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Coverage Canyon: What Happens If We Reject Medicaid Funds?

June 7, 2013 Common Cents

Marketplace Not a Substitute for ExpansionNew Hampshire lawmakers are currently debating whether to take the federal dollars available to us to insure many of our lowest-wage workers through Medicaid.  One of the consequences of not taking this money is to create a coverage canyon for many of the people who would have enrolled in Medicaid.

This means that in the absence of Medicaid expansion, a single mother with one child earning $11,000 a year would not be eligible for ANY financial assistance to purchase health insurance while a mother with one child earning  $22,000 would be eligible for substantial federal aid.

This strange situation arises because the Affordable Care Act, as written, expected most people with incomes up to 138 percent of the federal poverty level to enroll in Medicaid. The U.S Supreme Court subsequently determined this must remain optional for states.

As a result, the federal law provides few if any subsidies to those with incomes below 100 percent of the federal poverty limit.  In other words, many working poor – those who would have been covered by Medicaid – do not qualify for subsidies to buy coverage in the ACA’s health insurance Marketplace.  They can still shop in the Marketplace, but they will not qualify for any financial assistance to purchase private market products there.

In New Hampshire, this has very real implications for the debate about the Medicaid expansion because it means the vast majority of the people who are projected to enroll in Medicaid if we take the federal funds to offer that coverage to them, will be ineligible for subsidies if we do not.

In fact, 69 percent of the would-be Medicaid enrollees will be ineligible for premium subsidies available through the Health Benefits Marketplace because their incomes are below 100 percent of the federal poverty limit.

Without additional financial assistance, many of them will remain uninsured.  In sum, likely Medicaid enrollees will have neither the legal nor financial incentive to obtain health insurance coverage, leaving them in a coverage canyon where Medicaid leaves off and private market subsidies begin.  The only way to bridge that canyon right now is for New Hampshire to move forward with the Medicaid expansion. 

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House Fails to Pass State Budget, Process Moves to Senate

6 Apr 2017

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The New Hampshire House, for the first time in recent history, has opted to not pass the State Budget bills, introduced as House Bill 1 and House Bill 2. April 6 was the deadline set by legislative leadership to pass those bills out of the House and move them to the Senate, a day often referred to as “crossover.” The Senate phase of the budget begins after April 6, and the Senate has expressed an intent to move forward with a budget in the Senate Finance Committee. However, with no House Bill 1 or House Bill 2 crossing over, the Senate has to forge an alternative path to debate and amend the budget.