HRA Comments on HB271 Expanding Medicaid

Democrats’ Medicaid Vote Today Dooms N.H. Taxpayers to Millions in New Expenses
Short-Term Payout Will Cost the State Long Term When Future Legislature Faces Revenue Shortfall
 
CONCORD, N.H.—With their hands recklessly reaching out for federal tax dollars with no regard for the consequences, New Hampshire House Democrats voted to doom the state to about $100 million per year in additional Medicaid costs starting at the end of the decade, according to Pam Tucker, co-chairman of the N.H. House Republican Alliance (HRA).
 
“New Hampshire voters should be aware that their State Legislature had an opportunity today to pass HB 271 and prevent millions of dollars of optional state Medicaid costs, but House Democrats couldn’t resist a short-term handout from Washington and voted to kill the bill,” Tucker said. “Because of this, more New Hampshire residents will be stuck with long lines and limited options for medical care under the expanded Medicaid system, and a decreasing number of New Hampshire taxpayers will have to spend more of their hard-earned dollars to cover the cost.”
 
Written in response to the U.S. Supreme Court’s ruling that Congress cannot force states to accept major expansions to optional federal programs, HB 271 would have prevented Obamacare’s Medicaid expansion provisions from taking hold in New Hampshire. Because it didn’t pass, about 62,200 more New Hampshire citizens are expected to enroll in Medicaid by 2020, which is the same year the state will have to pay more toward the expanded program that covers everyone who earns up to 138 percent of the federal poverty level. The expansion is expected to cost New Hampshire $15 million per year leading up to 2020, and then at least $50 million to $100 million per year thereafter.
 
If the federal government decides to reduce its promised grants for the expanded Medicaid program, as it has for its promised contribution to the special education program, the burden on New Hampshire taxpayers could be even more dramatic. For the special education program, federal contributions have hovered around 15 percent in most years despite the initial promise of 40 percent per year in 1975. Whether the Medicaid money materializes or not; however, N.H. taxpayers will be hit with higher costs of government with no measurable benefit to society at large.
 
“Perhaps hospitals will make more money as they pass the costs of this Medicaid expansion on to patients who use health insurance, and health insurance firms will benefit by raising their premiums, but don’t let anyone tell you that new Medicaid enrollees will be happy with the result of the Democrats’ vote today,” Tucker said. “Medicaid is a bare-bones medical payer system that is not accepted by some of the state’s providers. The expansion of this government-run program does nothing other than increase the costs of medical care for the meager benefit of a few. Ultimately, the cost of the expansion will destroy opportunities for job creation and stifle the economy.”
 
Due to political pressure from special interest groups and the dollars involved, it will be difficult for New Hampshire to opt-out of the Medicaid expansion once it is underway, but it will still be legally possible.
 
“The year 2020 is just around the corner, and New Hampshire already struggles to pay for the entitlement programs we have today,” Tucker said. “The 2014 election could be the last chance New Hampshire voters have of stopping this expense, but they have to be diligent in electing Republicans who will honor their oath to the state and federal constitutions and stand by the principles of limited government and liberty.”

NH House Republican Leader Comments on Defeat of Bill Prohibiting Medicaid Expansion

CONCORD – Today House Republican Leader Gene Chandler (R-Bartlett) offered the following reaction to the defeat of HB271, which would have prohibited New Hampshire from accepting expanded Medicaid. The bill was defeated by a vote of 206-155.

House Republican Leader Gene Chandler (R-Bartlett)

“There is no such thing as free money. Every federal dollar we would receive for Medicaid expansion would come out the pockets of hard working Americans for this government expansion. As we know from past experience, the Federal government cannot be trusted to uphold their end of the bargain. It’s very possible that federal funding levels will drop leaving New Hampshire tax payers on the hook for possibly hundreds of millions of dollars annually. Once New Hampshire enters into such a program, we cannot pull back coverage, even if it becomes unaffordable. We also know implementation of expanded Medicaid will involve tens millions of dollars in direct cost to the State. Expanded Medicaid undermines New Hampshire’s current and future fiscal health. HB271 would have prevented putting our State in this precarious situation.”

HRA comments on Expanded Medicaid

House Republican Alliance URGES N.H. House to Block Medicaid Expansion
HB 271 Would Save Taxpayers Millions and Prevent Further Government Dependency
 
CONCORD, N.H.—A bill up for a vote in the N.H. House tomorrow would block the expansion of Medicaid in New Hampshire under Obamacare, saving taxpayers millions of dollars and protecting thousands of residents from dependence on a failing system, according to Pam Tucker, co-chair of the N.H. House Republican Alliance.
 
