What Does Repealing Obamacare Mean for New Hampshire?

My Turn: Health insurance in a post-Obamacare world

For the Monitor

Wednesday, January 04, 2017

The Republican-controlled Congress has pledged to repeal the Affordable Care Act, also known as Obamacare. Over the past six years since it became law, the ACA has brought major changes in health insurance laws that ended the worst insurance company abuses.

The effect of this has been important in New Hampshire, so, as we stand on the precipice of the ACA’s potential repeal, it’s a good idea to review the impact of these changes on New Hampshire’s people and consider how we will be affected if the law is repealed.

Perhaps the most important reforms involve the guarantee of insurance coverage. Thanks to the ACA, the 600,000 Granite Staters who have a pre-existing health condition can no longer be denied coverage or charged so much that they can’t afford it. Insurance companies can’t cancel their policies when they get sick or put caps on their coverage. Women can’t be charged more than men simply because of their gender, and young adults can stay covered through their parents until age 26 as they establish their careers. That’s a lot of peace of mind thanks to Obamacare.

The coverage itself is improved as well and has a better overall value. Important preventive services are always covered, such as colonoscopies and mammograms, and insurance companies are regulated on the amount of premium dollars that must go to pay for services, rather than marketing and executive pay. And with mental health services a critical need in New Hampshire, the ACA requires coverage of these services at parity to other medical services.

While the coverage has gotten better, the rate of cost increase for the 850,000 Granite Staters who get insurance through their employer has also slowed by more than a third. And more than 30,000 of us who buy insurance through the individual market qualify for tax subsidies to make the purchase more affordable.

Already more than 20,000 older New Hampshire residents are saving on average more than $1,000 a year on their medications. We must ask ourselves what will happen to this group of Granite Staters when the Donut Hole returns.

The Medicare program itself is also improved by the ACA. An annual exam and essential preventive services are now provided without cost sharing. In 2015, 74 percent of our seniors who are enrolled in Medicare Part B took advantage of this benefit. Medicare also brought payment reforms to hospitals to encourage fewer unnecessary readmissions.

Over the past five years, readmissions dropped 3 percent for New Hampshire’s Medicare beneficiaries, keeping our elders out of the hospital unless really necessary.

Finally, New Hampshire took advantage of the ACA’s Medicaid expansion, bringing health coverage along with mental health and substance abuse treatment access to many Granite Staters for the first time. Over the past two years since the expansion began, 107,000 residents have participated at some point; currently 50,000 people are enrolled. The Medicaid expansion has also brought financial stability to our smaller, rural hospitals since they are now compensated for care they must provide.

Virtually everyone in New Hampshire has felt the impact of the Affordable Care Act, whether they are on Medicare, get insurance through work, through Healthcare.gov or through Medicaid. For the past few years, they have had higher quality, more transparent coverage that treats them more fairly than in the past.

We can only wonder how Granite Staters will react and suffer when the Trump administration and Republican Congress take these benefits away.

(Rep. Cindy Rosenwald of Nashua is the deputy House Democratic leader.)


Nashua Telegraph

Friday, October 21, 2016

NH can’t afford to backtrack

Cindy Rosenwald

As I talk to voters around my district this fall, I ask them how their family is doing. I’m getting a consistent answer: “Things are OK, we’re doing fine.”

The numbers bear out their sense of confidence. Incomes in New Hampshire are up, unemployment is among the lowest in the country, and more people are working in New Hampshire today than ever before in our history.

At least in some measure, we can attribute our state’s recovery to prudent investments in our people and our infrastructure through the state budget over the past two cycles.

And there was a lot to clean up after the disastrous “O’Brien Budget” of 2011-12, which cut $40 million in general funds and devastated critical programs essential to safe, healthy communities and a vibrant economy.

