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NH Senate Republicans Issue Statement on Medicaid Expansion Commission Work

The New Hampshire Senate

Republican Majority Office

Concord, NH – Senate President Chuck Morse (R-Salem) and Senate Majority Leader Jeb Bradley (R-Wolfeboro) issued the following statement today in response to Medicaid Expansion Commission as they begin to put together their recommendations:

Senator President Chuck Morse said, “We appreciate the commission’s hard work to date.  However, simply adding more people to the existing Medicaid program on January 1 is not an option that is financially sustainable and affordable to hard working New Hampshire families in the long term. 

‘We share the goal of providing better access to affordable healthcare coverage for low-income New Hampshire citizens.  The recent approval of an Arkansas Medicaid waiver shows us we can move to a private insurance option quickly in a way that works for New Hampshire. We look forward to developing a bipartisan New Hampshire solution with private insurance.”

Senate Majority Leader Jeb Bradley said, “Senate Republicans continue to be concerned with a Washington driven Medicaid plan that totally depends upon a very uncertain federal funding promise of 90% funding. Given our nation’s $17 trillion deficit, New Hampshire taxpayers cannot afford a Washington promise that is likely to prove unsustainable. New Hampshire taxpayers are all too familiar with Washington's broken special education promises.  We cannot afford to repeat that with Medicaid Expansion.” 


NHSenateRepublicanCaucus - ICYMI: Lower Health Insurance Premiums to Come at Cost of Fewer Choices

