The bill reauthorizing Medicaid expansion passed the state Senate on Thursday when half of the 14 Republicans joined all 10 Democrats in voting to extend the Obamacare entitlement program for five years. This is why the #Headdesk Twitter hashtag was invented.
One of the Republican selling points was that the bill pays for for Medicaid expansion while protecting state taxpayers.
It doesn’t, though.
Some readers (the old, boring ones, you know who you are) might remember the ongoing fight to fund the state Alcohol Abuse Prevention and Treatment Fund (Alcohol Fund) established in 2000. 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.
New Futures created this handy chart to show the difference between the law’s required deposits and what was actually put into the account.
The Senate’s Medicaid expansion bill follows this grand 18-year bipartisan tradition and raids the Alcohol Fund.
The raid starts by first requiring that the Alcohol Fund at last be fully funded at 5 percent of gross Liquor Commission profits. (No sense in raiding an empty fund, right?)
This Liquor Commission money is then transferred to a new account created to pay for Medicaid expansion. It’s called the New Hampshire Granite Advantage Health Care Trust Fund. (One dedicated fund is being raided to finance another dedicated fund.)
The bill assures us that this transfer will happen only “provided” the programs financed through the Alcohol Fund “shall be paid for with federal or other funds available from within the department of health and human services.”
To provide a portion of those “other funds,” the bill lets the Alcohol Fund accept “gifts, grants, donations, or other funding from any source.” This magic money is directed to the substance abuse programs the Alcohol Fund can no longer finance because Medicaid expansion just swiped all of its Liquor Commission money.
Yeah, it’s Indiana Jones’ bag of sand trick. But with dollars.
What are the odds that those “other funds” will be made up of gifts and donations vs. state general funds?
Wait, don’t answer that question.
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.
Even if the department finds bags of federal money in an old vault somewhere, the Senate bill still shrinks the general fund. Think back to what we wrote nine paragraphs and two stupid gifs ago (we know, but try).
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.
Those are some pretty neat tricks to take general fund money via the Alcohol Fund. They could make for an interesting reception when the bill lands in the House.