We all remember the impact of the $40 million budget cuts under former House Speaker Bill O’Brien: downshifts of long term care costs to local property taxpayers, funding cuts to private nursing homes that forced staff reductions and put frail seniors at risk, elimination of the Children in Need of Services program that increased costs to local communities, cuts to hospitals that cost up to 2,000 jobs and brought on expensive litigation, and cuts to public universities and community colleges that drove tuition up. Funding for drug and alcohol prevention and treatment programs was decimated, and now we are faced with more than one drug overdose death each day.

The list goes on, affecting all areas of life in the Granite State.

It has taken several years for us to climb back from the O’Brien budget cuts of $40 million general funds, but we have, and residents of my district are happy with the quality of life in New Hampshire. But that quality of life could be threatened again with the legislature due to be elected next month.

The chair of the powerful House Finance Committee has filed a bill to eliminate the interest and dividend tax, which is paid by wealthier Granite Staters on their investment income. This bill would decrease state revenues by a whopping $187 million. The O’Brien $40 million budget cuts pale in comparison.

If New Hampshire residents didn’t like the impact of $40 million in cuts affecting seniors, individuals with disabilities, college students, property tax payers, and jeopardizing community safety with a rise in drug abuse, what would they think about a budget cut quadruple that size?

Would they want to see drug treatment services decimated again, with drug abuse our No. 1 public health problem? Cuts to snowplowing? Road paving? Nursing home care for our elderly family members?

Voters need to think very carefully about the legislators they choose to send to Concord in November.

If the Republican leadership’s bill passes, what important programs will be on the chopping block?

Will the next Legislature pass a tax cut for the wealthiest people in the state, shifting costs down to hard-working middle class families? New Hampshire can’t afford the risk, especially now that we’ve fought our way back from hard times.

Cindy Rosenwald, D-Nashua, is the Deputy Democratic Leader in the New Hampshire House.


Opioid prescribing bill signed into law

For Immediate Release
June 7, 2016

Communications Office

Governor Hassan’s Statement on Signing Bipartisan Legislation Requiring Updated Prescribing Rules for Opioids

CONCORD – Governor Maggie Hassan issued the following statement after signing House Bill 1423, legislation that she proposed in November as part of a comprehensive strategy to fight opioid abuse, requiring all prescribing boards to update prescribing rules for opioids:

“While opioids can play an important role in pain management and our healthcare system, we know that the heroin and opioid crisis stems in part from the overuse, misuse and abuse of addictive prescription opioids. In order to prevent the overprescribing of opioids, we have been working to improve provider training and to update the rules for prescribers, with the boards of medicine, nursing and dental examiners taking important steps forward with their own updated rules.

“House Bill 1423 builds on those efforts by requiring the boards governing all prescribers to adopt updated, permanent rules this year and by providing a uniform, statewide standard. I thank Representative Rosenwald, Representative Sherman, the New Hampshire Medical Society and our physicians for their leadership on this issue, and I am proud to sign this bipartisan bill into law in order to build on our efforts to prevent the overprescribing of opioids.”

House Bill 1423 builds on emergency rules that boards of medicine, nursing and dental examiners put in place in collaboration with Governor Hassan to ensure that best practices are followed in prescribing opioids, and the boards of medicine and nursing have been working to establish permanent rules. Beginning in September, the new law mandates the use of the prescription drug monitoring program and requires all boards governing prescribing to have new rules establishing standards for assessing the need for opioids, the risk for abuse and educating patients. It also requires boards to set standards for limiting the amount of days for an opioid prescription obtained in an emergency room to ensure follow-up care for patients.

The new law also contains exceptions for opioids prescribed for cancer patients, patients with terminal conditions or patients in long-term non-rehabilitative care settings, such as nursing homes.