Senator Sanborn and the CEO of Monadnock Community Hospital were recently quoted in a NYT article on fewer choices for consumers with restricted healthcare networks.
Lower Health Insurance Premiums to Come at Cost of Fewer Choices
Published: September 22, 2013
WASHINGTON — Federal officials often say that health insurance will cost consumers less than expected under President Obama’s health care law. But they rarely mention one big reason: many insurers are significantly limiting the choices of doctors and hospitals available to consumers.
From California to Illinois to New Hampshire, and in many states in between, insurers are driving down premiums by restricting the number of providers who will treat patients in their new health plans.
When insurance marketplaces open on Oct. 1, most of those shopping for coverage will be low- and moderate-income people for whom price is paramount. To hold down costs, insurers say, they have created smaller networks of doctors and hospitals than are typically found in commercial insurance. And those health care providers will, in many cases, be paid less than what they have been receiving from commercial insurers.
Some consumer advocates and health care providers are increasingly concerned. Decades of experience with Medicaid, the program for low-income people, show that having an insurance card does not guarantee access to specialists or other providers.
Consumers should be prepared for “much tighter, narrower networks” of doctors and hospitals, said Adam M. Linker, a health policy analyst at the North Carolina Justice Center, a statewide advocacy group.
“That can be positive for consumers if it holds down premiums and drives people to higher-quality providers,” Mr. Linker said. “But there is also a risk because, under some health plans, consumers can end up with astronomical costs if they go to providers outside the network.”
Insurers say that with a smaller array of doctors and hospitals, they can offer lower-cost policies and have more control over the quality of health care providers. They also say that having insurance with a limited network of providers is better than having no coverage at all.
Cigna illustrates the strategy of many insurers. It intends to participate next year in the insurance marketplaces, or exchanges, in Arizona, Colorado, Florida, Tennessee and Texas.
“The networks will be narrower than the networks typically offered to large groups of employees in the commercial market,” said Joseph Mondy, a spokesman for Cigna.
The current concerns echo some of the criticism that sank the Clinton administration’s plan for universal coverage in 1993-94. Republicans said the Clinton proposals threatened to limit patients’ options, their access to care and their choice of doctors.
At the same time, House Republicans are continuing to attack the new health law and are threatening to hold up a spending bill unless money is taken away from the health care program.
In a new study, the Health Research Institute of PricewaterhouseCoopers, the consulting company, says that “insurers passed over major medical centers” when selecting providers in California, Illinois, Indiana, Kentucky and Tennessee, among other states.
“Doing so enables health plans to offer lower premiums,” the study said. “But the use of narrow networks may also lead to higher out-of-pocket expenses, especially if a patient has a complex medical problem that’s being treated at a hospital that has been excluded from their health plan.”
In California, the statewide Blue Shield plan has developed a network specifically for consumers shopping in the insurance exchange.
Juan Carlos Davila, an executive vice president of Blue Shield of California, said the network for its exchange plans had 30,000 doctors, or 53 percent of the 57,000 doctors in its broadest commercial network, and 235 hospitals, or 78 percent of the 302 hospitals in its broadest network.
Mr. Davila said the new network did not include the five medical centers of the University of California or the Cedars-Sinai Medical Center near Beverly Hills.
“We expect to have the broadest and deepest network of any plan in California,” Mr. Davila said. “But not many folks who are uninsured or near the poverty line live in wealthy communities like Beverly Hills.”
Daniel R. Hawkins Jr., a senior vice president of the National Association of Community Health Centers, which represents 9,000 clinics around the country, said: “We serve the very population that will gain coverage — low-income, working class uninsured people. But insurers have shown little interest in including us in their provider networks.”
Dr. Bruce Siegel, the president of America’s Essential Hospitals, formerly known as the National Association of Public Hospitals and Health Systems, said insurers were telling his members: “We don’t want you in our network. We are worried about having your patients, who are sick and have complicated conditions.”
In some cases, Dr. Siegel said, “health plans will cover only selected services at our hospitals, like trauma care, or they offer rock-bottom payment rates.”
In New Hampshire, Anthem Blue Cross and Blue Shield, a unit of WellPoint, one of the nation’s largest insurers, has touched off a furor by excluding 10 of the state’s 26 hospitals from the health plans that it will sell through the insurance exchange.
Christopher R. Dugan, a spokesman for Anthem, said that premiums for this “select provider network” were about 25 percent lower than they would have been for a product using a broad network of doctors and hospitals.
Anthem is the only commercial carrier offering health plans in the New Hampshire exchange.
Peter L. Gosline, the chief executive of Monadnock Community Hospital in Peterborough, N.H., said his hospital had been excluded from the network without any discussions or negotiations.
“Many consumers will have to drive 30 minutes to an hour to reach other doctors and hospitals,” Mr. Gosline said. “It’s very inconvenient for patients, and at times it’s a hardship.”
State Senator Andy Sanborn, a Republican who is chairman of the Senate Commerce Committee, said, “The people of New Hampshire are really upset about this.”
Many physician groups in New Hampshire are owned by hospitals, so when an insurer excludes a hospital from its network, it often excludes the doctors as well.
David Sandor, a vice president of the Health Care Service Corporation, which offers Blue Cross and Blue Shield plans in Illinois, Montana, New Mexico, Oklahoma and Texas, said: “In the health insurance exchange, most individuals will be making choices based on costs. Our exchange products will have smaller provider networks that cost less than bigger plans with a larger selection of doctors and hospitals.”
Premiums will vary across the country, but federal officials said that consumers in many states would be able to buy insurance on the exchange for less than $300 a month — and less than $100 a month per person after taking account of federal subsidies.
“Competition and consumer choice are actually making insurance affordable,” Mr. Obama said recently.
Many insurers are cutting costs by slicing doctors’ fees.
Dr. Barbara L. McAneny, a cancer specialist in Albuquerque, said that insurers in the New Mexico exchange were generally paying doctors at Medicare levels, which she said were “often below our cost of doing business, and definitely below commercial rates.”
Outsiders might expect insurance companies to expand their networks to treat additional patients next year. But many insurers see advantages in narrow networks, saying they can steer patients to less expensive doctors and hospitals that provide high-quality care.
Even though insurers will be forbidden to discriminate against people with pre-existing conditions, they could subtly discourage the enrollment of sicker patients by limiting the size of their provider networks.
“If a health plan has a narrow network that excludes many doctors, that may shoo away patients with expensive pre-existing conditions who have established relationships with doctors,” said Mark E. Rust, the chairman of the national health care practice at Barnes & Thornburg, a law firm. “Some insurers do not want those patients who, for medical reasons, require a broad network of providers.”
A version of this article appears in print on September 23, 2013, on page A1 of the New York edition with the headline: Lower Premiums To Come At Cost Of Fewer Choices.


