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N.H. Republicans blocking Medicaid expansion

Obamacare provision would boost aid to working poor

Billie Jo Buskey, owner of Cuts & Curls hair salon in Plymouth, N.H., is one of 58,000 state residents who could benefit from Medicaid expansion under the new health care law.MARK LORENZ FOR THE GLOBE

WASHINGTON — With partisan bickering, delays, and confusion on the rise nationally over the impending launch of President Obama’s health care law, tens of thousands of low-income people in New Hampshire are watching the calendar, caught up in their own anxious uncertainty.

Republicans in the Legislature have blocked the state from participating in a federally funded expansion of the Medicaid program, meaning that up to 58,000 Granite State residents are in line to be denied coverage.

But the decision may not be final. The state has established a commission to report back with nonbinding recommendations in October, giving advocates slim hopes of a turnaround and leaving potential beneficiaries in a state of limbo. Meanwhile, the clock is ticking towards a Jan. 1 deadline for the legal mandate that individuals obtain insurance.


This is the sort of bureaucratic bind and confusion that is spurring predictions of turbulence surrounding Obamacare’s liftoff, and generating anger among representatives of the poor in New Hampshire who say Republicans are seeking to sabotage the national health care law.

“Once again, they’re playing a political game in saying no to all aspects of Obamacare, no matter how common sense and right for us as a state and as a nation,’’ said Kary Jencks of the New Hampshire Citizens Alliance, a social justice advocacy group. “The folks who end up paying a price are the hard-working middle- and low-income people.’’

A sweeping national expansion of Medicaid was a central component of the 2010 health care law, but the US Supreme Court in 2012 deemed the expansion optional for states.

The result is a patchwork of policies sprouting around the country, including within New England, highlighting how health care access is becoming highly dependent on where you live.

Maine was the first New England state to opt out, and New Hampshire became the second, at least temporarily, with its move last month. At the other end of the spectrum, neighboring Vermont is pursuing a universal health care program, following in the footsteps of Massachusetts.


Currently, 137,000 New Hampshire residents are on Medicaid, about 10 percent of the state. Expansion would bring in an additional 58,000 residents over the next seven years, an increase of 42 percent, according to a state report.

The state’s Republicans cited uncertainty over the law’s scheduled 2014 launch for their opposition to the expansion.

“I’m very skeptical that we should expand Medicaid and I get more skeptical every day as other aspects of Obamacare can’t seem to get implemented,” said state Senate majority leader Jeb Bradley, a Republican who has served in the US House for two terms and is weighing a run for US Senate.

On Thursday, Obama continued his efforts to sell the law’s benefits politically, with a speech centering on how health reform is already holding insurance companies accountable by requiring them to spend the majority of their premiums on medical care. A day earlier, House Republicans held its 38th vote to dismantle Obamacare.

Under health care reform, the Medicaid expansion was supposed to help 17 million new people get coverage nationally, including childless adults, a group most states currently do not cover under the government-subsidized health insurance program for the poor and disabled.

The Obama administration has said that for states that choose to expand Medicaid to individuals making up to 138 percent of the poverty line, the federal government would pay the full costs of expansion the first three years starting in 2014 and gradually taper down to 90 percent by 2020, a level where it is supposed to remain in future years.


It is a much better deal than states currently get for their existing Medicaid caseloads. Currently the federal government only pays half the cost of Medicaid in New Hampshire, for instance.

According to the latest survey by the Kaiser Family Foundation, a nonprofit organization focused on health policy, 23 states plus the District of Columbia are moving forward with expansion, and 21 have said no.

New Hampshire, because it is awaiting the commission’s recommendations, is considered undecided. Other states still weighing their options are Indiana, Michigan, Ohio, Pennsylvania, and Tennessee.

In Maine, Governor Paul LePage, a Tea Party-backed Republican, has vetoed legislation authorizing an expansion. Maine is not only refusing to expand Medicaid, it has already begun rolling back existing coverage, freezing out 44,000 Mainers.

In states that do not plan to expand Medicaid such as Maine and New Hampshire, low-income individuals above the poverty line still must obtain health insurance under the national mandate, putting them in the uncomfortable position of facing a financial penalty or spending at least 2 percent of their income to sign up for private coverage through state online marketplaces — called exchanges — that will debut in October.

“It is sad that in New Hampshire, you can stay at home, raise your kids and not work and get food stamps and health care, but then those of us who are actually working and paying taxes and trying to help ourselves can’t get a little bit of insurance for health care,” said Billie Jo Buskey, owner of a Plymouth hair salon.


Buskey, 35, and her husband, a landscaper, both started working at age 14 and make just under $28,000 a year. But that is too much to qualify for Medicaid under New Hampshire’s current income guidelines. Neither can afford health insurance so they go without. Their sons, ages 5 and 13, are covered by Medicaid, which has more generous eligibility criteria for children.

Buskey prides herself on paying her bills – mortgage, phone, electricity, and day care — on time. Last year she needed to have her gall bladder removed, and now owes the hospital more than $8,000, which will take her nearly six years to pay off at $115 a month.

“I’d much rather pay $115 a month for health insurance than $115 a month to pay off one hospital bill,” she said. It is still unclear what private coverage options would be affordable to Buskey and her husband, if any, without Medicaid expansion.

Echoing the national discord and wrangling in Washington, New Hampshire Republicans doubled down during recent debates over the state budget. A common objection is that states can’t trust the federal government to keep its promise to pick up most of the tab of the Medicaid expansion. State Senator Andy Sanborn, one of three Republican legislators appointed to the nine-member commission to study the issue, likened Medicaid expansion to “the gift of a baby elephant.”


“It’s really cute when you get it,” Sanborn told his Senate colleagues last month. “It’s slow, expensive, eats a lot, and makes a lot of waste when it grows up.”

In a radio appearance last week, Sanborn compared Obama’s health care law with the Asiana plane crash, saying that Obamacare is “barreling down on us like a jet landing in San Francisco.”

New Hampshire ranks among the least generous when it comes to determining Medicaid eligibility. The cutoff for a parent is if income that falls at 40 percent of the federal poverty line. That means someone would have to be so poor as to be receiving welfare, or a household income of about $6,200 a year for a family of two, according to the New Hampshire Fiscal Policy Institute. (Massachusetts extends Medicaid eligibility up to 133 percent of the federal poverty line.)

There is no federal deadline for expansion, but advocates for the poor say they worry that the state may drag its feet until well past Jan. 1 and miss out on receiving its full share of federal money, estimated to be $2.5 billion over the next seven years.

Democrats expect Governor Maggie Hassan to call the Legislature back into a special session in the fall to vote specifically on Medicaid expansion, but some Republicans are already balking at that suggestion, preferring instead to take up the issue next year when the Legislature reconvenes.

“I don’t think any of us are certain that expansion could happen,” said Lisa Kaplan Howe, policy director at New Hampshire Voices for Health, which is advocating for Medicaid expansion.

Tracy Jan can be reached at tjan@globe.com. Follow her on Twitter @GlobeTracyJan.