Governor Hassan has outlined and consistently worked to implement a comprehensive strategy to support law enforcement and strengthen prevention, treatment and recovery in combating the crisis, including calling a special session of the legislature last November. In addition to House Bill 1423, the Governor has signed legislation to increase the penalties for the illegal sale and distribution of fentanyl, to limit prior authorizations for outpatient substance abuse treatment and to improve the state’s prescription drug monitoring program. The Governor also fought to reauthorize the bipartisan New Hampshire Health Protection Program, which has provided substance misuse and behavioral health services to thousands of Granite Staters, and she has revised licensing requirements to make it easier for providers to open treatment facilities, worked to increase the safe and effective use of Narcan, and launched a statewide substance misuse hotline to help connect individuals with resources 24 hours a day, seven days a week.

Over the course of the next several weeks, Governor Hassan will also sign bipartisan legislation to limit insurance companies’ prior authorization requirements for in-patient hospital stays, to expand the use of the prescription drug monitoring program and to provide $5 million in additional resources for prevention, treatment and recovery programs and supportive housing. The legislature has also heeded Governor Hassan’s call to return next week to consider additional funding for law enforcement, expanding statewide the successful Operation Granite Hammer model that she helped launched last year.


Inefficient defense spending hurts New Hampshire


My Turn: Inefficient defense spending hurts New Hampshire

For the Monitor
Tuesday, March 15, 2016
(Published in print: Tuesday, March 15, 2016)

As Congress begins considering President Obama’s final budget request, it’s a good time to take stock of where our hard-earned tax dollars are going. As a state representative, I am concerned that some urgent funding needs in New Hampshire – such as drug treatment, education, our aging roads and bridges, and community development – are being squeezed out by wasteful spending at the Pentagon.

New Hampshire currently relies on federal funds for about 30 percent of its revenue. Yet, this flow of federal dollars to the state is constantly under siege because more than half of the nation’s discretionary budget goes to the Pentagon. While I strongly believe in the responsibility to provide for a robust national defense, there are far too many examples of inefficient spending eating up our tax dollars.

One area that deserves particular scrutiny is the planned full-scale update of the U.S. nuclear weapons arsenal, expected to cost taxpayers $1 trillion over the next three decades. The so-called nuclear “modernization” programs include new fleets of nuclear-armed submarines, bombers and ground-based ballistic missiles, a new air-launched cruise missile, and new bells and whistles for the associated nuclear warheads.

The president and his military advisers have stated that we can reduce the deployed arsenal by one-third while maintaining stability with other nuclear powers. Yet, the current plans lock in a nuclear force structure that looks the same as it did 25 years ago and a spending trajectory that some experts are calling a budget train wreck. For instance, in 2029, the Pentagon will be spending $34 billion on nuclear force modernization alone, or “about as much . . . as the total budget of the U.S. Department of Justice,” according to the Center for American Progress.

Indeed, the Defense Department and supporters in Congress are beginning to justify the nuclear build-up with Cold War-like rationales, calling investments a counter to Russian aggression. Such thinking is backward, dangerous and provocative. Nuclear weapons did not stop Russia from invading Crimea or intervening in Syria.

Wasteful spending on dangerous weapons takes away from the safety and welfare of Granite Staters where they need it the most. Over the last several years, New Hampshire has seen a sharp increase in heroin overdoses and many families have been affected by the devastating epidemic of drug abuse. In addition, in public education, taxpayers have been picking up the slack where the current funding formula does not cover schools that are growing. Our state’s businesses and manufacturers also suffer when Congress cannot nail down long-term highway and transit appropriations. It will take purposeful resource mobilization to provide drug addicts with effective rehabilitation, students with a first-class education and commuters with highly efficient transit systems.

Budget decisions are hard to make. Yet, today, unchecked public spending largely benefits the military-industrial complex without tackling 21st-century security threats and needs. New Hampshire’s hard-earned tax dollars ought to be put toward the things that really keep us safe and secure.

President Obama entered office calling for the “peace and security of a world without nuclear weapons,” but given the current political atmosphere, we cannot assume the next president will be quite as visionary. It is time for all of us, at the local, state and federal level, to speak out against excessive, wasteful and counterproductive nuclear weapons spending.


