portsmouth Herald in full. -Ed.

Laboring out of sight of most of us, New Hampshire's Executive Council has worked hand-in-glove with the Legislature to create a health insurance market that will be complex and confusing for New Hampshire citizens. And, now, as a result of last week's Supreme Court decision, the Council is in a position to do even more damage.

The five-member Executive Council plays a critical role in governing New Hampshire. It makes hundreds of decisions every month because the Council's approval is required on all gubernatorial appointments and executive department contracts.

The Executive Council started down the wrong road on health insurance soon after it took office in 2011. The new tea party majority refused to accept federal funding to establish New Hampshire's own Affordable Insurance Exchange. Then the Legislature followed through in HB 1297 by prohibiting the establishment of a New Hampshire insurance exchange.

Affordable Insurance Exchanges are insurance marketplaces established by President Obama's Affordable Care Act. Insurance companies will compete through the exchanges to provide their services to small businesses and individuals in the state. And the federal government will subsidize the cost for low-income people. They are a way of bringing to the rest of us the same benefits large businesses get from purchasing health insurance for large numbers of people.

There would be great advantages to setting up our own exchange to serve the needs of our own citizens. Most importantly, New Hampshire could have regulatory control over the insurance plans offered through the exchange. Our insurance commissioner could regulate benefit levels and eligibility. We could establish our own health care priorities, such as reforming how payments are made or development of "medical homes" and accountable care organizations.
But the Executive Council and Legislature have opted out of creating our own strategies and priorities. The result will be confusion for New Hampshire citizens, some purchasing insurance from the federal exchange and others purchasing insurance regulated by the state. We will have a jumble of differing policies for individuals and small businesses purchasing insurance.

New Hampshire is one of only three states to take this radical position. There is an opportunity to turn this around. The Obama administration has expressed a willingness to work with states like New Hampshire that have rejected participation so far, but change their policies to make the most of the Affordable Care Act. We should elect Executive Councilors and Legislators who will commit to doing that.

But last week's Supreme Court gives us an even bigger decision to make. States have to decide whether to take advantage of the dramatic improvements in Medicaid created by the Affordable Care Act. If the state agrees to expand Medicaid eligibility, the federal government will pick up all the additional cost in the first three years. Eventually, the state would pay a small percentage of the cost of expanded eligibility.

Medicare expansion, as it is called, would have great benefits for New Hampshire citizens. Currently, Medicaid eligibility rules are complex, a matter fitting applicants into one of dozens of categories of recipients. The Affordable Care Act simplifies all that. Now, if you are under 65 and have an income of less than 133 percent of the poverty level, you would qualify for Medicaid. Simple as that. In New Hampshire, that would increase the number of people served by Medicaid by more than 50 percent, from 130,000 to 200,000 people, a dramatic improvement for people in need.

That is the choice before us over the coming months. Your Executive Councilors will be able to play a major role as advocates and decision makers in determining whether to bring the benefit of expanded Medicaid coverage to our low-income citizens.

This is not a matter that can be entrusted to an Executive Council that has demonstrated that it is more interested in making political statements about federal health care reform than in serving New Hampshire citizens. The consequences for New Hampshire are too serious.

That's why I am running for the Executive Council in District 3, the 32 communities running from Portsmouth and Newington down to Salem and Derry. My goal is to restore balance and pragmatic decision making to the Executive Council. But whether you're in my district or not, I would urge you to question your Executive Council candidates - and all other candidates for state office - on their positions on this critical issue.