During today’s meeting of the Commission to Study the Expansion of Medicaid Eligibility, Avik Roy, a Senior Fellow at the New York-based Manhattan Institute, offered one alternative to the approach New Hampshire is now considering for using federal funds to provide health care coverage to low-income Granite Staters.
While the full details of the proposal are not yet available, in general, it would appear to result in substantially higher costs to the state budget, provide fewer New Hampshire residents with health care coverage, and force those covered to incur greater out-of-pocket costs.
More specifically, the Roy proposal would appear to require that New Hampshire spend $46 million out of its own budget each year in order to cover 11,150 low-income residents. Under the proposal, the state would act as an insurance carrier, contracting directly with physicians and paying them only $100 per month for primary care consultations. The participants in such a plan would be covered solely for catastrophic events, but only after satisfying a $6,000 deductible.
In contrast, under the version of Medicaid expansion that was included in both the Governor’s and House’s FY14-15 budget plans, New Hampshire would spend a total of roughly $20 million over the next 7 years to cover 58,000 people. In return, the federal government would pay $2.4 billion to help provide such coverage. Under this version of Medicaid expansion, participants would face some cost sharing, but never more than $793 per year.
In other words, the alternative proposal presented to the Commission appears to suggest that New Hampshire should:
- increase its own spending over the next 7 years from $20 million to approximately $320 million;
- forego $2.4 billion in federal aid that would come into the state’s economy;
- cover 80 percent fewer people;
- leave 70 percent of the low-income uninsured without coverage;
- offer participants bare bones benefits that could expose them to the individual mandate penalty;
- offer providers Medicaid reimbursement rates lower than current levels; and,
- force participants to face cost-sharing requirements that could amount to as much as 40 percent of their gross annual pay. A deductible of the size included in the Roy proposal may well drive people away from seeking the care they need.
Earlier this year, the Lewin Group found that “the ACA significantly boosts NH’s economy and revenues, and Medicaid expansion maximizes these economic and fiscal impacts.” At first glance, the Roy proposal seems to fall well short of accomplishing the same result. NHFPI will provide further analysis of the proposal as more details become available.