KEENE - U.S. Sen. Kelly Ayotte, R-N.H., met with Keene Rotary Club members at the Keene Country Club on Monday.
Ayotte started by talking about various bipartisan bills she supports that she said would move the federal government towards using taxpayer money more effectively.
A bill that calls for the regular review of duplicate federal programs that could be eliminated or combined is once such action.
When she asked for questions, Rotary members expressed concerns about the cost of the Affordable Care Act down the road, the cost of health care in the United States and defense spending.
The Rev. Samir J. Habiby, 81, of Swanzey, a disabled veteran who served as a Naval chaplain for 28 years, told Ayotte the heavy cut backs to federal defense personnel and cuts to veteran services has to stop.
"We are at war in the world even though we don't seem to realize it. People don't like us. They want to destroy us, and to reduce our armed forces below the level of the second world war is unacceptable in this world," he said.
He said he understands the need to fund other programs, but the country still needs to be properly defended.
Ayotte agreed, "Without a safe country you can't prosper economically."
Ayotte said cuts were expected after forces pulled out of Iraq and as forces in Afghanistan diminish, however the cuts proposed by the administration are drastic.
"We have to address this because ultimately there are ways we can more effectively spend our defense dollars," Ayotte said, adding "It's not sustainable going forward - the proposal by the administration - because of the challenges we face."
Kris Roberts of Keene said he is concerned about the cost of covering new Medicaid enrollees under the Affordable Care Act.
"I was reading that up to 4 million people signed up under Medicaid, and New Hampshire was going to sign up about 50,000 under Medicaid," Roberts said.
Under the Affordable Care Act, the federal government would cover new Medicaid patients at 100 percent, but after three years would reduce that funding to 90 percent.
"I don't see how the federal government will be able to pay 90 percent with the debt continuing to go higher," Roberts said.
In a few years, what would the government be able to cover? he asked.
Morally and ethically the state would be bound to continue to cover the Medicaid enrollees and that would have a devastating effect of the New Hampshire budget and other state budgets, he said.
"I don't think people are looking at this three years out," Roberts said.
Ayotte said it is a fiscal challenge the country will face if not addressed.
"When you think about where things are, with 17 trillion dollars in debt and when you think about how things now not being fully funded," Ayotte said. "It is a fiscal challenge. ... That question has to be asked and answered."
Marty Reisig of Keene said one of the reasons medical costs in the United States are high when compared to other countries, is that the United State pays far more for medical devices.
"You can go to India and get a hip replacement for less than you pay for an insurance co-payment here," Reisig said. "Here in the United States we're supporting the rest of the world on these medical devices."
Ayotte said that in the United States there is no transparency of cost or competition in the health care industry.
"If you've ever tried to shop around in our health care system it's very challenging. How do you do it?" she said.
The state of New Hampshire has made some progress getting some health care providers to offer some fees online, but the industry is nowhere near where it should be in terms of transparency of pricing, she said.
"If we want to look at cost, we've got to look at that issue," Ayotte said.
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This document was issued by Kelly Ayotte and was initially posted at ayotte.senate.gov. It was distributed, unedited and unaltered, by noodls on 2014-04-23 19:58:18. The original document issuer is solely responsible for the accuracy of the information contained therein.