Magical thinking in Republican budget will turn NH into Kansas


We stand with Gov. Hassan in her decision to veto the fiscally irresponsible and unbalanced Republican budget, which we can only describe as a trail of false promises.

You may have heard Republicans claim that their budget increases funding for critical priorities like substance abuse treatment, mental health services and our seniors. But there’s one very big problem. Republicans’ fiscally irresponsible budget isn’t actually balanced, placing every single one of those priorities – and more – at risk.

This budget overpromises and under-delivers. Our Republican colleagues know that their budget doesn’t actually do what they say it does, but that doesn’t seem to bother them.

Instead of making tough choices and being honest with the people of New Hampshire about what their budget actually funds, Republicans would rather pass a budget riddled with magical thinking and false promises.

Republicans know that because their budget is unbalanced as written, they are simply passing the buck onto state agencies who will inevitably have to decide what critical services to cut down the road to keep the state in the black.

Even worse, their budget hurts our state’s long-term economic outlook by including unpaid-for tax giveaways for big corporations that will blow a $90 million hole in future budgets.

By blowing a massive hole in future budgets, it will be impossible for our state to invest in critical priorities like holding the down the cost of tuition, maintaining safe roads and bridges, and ensuring access to affordable health care.

We don’t have to guess what would happen as a result of these large, unpaid-for tax giveaways. We only need to look at the example of other states across the country, particularly Kansas.

The governor of Kansas proudly declared that his state was a real-world experiment in trickle-down, Koch Brothers’ economics when he pushed through massive, unpaid-for tax giveaways in his state.

What resulted? The state teetered on a fiscal cliff, deficits exploded, bond ratings sank, and none of the economic benefits that were promised actually materialized.

From Kansas to New Jersey to Louisiana and Wisconsin, we’ve seen what happens as a result of unpaid-for tax giveaways: first, deficits balloon, and then critical economic priorities must be cut.

New Hampshire’s economic outlook is promising. In 2014, New Hampshire’s economy grew the fastest in New England and faster than the national average. Not to mention that our unemployment rate is fifth lowest in the country, and our businesses have recovered all of the jobs lost in the recession – and then some.

This is the time to build on our progress by investing in our people and businesses, not let Republicans turn us into Kansas.

House and Senate Democrats will continue to stand with Gov. Hassan as we fight together for a responsible budget that is balanced and that will live up to the promises we make to our families and our businesses.

Rather than repeating the mistakes of states like Kansas, we encourage our Republican colleagues to come to the table and negotiate in good faith so that we can pass a responsible budget that will build on our economic progress and move our state forward.


Proud to Help Promote North Country Economic Development



Budget is a twisted tale of Broken Promises

The Telegraph
Sunday, April 5, 2015

Budget is a twisted tale

The House Republican budget is a twisted tale of broken promises. It breaks its word to voters, to taxpayers, to employers and employees, to the elderly, to people with mental illness or disabilities, and to our state’s future. It is a budget with shocking and Dickensian assaults on our economy and our citizens.

The Republican majority made a public promise at the beginning of the session that their budget would not raid dedicated funds, downshift costs to local taxpayers, or use other budget gimmicks. Their budget breaks all three promises.

In a dazzling money grab, this budget raids $51 million dollars from the Renewable Energy Fund. This money, collected from ratepayers, is dedicated to helping municipalities, businesses and individuals lower their energy costs.

As the majority’s budget passes down costs in the millions to counties for long-term care, it breaks its promise not to downshift to local taxpayers. Adding to the $12 million in downshifts to county property taxpayers are the yet-undetermined costs to municipal taxpayers that will result from deep cuts in safety net programs. Property taxpayers will be left holding the bag for these broken promises.

Perhaps the most shocking aspect of the O’Brien-Jasper budget’s broken promises is their decision to empty the state’s Rainy Day Fund. According to the state treasurer, such a move could jeopardize New Hampshire’s credit rating, which has recently improved. In a growing economy, wiping out our emergency savings account is completely irresponsible.