HB 271 would seize a rare opportunity offered in the U.S. Supreme Court Obamacare decision that gave states an out from Obamacare’s Medicaid expansion provisions.
 
Proponents of Medicaid attempt to sell the expansion on the idea that the federal government would cover most of its cost up front, but New Hampshire taxpayers would be responsible for at least $15 million of the cost each year through 2019 and then up to $100 million per year after that—and that’s in a best-case scenario.
 
“When our state’s budget is stretched to its limit every two years even without this new entitlement, how is the Legislature going to come up with another $100 million each year without a new broad-based tax to pay for it?,” Tucker said. “Government has already grown so large that it impedes the growth of our state’s economy by taking money out of the hands of private-sector job creators. The new spending under a Medicaid expansion is the exact opposite approach we need to facilitate new jobs and get the state’s economy back on track.”
 
What’s worse, the Medicaid expansion could cost New Hampshire even more money if history repeats itself. There hasn’t been one year since Congress passed a special education law in 1975 that the federal government has given states the 40 percent contribution it promised. The federal contribution has only rarely risen above 15 percent, and the highest it ever reached was 32 percent.
 
“With Congress looking for more areas to cut spending in the next few years, its Medicaid contribution could easily become its next broken promise,” Tucker said. “Even with the federal government’s full contribution to an expanded Medicaid system, fewer New Hampshire residents will be supporting the failing system for even more people. What happens when there are no taxpayers left because no one can support the cost of their own medical care?”
 
Because Medicaid pays medical care facilities below their market rate for products and services, fewer facilities are accepting Medicaid as payment for service. That means the growing number of people with Medicaid due to the expansion would be forced into longer lines at fewer facilities with insufficient services at their disposal. At the same time, those facilities that do accept Medicaid would pass their losses on to patients who buy health insurance, which would continue to drive up the cost for medical care.
 
“There may be money on the table to pay for the Medicaid expansion up front, but even in a best-case scenario New Hampshire’s burden will be too great in just a few years,” Tucker said. “We urge the House to pass HB 271 on to the Senate to seize the rare opportunity to avoid another underfunded mandate from Washington.”

Governor Hassan Statement on Federal HHS Approval of Partnership Health Insurance Marketplace

Office of New Hampshire Governor Maggie Hassan

CONCORD – Following conditional approval today from the federal Department of Health and Human Services of a State-Federal Partnership health insurance marketplace, Governor Maggie Hassan issued the following statement:

“New Hampshire’s health insurance marketplace will help more Granite Staters access quality, affordable health coverage, and moving forward with a partnership marketplace is critical for preserving oversight at the state level in order to ensure that the health insurance offered to our citizens and businesses meets their needs. I thank Secretary Sebelius and HHS for their quick approval, and I look forward to working with the federal government and in collaboration with the state legislature to ensure that New Hampshire maintains flexibility and is protected financially as we work to maximize the resources available to improve the health of our people.”

Governor Hassan Moves Forward to Protect State Control of Health Benefit Marketplace

Office of New Hampshire Governor Maggie Hassan

Sends Letter to Federal Department of Health and Human Services Declaring Intent to Pursue Partnership Exchange

CONCORD – To best serve the health of New Hampshire’s individuals, families and businesses, Governor Maggie Hassan today sent a letter to the Federal Department of Health and Human Services declaring the state’s intent to pursue a federal-state partnership health benefit exchange, which would allow New Hampshire to maintain the most control possible at the state level and maximize federal health care dollars.

Each state is required under the federal Affordable Care Act to have a health benefit exchange: a virtual marketplace where individuals and small businesses can compare qualified health plans, find out if they are eligible for tax credits or health benefit programs, ask questions about coverage, and enroll in a qualified health plan that meets their needs. While states may establish their own exchanges, a 2010 New Hampshire law prevents action to build an exchange, forcing the state to either allow the federal government to create our exchange or to pursue a partnership exchange.

“I do not believe it is in the best interest of our people to allow the federal government to impose a one-size-fits-all exchange on New Hampshire,” said Governor Hassan. “Because of action taken by the last legislature, pursuing a partnership health benefit marketplace is the best option we have left to maintain control at the state level of health insurance coverage offered to our citizens and businesses. As the process moves forward, I will work with the federal government and in collaboration with the state legislature, to ensure that New Hampshire maintains flexibility and is protected financially. But we must make sure that we are maximizing the tools and resources available to help more New Hampshire families and businesses access quality, affordable health coverage.”

