While caution is usually a good strategy, in this case any significant delay could cost the state millions of dollars and leave thousands of people without access to affordable health care.
Several lawmakers have argued that New Hampshire should wait and learn from the experiences of other states before moving ahead.
But any benefit should be weighed against the very real – and very substantial – cost. Simply put, the longer New Hampshire waits, the less it will receive in federal funds.
It’s also worth noting that Medicaid has a long track record of success in New Hampshire, providing low-cost health insurance for poor children, expectant Moms and seniors in nursing homes. It’s not an untested program; it is well suited to serving more low-income adults.
As the graph above illustrates, any of the costs New Hampshire incurs in extending Medicaid would be paid in full – 100 cents on the dollar – by the federal government each year between 2014 and 2016. In subsequent years, the federal government pays a slightly smaller share of those costs, but at no point would it drop below 90 percent.
Consequently, if New Hampshire delays, it would lose out for a year – maybe more – on the 100 percent federal match. In detailed reports assessing the impact of the Medicaid expansion on New Hampshire, the Lewin Group estimated that a one-year delay would reduce the federal funds coming into New Hampshire by $340 million.
Of course, this is strictly the fiscal impact of delay. Thousands of childcare providers, waiters and waitresses, and other Granite Staters in physically-demanding but low-paying occupations would have to wait for access to affordable, reliable health care.
In short, if New Hampshire wants to maximize the benefit – and minimize the cost – of extending its successful Medicaid program, this is no time to wait.