We have a long-standing social commitment to our elders who helped ensure the previous generation could live their lives with security and dignity, with the trust that we would do the same. Yet this budget reduces the level of important services for frail seniors, putting their safety at risk.

We have a social commitment, also, to individuals with developmental disabilities and mental illness. This budget reduces funding below current levels and cuts back on mental health treatment and services. As a result, vulnerable populations will find themselves pitted against each other as they struggle to gain access to critical services without adequate funding.

Our business community has been clear that they need a healthy workforce and they are sick of the impact on their insurance premiums that comes from uncompensated care costs. The failure to extend the New Hampshire Health Protection Plan breaks our promise to help reduce uncompensated care. It also leaves almost 40,000 Granite Staters out in the cold when their insurance is cancelled next year.

This budget won’t promote economic development or attract youth to the state – two promises that we cannot break if we are to commit ourselves to a prosperous New Hampshire. The budget passed by the House is a budget so filled with broken promises as to shatter our prospects for a better tomorrow. We must hope that the Senate takes a different approach, and works across party lines to pass the kind of responsible budget that our future is counting on.


State Finances Can’t Depend on Unstable Currency –Union Leader op-ed

SINCE REGAINING the majority in the New Hampshire House of Representatives last November, the Republican leadership has promised responsible fiscal stewardship. Arguably, however, the most fiscally irresponsible bill this year is sponsored by Republican legislators. House Bill 552 would require the state to accept the digital currency bitcoin as payment for taxes and fees.Many people have never even heard of Bitcoin. It is a virtual currency introduced in 2009. Unlike major currencies, however, such as the dollar or euro, it has no central repository, and it is extremely volatile. From a high of $900 in late 2013, the value of a bitcoin has dropped to its current value of $224. That’s a drop in the value of the currency of 75 percent in less than a year!It would be supremely irresponsible for the State of New Hampshire to gamble with the public’s money by taking payments in such an unstable currency. Right now, New Hampshire’s cash reserves are approximately $160 million. Imagine if, all of a sudden, that reserve was worth 70 percent less. It would become more expensive to pay our financial obligations, for example, on our $1.6 billion of bond debt.Bond rating agencies look for stability and prudent fiscal policy. New Hampshire’s bond rating outlook was just improved to “stable” by Standard & Poor’s, due in large part to the settlement of a large hospital lawsuit. Currently, our average interest rate on outstanding general obligation debt issued in the last 10 years is just over 3 percent. This rate is based in large part on our bond ratings. It’s difficult, if not impossible, to imagine our bond ratings not being downgraded if our cash flow was dependent on such a volatile currency!Our financial obligations are not only to our debt service. We have 15,000 state employees whose families’ security depends on their paychecks not bouncing. We send money to our local communities to help pay for schools. We pay contracts to thousands of outside companies as well, and we also have financial obligations such as for rent and to the utility companies for lights and heat on 3.4 million square feet of building space.Imagine if we had to meet all these obligations and were doing so based on revenue collected that could be worth significantly less the day after it was received.The New Hampshire House has a long history of working hard to build responsible, frugal budgets that deliver essential services without overburdening taxpayers. Accepting tax and fee payments in bitcoin is not in keeping with responsible fiscal stewardship.We cannot afford to take our bonds to market with a scheme to pay the debt in a currency CNN recently termed “worse than the Russian ruble.” We cannot pay our employees with what Bloomberg has called “the worst currency of 2014.” Our state can and must be governed responsibly if we are to retain our New Hampshire Advantage.


From the Nashua Telegraph, setting the record straight on the budget deficit myth

Friday, February 6, 2015

Republicans promote myth of $800M deficit

Letter to the Editor

Republicans have been telling a story for five years that when they took over the legislature in 2010, they were stuck with an $800 million deficit left by the Democrats.

