15Jul/14

Medicaid Commission Recommendation is a Balanced, Consensus Approach

The bi-partisan commission established in the budget to study the feasibility of expanding Medicaid to provide health insurance to New Hampshire’s lowest income, uninsured adults issued its recommendation this week, and it represents the work of our volunteer state government at its best.  The commission issued a recommendation to create a pathway to Medicaid expansion that is a balanced, careful New Hampshire solution, representing our shared values and a respect for our citizens, our health care providers, and our health insurance carriers.

Our recommendation to extend health insurance to nearly 60,000 low income, working Granite Staters maximizes consumer choice and use of the private insurance market.  New Hampshire is ahead of a number of other states in that we have already elected to make use of a managed care model delivered through contracts with private managed care organizations.  Consumers have a choice among plans, and the carriers have the experience in coordinating an often fragmented health care system that will result in efficiencies and savings.  In addition, our commission’s recommendation is to expand New Hampshire’s premium assistance program that keeps Medicaid-eligible individuals on insurance offered by their employer instead.  Not only will this prevent people from dropping private insurance for Medicaid, but it will also allow them the stability of not needing to change doctors when their incomes fluctuate.

The commission’s recommendation is fiscally responsible as well, respecting the interests of New Hampshire taxpayers.  We aim to begin the expansion as soon as possible next year to take maximum advantage of 100% federal funding for three years while we incorporate newly-insured residents into rational use of health care resources, emphasizing prevention and primary care.  The increased use of the premium assistance program is expected to save as much as $35 million in the current budget.  We will cap the state’s financial risk as well, as we shift the risk to the private market through our capitated managed care contracts.  These contracts offer savings already incorporated in our current budget.  Finally, the commission recognized that, despite nearly 50 years of the federal government’s living up to its promised financial contribution to Medicaid, there are those who doubt the promised funding level for Medicaid expansion.  We recommend, therefore a “trigger” to discontinue expansion if the statutory requirement for guaranteed federal funding levels were to be changed by Congress.

We will trust the commercial market to implement its own successful business models as long as we realize our expected efficiencies.  Improved data collection, required by contract, will give both our department of health and human services and the carriers information on health outcomes as they are expected to be impacted by prevention, access to primary care and coordination of health care.  The carriers have the opportunity to offer wellness incentives or cost-sharing requirements as appropriate.  In any case, the risk is theirs in the managed care environment.  The commission also recognized the potential value to encouraging the managed care companies to participate in the new Marketplaces as early as 2015, broadening their attractiveness to more residents, and minimizing network churn for people with fluctuating incomes.  This is an innovative model being implemented in other states with potential benefit for us too.

Finally, the Medicaid Expansion Commission’s recommended pathway supports our health care providers.  In decreasing the number of uninsured Granite Staters, we reduce the amount of uncompensated care delivered by our hospitals, health clinics and mental centers by a projected $117 million in this biennium alone.  This is an enormous help for our critical health care safety net providers.  Beyond reducing uncompensated care, the recommended expansion of the premium assistance program helps providers with commercial market reimbursement rates which have traditionally been higher than public payers such as Medicaid and Medicare.

Working hard over the past three and a half months, we have agreed to a recommendation the way the public wants us to:   by putting our heads together and listening to each other, across the aisle and across the other states, we have recommended a balanced, responsible approach to decreasing the rate of uninsured New Hampshire residents.  As someone who worked on the House vision of Medicaid expansion last winter, it’s not where I expected to end up, but I’m glad I did; this is a better New Hampshire solution.

15Jul/14

Medicaid Expansion Must be Legislature’s Top Priority for 2014

When the Legislature gets back to work next month, our first priority must be to pass Medicaid expansion.  Offering health insurance to New Hampshire’s poorest adults is the single most important step we can take to improve the health and security of our population, while investing in jobs and the economy.

58,000 New Hampshire residents between the ages of 19 and 64, who earn less than $16,000 a year, are currently unable to afford health insurance.  These are our state’s working poor: hairdressers, bus drivers, waiters and construction workers.  We depend on them for the quality of life we enjoy here in the Granite State.  However, these important members of our communities often put off routine care because they are unable to afford medical treatment and are more likely to end up in emergency departments, where care is more expensive and lacks coordination and follow-up.  A catastrophic illness or accident can cause result in crippling debt and bankruptcy for too many New Hampshire families.

Fortunately, comprehensive, affordable health insurance is now an option, offered through our nearly 50-year old Medicaid program.  Medicaid can help these 58,000 New Hampshire residents get treatment for their heart disease, diabetes, high blood pressure and depression.  Treating their chronic conditions can help them get back on their feet, work more hours, find full time work, and eventually earn enough money to get off Medicaid.

As efficient as Medicaid is, especially now that it is delivered through managed care contracts with private insurance carriers, the expansion to low income adults is an even better deal.  For the first three years, the federal government pays 100% of the claims, eventually settling at 90%.  This is tax money we already send to Washington, only now it will be returned to New Hampshire.  Medicaid expansion will represent an investment in New Hampshire’s economy of more than half a million dollars a day, every day.  This investment will lead to the creation of over 5,000 new jobs in our state; something we all agree is a priority.

Finally, Medicaid expansion will decrease uncompensated care in our hospitals, health centers and mental health centers by at least $80 million a year.  This financial burden on our health care system is created when people get seriously ill or injured and cannot pay for the treatment.  It is a burden that is currently passed on to families and businesses, making health insurance more expensive for us all.

With Medicaid expansion, we will improve the wellbeing and security of the people of New Hampshire, decreasing the burden of uncompensated care on our hospitals and health care providers.  We will gain 5,000 new jobs through unprecedented investment in our economy.  It’s no wonder the New Hampshire Business and Industry Association supports Medicaid expansion.  They know a healthy population is ready and able to work hard in a vibrant economy.