NHDP - ICYMI -- NHFPI: Roy Proposal A Poor Alternative to Medicaid Expansion 

Key Point: "The proposal recently offered before the New Hampshire Medicaid Commission would cover far fewer people than the program expansion New Hampshire is now considering, would impose unaffordable out-of-pocket costs on participants in the proposal, and would forgo the economic and fiscal benefits of accepting billions of dollars in federal funds."

NH Fiscal Policy Institute: Roy Proposal A Poor Alternative to Medicaid Expansion 
Posted September 16, 2013

In recent testimony before New Hampshire’s Commission to Study Expanded Medicaid Eligibility, Avik Roy, a Senior Fellow at the Manhattan Institute for Policy Research, presented an alternative to expanding Medicaid under the Affordable Care Act.  While many of the details of the plan remain unknown, it seems likely that it would cover far fewer people than the expansion New Hampshire is now considering, would impose unaffordable out-of-pocket costs on participants, and would forgo the economic benefits of accepting billions of dollars in federal funds.  Even those elements of the proposal that might be viewed as positive – such as its acknowledgement of the importance of primary care and efforts to incorporate cost-sharing – are poorly deployed.  Consequently, the Medicaid Commission should not include the proposal among its recommendations when it reports to the Legislature next month. The Basic Elements of the Roy Proposal

Under the Affordable Care Act (ACA), states may accept federal funds to pay for the overwhelming majority of costs related to providing Medicaid coverage to adults with incomes under 138 percent of the federal poverty level (FPL), beginning in January 2014.  States can, in some instances, use those funds to pay premiums for private sector health insurance, whether sponsored by an employer or purchased on the individual insurance market, rather than for Medicaid coverage.

Under the Roy proposal, New Hampshire would reject all such federal funds and instead use only its own budgetary resources to provide health coverage to some of the individuals who would otherwise be eligible for the newly-expanded Medicaid program.  In particular, the Roy proposal would extend only to uninsured adults with incomes below the federal poverty level.  Adults with incomes between 100 and 138 percent of the FPL would be required to find insurance elsewhere, presumably the Insurance Marketplace where subsidies would be available.

Moreover, the health coverage available under the Roy proposal would be quite limited.  The proposal calls for New Hampshire to build an insurance policy that would provide catastrophic coverage as well as a network of providers who would agree to accept a monthly retainer, approximately $100 per enrollee per month, to be essentially on call for any enrollees. [i],[ii] Importantly, this latter element, known as concierge medical service, does not typically cover some of the most fundamental components of health care, such as prescriptions, surgery, hospitalizations, some technological diagnostic procedures like MRIs, mental health care, or substance abuse treatment.  The catastrophic coverage envisioned by the Roy proposal would entail a $5,950 deductible for any needed non-concierge services as well as an enrollment fee of $412 per person.  Finally, anyone who failed to meet a two-year work requirement would be ineligible to participate in the Roy plan.

Reduction in Uninsured Would Be Significantly Lower Than in Other Scenarios

A report issued earlier this year by The Lewin Group projects that, if New Hampshire were to move forward with the Medicaid expansion as included in the ACA, 58,000 of approximately 100,000 newly eligible New Hampshire adults would participate by 2020.  Of that group, roughly 37,900 are currently uninsured, while the remaining 20,500 enjoy some form of insurance.[iii] Based on that same report, New Hampshire’s Department of Health and Human Services estimated in July that about 63,000 newly eligible adults would join Medicaid under the expansion, with approximately 46,000 uninsured and 17,000 currently insured participating.[iv]

Reduction in Uninsured Would Be Significantly Lower Under Roy Proposal

In contrast, figures accompanying Roy’s testimony before the Medicaid commission suggest it would cover 11,150 of the currently uninsured, due, in part, to the proposal’s work requirement.  In other words, the Roy proposal would cover 71 percent fewer uninsured than the Lewin Group initially estimated and 76 percent fewer uninsured than DHHS projects.

