The case advocates make for reauthorizing expanded Medicaid is exactly the same as the case for rejecting it: Nearly 53,000 Granite Staters are now dependent on the program.

Supporters don’t use the word “dependent.” They say people “rely on” Medicaid. Functionally, the meanings are the same, like “inebriated” and “intoxicated” or “asparagus” and “disgusting.” Expanded Medicaid has made 52,726 Granite Staters (as of March 31) dependent on government health insurance.

Of course, as the dart said to the dartboard when it complained about the pain, “that was the point.”

When New Hampshire passed expanded Medicaid in 2014, state Sen. Andy Sanborn, R-Bedford, said “I have never seen, in the political realm, any entitlement program ever end. And I think the suggestion that they would end is frankly ludicrous.”

The votes for expanded Medicaid would appear to bear that out.

In 2014, Medicaid Expansion passed the Republican-controlled state Senate 18-5 and the Democratic-controlled House 202-132.

In 2016, Republicans controlled both chambers. Reauthorization passed 216-145 in the House and 16-8 in the Senate.

This year, with Republicans again in charge, reauthorization passed 17-7 in the Senate and 222-125 in the initial House vote, with the final outcome this week so obvious that the House passed the bill on a voice vote.

Such consistent support can be explained by the program’s constituency of dependents, which reaches every community. Supporters on Wednesday roamed the State House wearing T-shirts that stated how many people in their town were on expanded Medicaid.

It doesn’t matter that the Medicaid population is not static. A UNH study found that 29 percent of New Hampshire’s expanded Medicaid population stayed in the program for two full years. The biggest reason people left was that a rising income made them ineligible. (Watch for this to eventually be the basis for an argument to further expand eligibility.)

What matters is that tens of thousands of people at any given time depend upon the government, rather than the private sector, for their health insurance. That’s enough to make it permanent.

There are only two ways New Hampshire legislators will rethink keeping this program. One is if the federal government announces a reduction in federal support so large and so sudden that the state cannot absorb the cost or reduce eligibility enough to avoid the immediate creation of a massive broad-based tax. Even then, it might stay.

The other is if the health insurance markets are reformed to the point that competition explodes and premium prices collapse, falling to levels that are affordable for low-income families. Again, even then it might stay.

OK, there’s also a third way expanded Medicaid could end. SMOD could strike New Hampshire and destroy everything.

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