This story is a myth. The truth is that biennial state budgets are always balanced; it is required by law. As PolitiFact verified back in 2012, there never was a Democratic deficit in 2011. PolitiFact confirms that the budget Rep. Bill Ohm refers to in his recent letter (“Nashua rep fires back at letter-writing critic,” Jan. 30) left a $17 million surplus at the end of the biennium.

So if Democrats leaving the state budget with a $17 million surplus is the truth, where does the deficit myth come from? The $800 million Rep. Ohm refers to was additional federal funding, not part of the state budget. This was extra money all states received to help stabilize critical services during the Great Recession.

Every biennial state budget is balanced. In 2011, there was a $17 million surplus; the next budget had a surplus of $15 million. This budget will be balanced as well.

Governor Maggie Hassan has been working hard throughout the biennium, taking steps such as hiring freezes and directing budget cuts to meet bipartisan, legislatively-directed spending. A change in federal law governing Medicaid eligibility has also led to increased costs on the state level for low-income children and pregnant women.

The budget deficit myth of 2011 may have been a good story, but it just isn’t supported by the facts. The truth is that every two years the House and Senate work hard and produce a balanced budget. It’s what we do. It’s what we must do.

Rep. Cindy Rosenwald



The ABCs and Ds of Medicare by Rep. Cindy Rosenwald

Falling leaves, crisp nights and pumpkins signal Halloween and Thanksgiving—a busy time of year for all of us.  These seasonal markers also mean it’s time for New Hampshire’s 230,000 Medicare enrollees to choose their health coverage plans for 2015.

The annual open enrollment period for Medicare runs from October 15 to December 7.  Although no major benefit changes are expected, and some aspects of Medicare plans are standardized, individuals do have a number of important choices to make.  Since choosing Medicare coverage options can be confusing, it’s a good idea to take the time to review costs, coverage, and network options carefully.  As long as enrollment is completed by the end of the open enrollment period, coverage for 2015 will be in place.

Medicare is an alphabet soup of coverage for hospitals and skilled nursing care, outpatient services, and prescription drug insurance.  The open enrollment period is the time when most beneficiaries will need to assess their options and needs in detail.

Medicare part A covers hospital, skilled nursing home care, some home health care and hospice.  Part B covers outpatient medical care, including doctor visits and preventive care.  For the last few years, annual physical exams and important preventive health screenings and services have been covered without cost to the patient.  Parts A and B do otherwise have cost sharing, however, in the form of deductibles, co-payments and responsibility for co-insurance, and there is no limit on the amount for which the individual can be responsible.  Some retirees have supplemental insurance from their former employers to cover the payment gap; other beneficiaries will likely want to purchase Medigap insurance.

Since 2005, Medicare Part D has offered prescription drug insurance, either through private insurance plans or some employer-based coverage.  The infamous “donut hole” is closing under the health reform law.  Last year, approximately 15,000 Medicare beneficiaries in New Hampshire were able to save an average of $800 on their medications thanks to continuing closure of this loophole.

If you are confused by this alphabet soup, you might consider choosing a Medicare Advantage plan, known as Part C, which includes parts A and B, and sometimes D. Hillsborough County residents will have a choice of eight different Medicare Advantage plans for next year.  Some plans may also cover vision and dental care.  These plans may be the easiest and most inclusive options, but they can leave the insured person with high out of pocket costs.

When evaluating their coverage options, beneficiaries need to pay careful attention to cost sharing provisions such as premiums, deductibles, co-pays and co-insurance.  It is also important to make sure your doctors and other health care providers are covered by the plan you are considering, even if they are located in a different state.  This is especially crucial for “snowbirds” and frequent travelers.

There’s a lot to consider during Medicare open enrollment.  Fortunately, help is available locally through New Hampshire’s Service Link.  Their toll-free telephone number is 1-866-634-9412.  They also have a website:  http://www.nh.gov/servicelink/medicareinfo.html.

So enjoy the glorious New England Fall.  But make your choices in Medicare as well.