New Hampshire’s Budget Voodoo Path to Expanded “Expanded Medicaid”

On Saturday I referenced the passage of expanded Medicaid out of the State Senate. The new Bradley-Care Bill, SB313, complete with a new and improved five-year plan (instead of two, cue the Soviet national anthem) got the yeah votes of every Democrat in the New Hampshire Senate and seven out of fourteen “Republicans.”

The chief cheerleader of SB313 is also the chief facilitator of Medicaid Expansion in New Hampshire, Republican Senator Jeb Bradley who is, naturally, excited about the bipartisan support for his otherwise wholly progressive undertaking.

That any Republican would be happy to have convinced other Republicans to continue to saddle taxpayers with a massive unstable entitlement should give us pause, even under the “improvements” Mr. Bradley advertises.

Bradley said that if the federal funding for the benefits in the program were to fall short, the bill would automatically wind down operations in a six-month period, ensuring that there would be no need for a bailout. The bill also moves to a managed-care model, which Bradley suggested would likely lead to another insurance provider taking part in the individual market, which would drive costs for consumers down as much as $200 million.

He also talked about wellness incentives designed to avoid unneeded trips to emergency rooms.

“[The bill creates] incentives for patients and incentives for the managed-care companies so that we push people to the appropriate level of care,” Bradley said. “There are an awful lot of things that people should be using walk-in clinics for as opposed to emergency rooms.”

One of the key provisions of SB313 is the creation of the Granite Workforce pilot program. This will take $3 million from the Temporary Assistance to Needy Families program to try to help New Hampshire residents find employment.

There is also an incentive program to give employers cash for hiring people on Medicaid and more cash for retaining them. How we get them off the couch (to the training programs) and then to the employers is not disclosed. I can only assume that some legislators believe people who are miking taxpayers would rather not. But it occurs to me that most of those folks are already looking for work in an economy that is starving for jobs. An economy where Dunkin Donuts is hiring at up to $12.00 an hour.

I confess that I am cynical about the machinations of legislative goodwill at the expense of others (that federal money used to belong to someone else) so excuse this admission. I laughed out loud when Mr. Bradley is reported to have said this.

Here are the things that stay the same from our past efforts: no new taxes, no new fees, no general funds.”

Remember when New Hampshire Democrats “sold” a section of state highway from one department to another and called that revenue?

Well, of the Republican revenue gymnastics, we can say this. There are no new state taxes, not yet. But the rest, for longtime observers of New Hampshire Budget voodoo, is another parlor trick explained with all the necessary detail over at the Josiah Bartlett Center for Public policy.

In a nutshell, SB313 forces the legislature to fully fund the Alcohol Abuse Prevention and Treatment Fund with money from State Liquor sales (which it has never done in the past) so that Medicaid Expansion can empty it.

State law long required that 5 percent of the state Liquor Commission’s gross profits go into the Alcohol Fund. Only once — in 2003 — have the people’s elected officials followed that law. Typically they write a suspension of the law into the state budget.

Not to worry, SB313 assures us that the Alcohol Abuse fund will get money (in theory) by authorizing gifts and grants and couch-cushion cash from anywhere such funds may be raided found.

The important point is that the Senate bill takes Liquor Commission funds and replaces them with whatever the Department of Health and Human Services has lying around. Like, say, lottery tickets, Funspot tokens or, we don’t know, maybe state general funds.

Nature and state budgets abhor a vacuum.

The Senate bill first addresses the Alcohol Fund by ensuring that it finally receives its full 5 percent of Liquor Commission gross profits. For 15 years, legislators have been taking for the general fund the difference between that full 5 percent and whatever they decided to put into the Alcohol Fund.

Under the Senate bill, those general fund appropriations will no longer happen. They will go instead to fund Medicaid expansion.

This long story leads to a short answer. Senator Bradley’s bill is a 5-year shell game designed to, if at all possible, prevent the inevitable. A statewide sales or income tax to fund a program that, like most government entitlements, will never go away, and whose budget will never, ever, really go down.

So SB313 is the same old can in a new dress, kicked a bit further down the road.

Here’s the roll call.