NH Union Leader Advocates Turning Medicaid Expansion Into A Voucher Program

The New Hampshire Union Leader argued against a proposal to expand Medicaid in the state and instead advocated for using the federal expansion funds to enact a voucher system. However, numerous studies have found that traditional Medicaid provides more coverage for less cost.

In a November 6 editorial discussing a state initiative to expand eligibility for Medicaid, the Union Leader claimed that Medicaid offered few health benefits and denounced the low reimbursement rates for doctors. The editorial went on to suggest that Medicaid expansion dollars should fund a voucher system:

Studies of Medicaid enrollees show that the program improves health care access, but not measurable health outcomes. And because it pays doctors and hospitals a fraction of what it actually costs for treatment, it does not solve the problem of cost-shifting. Nonetheless, there is pressure to expand eligibility from the state's current 63 percent of the federal poverty level to the Obamacare-demanded 138 percent.

[Sen. Chuck] Morse [(R)] and [Sen. Jeb] Bradley [(R)] have proposed a better way. Rather than throw people onto Medicaid, they would use Medicaid funding to enhance the state's premium support program. Low-income families would get better-quality private insurance, which pays full hospital and doctor reimbursement rates. And unlike straight Medicaid expansion, eligible people who are already privately insured would not be lured onto Medicaid.

Contrary to the Union-Leader's assertion that Medicaid doesn't show “measurable health outcomes,” a study of Oregon's 2008 Medicaid expansion published in the New England Journal of Medicine found that while certain health outcomes were not achieved -- such as lowering cholesterol and hypertension -- expansion had other benefits such as lowering rates of depression and increasing the rate of diabetes detection and treatment.

Moreover, the American College of Obstetricians and Gynecologists has argued that expanding Medicaid is a key strategy to improving women's health, as Medicaid “is the largest payer of pregnancy services, financing between an estimated 40% and 50% of all births in the United States, and family planning services, accounting for 75% of all public expenditures.”

Reimbursement rates under Medicaid expansion will increase as a result of the ACA, a fact the Union Leader failed to mention. As part of the law, provisions were included to raise rates so that doctors are more likely to accept new Medicaid patients. Rates will increase across the country by an average of 73 percent according to the Kaiser Family Foundation, and in New Hampshire, rates are expected to increase 50-99 percent:

In lieu of support for Medicaid expansion, the editorial advocated for a plan proposed by state Sens. Morse (R-Salem) and Bradley (R-Wolfeboro) that would use Medicaid expansion funds to further expand the state's voucher program. Yet, as Kaiser Health News explained, it is inherently cheaper to enroll more people in Medicaid than to give them subsidies for private insurance. Since HHS requires voucher programs like Morse-Bradley's to provide Medicaid-level benefits, the voucher program would promote more expensive plans but offer identical benefits to Medicaid. Furthermore, according to a study appearing in the Journal of General Internal Medicine, Medicaid offers better protection against underinsurance -- measured as out-of-pocket health care cost over 5% of income -- than basic minimum plans that low-income individuals can afford on the private market:

Greater than one-third of low-income adults nationally were underinsured. Medicaid recipients were less likely to be underinsured than privately insured adults, indicating potential benefits of expanded Medicaid under health care reform. Nonetheless, more than one-quarter of Medicaid recipients were underinsured, highlighting the importance of addressing cost-related barriers to care even among those with public coverage.