To The Daily Sun,
As the 2016 New Hampshire Legislative Session gets under way, one of the biggest decisions legislators will have to make is whether to reauthorize the successful New Hampshire Health Protection Plan. In 2014, I was one of six bipartisan senators that negotiated the compromise NHHPP — or expanded Medicaid — which provided health insurance coverage for an estimated 50,000 people whose income was too high to qualify for traditional Medicaid, but not high enough to qualify for subsidies on the healthcare exchange. Our plan used federal funds to provide private insurance coverage for these 50,000 people stranded by Obamacare. Why did we do this?
We knew that uninsured people get sick like everyone else, and that when they get sick health care providers, like hospitals, are obliged to provide treatment even though in most instances there is not any viable way to be reimbursed for providing these mandated healthcare So what happens? These unreimbursed costs have to be recovered somehow by hospitals, or services are harmed, or they go bankrupt.
The health delivery system would be undermined for everyone if providers can't treat patients or hospitals close. So these unreimbursed costs called "uncompensated care" are baked into the agreements that hospitals and insurance companies negotiate to provide care and coverage.
Who pays for this uncompensated care? Everyone with an individual insurance policy or employer-sponsored coverage pays higher insurance rates as a result of these uncompensated care costs being shifted into insurance premiums. It's a hidden tax that several years ago reached $427 million. That amount happens to be the largest single tax in New Hampshire, nearly $80 million higher than the next highest transparent tax, the Business Profits Tax. This uncompensated care stealth tax is one of the main reasons New Hampshire health insurance rates are among the highest in the nation and a source of consternation to business leaders in our state trying to compete on the national and world stage.
The six bipartisan senators recognized that, like it or not, we were paying the costs of the uninsured. While hidden from public view, this has all of the negative ramifications on our state's economy as high electric rates, business taxes and workers compensation costs.
Since the original legislation passed in 2014, 44,000 of the estimated 50,000 individuals have signed up for coverage, improving their own health care. Just as important, uncompensated care costs have dropped by nearly $150 million and health insurance cost increases in New Hampshire rose more slowly than other states.
According to data from the Center for Medicare and Medicaid Services released last October, the average silver plan in 37 states increased by 7.5 percent. In contrast, the increase in New Hampshire was 5.1 percent. In my view reducing the stealth tax of uncompensated care has helped to minimize rising health insurance premiums.
So back to the question for legislators: Should we reauthorize the New Hampshire Medicaid Expansion plan? I believe (the answers is ) "Yes" for three reasons.
First, I have spoken with many individuals and families who have insurance for the first time. They speak of improving health through preventative and primary care that has helped them maintain jobs and better provide for their families. I have also spoken with businesses and chambers of commerce across the state that tell me that a healthier workforce is both good for the individuals and improves the productivity and competitiveness of our state's businesses.
Secondly, New Hampshire continues to struggle with a substance abuse crisis. Almost 1,700 people in the second quarter of 2015 utilized treatment under the New Hampshire Health Protection Plan. Without this funding those services would not have been available, exacerbating the substance abuse crisis.
Lastly, reducing the hidden tax of uncompensated care will continue to help control high health insurance costs, improving a key cost center for New Hampshire employers and making our state more competitive.
Questions do remain, however. Starting next year states have to contribute to the program funding. It is important that New Hampshire finds a method of funding this initiative without increasing taxes or undermining other programs. We should explore work requirements for able-bodied childless adults. We should also enhance modest personal responsibility measures that discourage inappropriate use of emergency rooms. These measures will strengthen a program that is already working well and improve its chances for reauthorization.
Despite over $400 million of federal funds being at stake for our state annually, many responsible legislators tell me this is a difficult vote because they fear Washington could change the funding equation. In 2014 we placed taxpayer protection measures into the legislation — loss of federal funds meant this program ended. This taxpayer protection is just as necessary in 2016. We must hold Washington accountable for its promises.
Without the New Hampshire Health Protection Plan, health outcomes will be poorer and we still pay for the costs of the uninsured. A stealth tax is still a tax that not only harms hard working families, it's also a tax on New Hampshire employers and jobs and this hurts us all.
State Sen. Jeb Bradley
- Category: Letters
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