Unless the macro-political forces are so strong this fall that not only the New Hampshire State Senate and the New Hampshire House go Republican (note that “go” was intentional, after today’s vote for Obamacare-Medicaid-Expansion the New Hampshire State Senate has to be considered Republican-in-Name-Only), but in addition Andrew Hemingway pulls the greatest political upset in history, today will mark the day that New Hampshire voted for an income tax and the New Hampshire Republican Party was relegated to an irrelevant minority party.
I am referring to the New Hampshire Senate’s vote to go “all in” on Obamacare-Medicaid-Expansion. The GOP State Senators are still claiming that the bill they voted for is not Obamacare-Medicaid-Expansion. Technically, that’s true, but as a practical matter it’s not. The bill, as I understand it works as follows: (1) NH immediately opts into Obamacare-Medicaid-Expansion, that is we expand what is already in place to 138% of poverty level. (2) NH applies for a waiver for what is described as some innovative NH approach but really is basically the same alternative approach Iowa is pursuing. (3) If the waiver isn’t granted by mid-2016 the program automatically ends. But fat chance it stays automatically ended. As Charlie Arlinghaus has written:
The bill does say that if the federal overseers of Medicaid don’t approve the changes we want then, after two years of coverage, the program would technically expire and need to be reauthorized or else 50-80,000 would have their Medicaid coverage taken away from them.
No rational person honestly believes this expiration is anything but procedural. No legislature elected in recent memory of whatever partisan flavor could ever bring itself to cancel pre-existing benefits, especially health benefits, for such an enormous population. It will not ever happen and everyone knows that including federal regulators.
Even if the waiver is granted there is supposedly another layer of protection in that the program automatically ends if federal funding drops below 100 percent. We already know that will happen in 2017. But for the same reason the Legislature won’t cancel the program if the waiver is not approved, it won’t cancel the program once federal funding begins to ratchet down in 2017.
So to repeat, while as a technical matter the New Hampshire State Senate did not vote for Obamacare-Medicaid-Expansion, as a practical matter it did.
Now let’s go to the scorecards. Sadly a majority of the GOP State Senators voted for the bill. They were: Bradley, Morse, Odell, Stiles, Rausch, Boutin and Forrester. The following voted against: Sanborn, Reagan, Prescott, Cataldo and Carson. And Bragdon abstained. So the GOP’s fingerprints are all over this.
The reason the pundits have been predicting big things in 2014 for Republicans is that it is an off-year election, in the sixth year of a President’s term –the six-year itch– and President Obama is extremely unpopular, sort of like a full moon and high-tide and high winds all coinciding, and washing in waves of voters disposed to vote for the GOP. Except in one fell-swoop, the GOP State Senators have inoculated the Democrats on, if not the key issue, one of the key issues helping Republicans and hurting Democrats in 2014 – Obamacare.
We’ve been told by the Union Leader that we shouldn’t be criticizing Senate President Chuck Morse and Majority Leader Jeb Bradley because at least two GOP Senators were ready to break ranks and vote with the Democrats for their Obamacare-Medicaid-Expansion bill. The problem with that argument is twofold: there is no difference between the alleged alternative and the people of New Hampshire know that there is no difference.
The far better approach than offering an alternative that really wasn’t an alternative except in name was to have fought and lost. Oppose Obamacare-Medicaid-Expansion because it massively increases the number of people dependent on government. A large number of the people eligible for this entitlement are already paying for their own health insurance. While they will see a short-term financial benefit in having the government pay for their insurance in the long-run they will be much worse off. The CBO recently reported with respect to the Obamacare exchanges that the cost of taking a better job to those receiving subsidies in the form of lost subsidies is so high that significant numbers of people will choose not to take a better job. The same principle applies to Obamacare Medicaid Expansion. It imposes such a high cost on pursuing upward mobility that people won’t.
Is that what we want to do as Republicans, pursue a policy that discourages upward mobility and encourages dependence on government? Of course not. But that is what Bradley, Morse, Odell, Stiles, Rausch, Boutin and Forrester voted for today.
A criticism of some Republicans is that they only offer same but less. That is too generous to describe today’s vote. Today’s vote was same but same. And if on arguably the most important issue of 2014 New Hampshire Republicans are not even offering same but less, but are offering same but same, can you blame conservatives for staying home, or voting Libertarian out of frustration, or moving to a conservative State? We know that a big reason that New Hampshire went from Red to Purple to Blue is demographic changes to the State. Simply put a bunch of liberals moved in, while conservatives died and moved out. What kind of voter is going to be more inclined to move to New Hampshire once the House has approved the Senate bill and Governor Hassan has signed it?
Republicans like Jeb Bradley are constantly telling us – forget the social issues, focus on the fiscal issues. Sound advice, except that Jeb and company are now telling us to forget the fiscal issues. More particularly, they are not telling us how they intend to pay for Obamacare-Mediciad-Expansion once federal funding begins ratcheting down from 100 percent to only 90 percent, beginning in 2017.
We know that government spending programs end up costing a whole lot more than predicted. Charlie Arlinghaus has already predicted that many more will go on expanded Medicaid than predicted:
Further, sponsors routinely describe the bill as providing a benefit to 50,000 people. That’s just plain wrong. The bill makes an estimated additional 100,650 people eligible. The analysis of a year ago suggested that 83% of the half of the eligible population without insurance would take the free coverage (I use their higher end estimate because we are now spending millions recruiting people to coverage which seems likely to be more effective than when we spent nothing).
That analysis estimated that only 12,000 of the half of the newly eligible with existing private coverage would cancel their current plan and switch to Medicaid. But the offer now is for them to keep their existing coverage and merely have the state pay all their premiums and co-pays – hardly invasive or inconvenient. A better estimate is that 80% of that population will permit the state to send them free money.
When sponsors say 50,000, replace that number with 80,000 and increase their cost estimates by 60%. I presume cost estimates, not yet available, will emerge sometime before Senators vote.
New Hampshire Voices for Health says that the feds will be pumping in approximately $281 million a year. Let’s increase that by Arlinghaus’ estimate, which gives us $450 million. So what happens when the feds share drops to 90 percent? Where does that missing $45 million (assuming funding is static, more if it’s not) come from?
Looks to me like at least a twofer or more for Democrats, they can use the New hampshire Republican Party as a human-shield against the anti-Obamacare sentiment in 2014, a U.S. Senator Hassan in 2016 and the long sought after income tax in 2017 or shortly thereafter.