Out-of- Pocket Costs and Minimal Coverage Would Leave Recipients Underinsured       

As noted, the Roy proposal would impose a $5,950 annual deductible on each participant and an enrollment fee of $412 per person.[v]  To put those sums in perspective, the average deductible for an individual in the group market in New Hampshire was $1,393 in 2011.[vi]  The national average deductible for an individual in the non-group market in 2011 was $2,935.[vii]   Assuming that each individual taking part in the Roy proposal earns less than the federal poverty level of $11,490, the out-of-pocket costs assumed could represent 55 percent or more of annual income for these participants.  This would leave recipients underinsured, which is frequently defined as contributing 10 percent or more of annual income towards health insurance costs.

To put the scale of this cost-sharing into further perspective, under the Medicaid expansion envisioned in the ACA, cost-sharing in the form of deductibles, co-insurance, and co-payments is allowed so long as it is generally no more than five percent of household income.[viii]  For an individual with income of $11,490, five percent of household income is $575.  However, neither the Lewin Group’s assessment nor NH DHHS’ projections assume any additional cost-sharing devices beyond those currently used by NH Medicaid.[ix]

While cost-sharing may be an attractive component of a Medicaid expansion, if it is bluntly and aggressively applied to all services, it may be counter-productive.  Even nominal cost-sharing can deter the use of health care by low-income people.[x]  This, in turn, may lead to reduced utilization because the cost-sharing reduces the use of care -  even effective and essential care  – as well as optional care.[xi]  Unless cost-sharing is deployed strategically around only those services with the lowest value, it may well backfire and result in higher costs, rather than smart use of health care resources.

Roy Proposal Would Leave Billions in Federal Funds on the Table

The Roy proposal presumes that New Hampshire does not accept the federal dollars available to it to extend health insurance to low-income residents.  The Lewin Group projects that New Hampshire would receive a total of up to $2.5 billion in federal Medicaid payments between 2014 and 2020 if it were to move forward with the expansion.  As a result of these federal dollars, New Hampshire would experience increases in gross state product, personal income, and employment.  Under an expanded Medicaid program, health care providers of all stripes will see significant decreases in bad debt and charity care costs.  In its report, the Lewin Group makes it plain that:  “the ACA significantly boosts NH’s economy and revenues, and Medicaid expansion maximizes these economic and fiscal impacts.”[xii]

If the Roy proposal were enacted as an immediate substitute for the Medicaid expansion in 2014, New Hampshire would incur an annual General Fund cost of $46 million, without reaping any of the economic benefit of federal dollars coming into its economy.[xiii]  What’s more, the state would be unlikely to realize other expenditure or revenue offsets elsewhere in the budget, offsets that would be generated specifically by expanding Medicaid coverage.  Forgoing the Medicaid expansion would also significantly affect the managed care organizations (MCOs) hired to administer New Hampshire’s Medicaid program.  The MCOs would not receive any of the business associated with the Medicaid expansion that was anticipated in the third agreement year of the original contracts.  At a minimum, those contracts will have to be renegotiated and the savings desired from that initiative would be at risk.


The proposal recently offered before the New Hampshire Medicaid Commission would cover far fewer people than the program expansion New Hampshire is now considering, would impose unaffordable out-of-pocket costs on participants in the proposal, and would forgo the economic and fiscal benefits of accepting billions of dollars in federal funds.  Even those elements of the proposal that might be viewed as positive – such as its acknowledgement of the importance of primary care and efforts to incorporate cost-sharing – are poorly deployed.  Consequently, the Commission should not include the proposal among its recommendations when it reports to the Legislature next month.


[i] As defined in the ACA, a catastrophic plan covers essential health benefits, but only after out-of-pocket cost-sharing reaches a high deductible that will match the level of the ACA’s required out-of-pocket maximum. In 2014, it is anticipated that threshold will be $6,400 for self-only coverage and $12,800 for family coverage.  In 2014, catastrophic plans can be offered both on and off the Exchange.  Catastrophic plans may only be offered to individuals who are under age 30 before the plan year begins, have received a certification from the Marketplace that they are exempt from the individual mandate because they do not have an affordable coverage option, or because they qualify for a hardship exemption.  No subsidies are available for such products.