Without pursuing a partnership exchange, New Hampshire would be handing over to the federal government traditional state regulatory authority over insurance. This could include the authority to approve health insurance policies and rates, appeal rights, network adequacy, handling consumer complaints, and determining the relative roles of navigators and producers.

States interested in pursuing a federal-state partnership health benefit exchange are required to submit a letter of intent to the Federal Government by February 15.

The full text of the Governor’s letter to HHS Secretary Sebelius can be found below:

The Honorable Kathleen G. Sebelius

Secretary, U.S. Department of Health and Human Services

c/o CMS Center for Consumer Information and Insurance Oversight

200 Independence Avenue, S.W., Suite 739H

Washington, DC 20201

Dear Secretary Sebelius:

Under guidance issued by your office, states wishing to enter into a Partnership Exchange must submit a declaration letter signed by their governor stating that intention no later than February 15, 2013.  As Governor of New Hampshire, I ask that you accept this declaration of intent to participate in a State Partnership Exchange for both Plan Management and Consumer Assistance.  New Hampshire Insurance Commissioner Roger A. Sevigny will be the primary point of contact regarding our application. Nicholas A. Toumpas, the Commissioner of the New Hampshire Department of Health and Human Services, will be the point of contact on issues of Medicaid and CHIP eligibility determination and coordination.

New Hampshire’s legislature has set forth its goals for the Exchange, including: (1) promoting preservation of the private, commercial delivery of health coverage through carriers and producers to the greatest degree possible; (2) minimizing overhead and administrative expenses of the exchange; (3) promoting competition and consumer choice; and (4) preserving to the greatest extent possible the state's insurance regulatory authority and the state's flexibility in determining Medicaid eligibility standards, and program design and operation. Consistent with these objectives, the Legislature specifically created a Joint Health Care Reform Oversight Committee and directed the New Hampshire Insurance Department (NHID) and the New Hampshire Department of Health and Human Services (NHDHHS) to take action necessary to maintain the regulatory functions that they have traditionally performed. 

A Partnership Exchange is essential to preserving New Hampshire’s traditional regulatory authority over insurance carriers and producers, as well as its Medicaid program.  A Plan Management Partnership would allow New Hampshire to maintain its status as the primary regulator with respect to insurance products sold in New Hampshire on the Federally-facilitated exchange, including: producer and insurer licensing, form and rate approval, network adequacy, internal grievance standards, external review, and unfair trade practices. A Consumer Assistance partnership would involve both NHID and NHDHHS, and would have as its central component the regulation of Navigators that have been selected and funded through the Federally-facilitated Exchange.

Through NH RSA 420-N, the New Hampshire Legislature has directed both commissioners to exercise authority to regulate the operation of Navigators, as Navigators’ activities affect each commissioner’s respective sphere of responsibility. A Consumer Assistance partnership would also enable the state to develop its own consumer assistance model and in-person assistance program in a manner that would supplement, not supplant, existing insurance delivery and Medicaid application assistance systems in the state, as well as to clarify the role of insurance producers with respect to consumer assistance. A Consumer Assistance Partnership would enable New Hampshire to adhere to the legislative directive to preserve the existing health insurance delivery systems and minimize interference with insurance markets.

This letter of intent is provided with the understanding that the Memorandum of Understanding (MOU) governing the expectations, roles and responsibilities of the State of New Hampshire in a Partnership Exchange will not impose a cost on the state’s general fund or create new state programs. All partnership activities through the end of 2014, the critical time period for adoption of ACA-specific regulatory checklists, initial plan approval, and outreach and enrollment, would be funded by section 1311 Establishment Grant funds. Once this critical time period is over, the ongoing state regulation of Quality Health Plans (QHPs), QHP issuers, and Navigators would continue as part of the Insurance Department’s traditional regulatory activities. We further understand that a central tenet of the partnership concept is that partner states are not obligated to expend any funds beyond those awarded through federal grants, and that the partnership may be terminated without further obligation, beyond accounting for proper use of any grant funds that have been awarded. Finally, we understand that any product or service deployed in this state under any MOU will be subject to the regulatory authority of the State of New Hampshire.

This letter of intent is provided subject to any subsequent consent that may be required under state law with regard to implementation of the Partnership Exchange; including consent to any MOU between these agencies and CMS by the Joint Health Care Reform Oversight Committee established pursuant to NH RSA 420-N.

New Hampshire Governor Lynch indicated in December 2012 that New Hampshire was potentially interested in administering the reinsurance program for the state. The state has now determined that it will not operate the reinsurance program.

                                                                        With every good wish,

                                                            Margaret Wood Hassan

                                                                        Governor