When the Legislature reconvenes in January, we need to roll up our sleeves and make Medicaid expansion happen.  Our friends and neighbors, health care providers and businesses are waiting for us to act.

15Jul/14

House Republicans Play Fast and Loose with the Taxpayer’s Money

I oppose turning over responsibility for planning our state’s $2.6 billion Medicaid Managed Care program to an unnamed private group that won’t even have enough time to do the work required.  The sponsor of House Bill 652, the chairman of Finance division 3, stated he filed it because the department of health and human services missed a reporting deadline in July, and he wanted to send them a message.  The sponsor also stated that the department is currently on task and on time to issue the Medicaid Managed Care RFP by this coming Monday, October 17, the first business day following the statutory deadline of October 15.

So not only is this bill unnecessary, but the sponsor has also admitted it is, in his words, “unworkable.” And it truly is unworkable.  It delegates the designing and contracting for a new Medicaid program to a private group, but it cannot actually remove the state’s responsibility to manage Medicaid. There is also no authority for such private delegation of federal Medicaid funding.

Beyond this very basic legal problem, the timing is also completely unworkable. The bill would require that 5 individuals outside of government be appointed to develop an RFP for the state’s $2.6 billion dollar Medicaid program by Monday, October 17.  During these five days, before anyone can even be appointed to the commission, the Senate has to come back, introduce and approve the bill, and the Governor has to sign it.  The department experts have been working on this challenging program design for four months.  It is completely outside the realm of possibility that 5 new people could do it in 5 days.  And please don’t think we could just push back the RFP deadline.  The $32 million dollar savings in the budget depend on the current timing.

The sponsor would probably say this bill is needed as a vehicle to make changes down the road in managed care.  But it won’t be any such vehicle because, it’s a 2011 bill, and the Senate has gone for the year.  This bill will not be enacted; it will simply expire.

House Bill 652 does indeed send a message.  But it’s not the message we want to send.  While there is a potential for significant savings in managed care, the actual message HB 652 will send is that the legislature is willing to risk these savings for an unnecessary, unworkable process and a timeline that is total fiction.

The public has a right to expect better fiscal management from its representatives.

15Jul/14

Numbers Don’t Add Up for Republican Claims They Have Grown the Economy

In a recent op-ed, House Speaker William O’Brien and Ways and Means Chair Stephen Stepanek claimed that the Republican state budget has driven down the unemployment rate in New Hampshire.  Looking solely at the change between September and November is disingenuous, at best.  To assess fairly the data on unemployment, it’s necessary to look both at a longer period of time and also evaluate our performance vs. surrounding states.  On both measures, the Republican leadership’s bragging doesn’t add up.

Under Democratic Leadership and Governor Lynch, unemployment went on a 16-month decline from January, 2010 – May, 2011.  By January of 2010, the state had already recovered more than half the jobs lost in the Great Recession and was out-performing its neighbors.  According to the US Dept. of Labor, under Democratic leadership, New Hampshire had the second fastest job growth in the nation.

Things sure have changed.  Unemployment has actually risen in New Hampshire since the Republican budget took effect.  In June of this year, while still under a Democratic budget, New Hampshire’s unemployment rate was 4.9%, approaching half a percentage point lower than it is now.  That’s right: in the six months since the Republican budget took effect, unemployment in New Hampshire has gone up!

Furthermore, the jobs lost under the radical Republican budget are mainly private sector jobs, including at least 1,000 health care jobs.  In their zeal for spending cuts, the Republican budget has in reality had a devastating effect on the private sector.   Even the normally conservative Business and Industry Association agrees the $250 Million cut in hospital funding was a bad move and expects that, in addition to the loss of at least 1,000 good-paying jobs, the budget’s attack on hospitals will lead directly to higher health insurance costs for businesses and individuals.  The irresponsible decision to slash hospital funding is actually a tax increase on health care providers that has led to a recalculation of their tax base and a potential loss of $50 Million in state revenues.

Beyond unemployment actually going up under the Republican budget, the recent good news of a tenth of a percent drop in the unemployment rate indicates that New Hampshire is underperforming its neighbors and the US average.   During the same period that Reps. O’Brien and Stepanek are crowing about a 0.1% drop in unemployment, unemployment in our bordering states of Massachusetts, Maine and Vermont all dropped by 0.3%, and the US unemployment rate fell by 0.4%.

In addition to the irresponsible slashing of health care funding that led to job losses and early retirements, the Republican budget also cut $90 million out of the Highway Fund.  This is money that would have been spent on highway projects over the next two years, creating many construction jobs.   At the same time that the Republicans were making decisions that have been disastrous for the health care and construction employment sectors, they were insisting that the cigarette tax be cut 10 cents a pack.  The terrible result of that decision that was forecast has indeed come to pass:  Cigarette companies raised their prices to make up the difference, the retail price did not decline, but the state’s tobacco revenues are off millions over the last few months.

We all want to see New Hampshire’s economy prosper and grow.  But to do that, legislators need to make responsible budget decisions and policy initiatives, rather than caving in to special interests.  Speaker O’Brien and Rep. Stepanek’s claim that the Republican budget has succeeded in lowering unemployment just isn’t supported by the numbers so far.   Granite Staters deserve a better answer than just political spin.

In the meantime, many families in New Hampshire are suffering from a long term lack of unemployment, including a mother of five, whose husband has been out of work for a year and a half. This mother was able, only through the generosity of coworkers, to buy a Christmas tree and new shoes to replace the boys’ sneakers that had holes.  This New Hampshire resident’s husband finally has a good job prospect, but, ironically, it’s in another state.    Surely we can expect better opportunities at home.