[ii] If the proposal is read less generously, then even primary care services would be unavailable until after the deductible was paid, leaving many recipients without any actual access to care.

[iii] The Lewin Group estimates 37,919 uninsured and 20,513 currently insured with minor disenrollments in a variety of other categories.  The Lewin Group does not directly address the likely behavior of the remaining 42,000 eligible non-participants.

[iv] NH DHHS projects 45,794 uninsured and 16,996 currently insured, with minor disenrollments in a variety of other categories.

[v] Again, if the proposal is read less generously, then even primary care services would be unavailable until after the deductible was paid, leaving many recipients without any actual access to care.

[vi] Agency for Healthcare Research and Quality, Center for Financing, Access and Cost Trends, 2003 and 2011 Medical Expenditure Panel Survey Insurance Component.

[vii] National Institute for Health Care Management, Spending for Private Health Insurance in the United States, Data Brief, Figure 6, pp. 8, January, 2013.

[viii] Social Security Act, §1916(A)(b)(1)(B)(ii) and 42 CFR §447.56.  Premiums are permitted for some Medicaid beneficiaries with income above 150 percent of the federal poverty level.

[ix] New Hampshire Medicaid currently employs $1 co-pays for prescriptions.  Premiums are paid by employed adults with Medicaid with incomes above 150 percent FPL.

[x] Premiums and Cost-Sharing in Medicaid:  A Review of Research Findings, Kaiser Family Foundation, February 2013

[xi] Ibid.

[xii] Lewin Group PowerPoint presentation, slide 41, January 11, 2013.

[xiii] If the state defers the implementation of the Roy proposal until 2022, it would be rejecting any coverage for the low-income uninsured until such time.  This effectively leaves at least 22,300 people uninsured over the next 8 years.  If the state then instituted the proposal in 2022, New Hampshire could face financial exposure beyond $46 million per year, since the substantial majority of the would-be Medicaid eligibles have income below the poverty level.  Thus, any loss of health insurance experienced by this population in the intervening 8 years would increase the number of people who are eligible for the program.  In addition, the economic benefit of reduced bad debt and charity care that all providers would have experienced under the Medicaid expansion will largely be erased.

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NH Republican Caucus - Sen. Morse Secures Unanimous Republican Support for Senate Presidency

The New Hampshire Senate

Republican Majority Office

Looks forward to conversations with Senate Democrats ahead of next week’s vote

Concord, NH – Senate Finance Chairman Chuck Morse (R-Salem) has secured the unanimous support of the 13-member Republican Caucus in his bid to become the next Senate President.  A simple majority of the Senate’s 24 members is required to elect a successor to Senate President Bragdon when the body meets on September 3rd.

Senate Republicans met on Tuesday morning to discuss selecting a new Senate President.  Following the caucus, Sen. Morse said:  “I am honored to have the unanimous support of my fellow Republican Senators.  As under the leadership of President Bragdon, our caucus remains committed to responsibly managing state government while enacting policies that will encourage job growth and improve our economy.  I am humbled the caucus has entrusted me to lead as we continue those efforts.” 

“In the days ahead I look forward to talking with members of the Democratic Caucus in order to gain their support ahead of the Senate meeting next week,” continued Sen. Morse.  “As our work over the last year has shown us, there is much more that unites us than divides us, and by seeking to expand those areas of agreement, and reiterating my pledge to lead the Senate in an open, honest, and transparent manner, I am confident I can earn their votes next Tuesday.”

Senate Majority Leader Jeb Bradley (R-Wolfeboro) said:  “As a small business owner, Sen. Morse understands how to manage and how to meet a payroll.  Equally as important, he understands the challenges facing our economy – its employers and its employees – and has a proven track record of championing legislation to ease those burdens and make New Hampshire a better place to live and work.  Those qualities, along with his unquestioned integrity and work ethic, make Sen. Morse the right person to lead the Senate at this important time.” 

Sen. Bradley continued, “It has been a true pleasure working with President Bragdon over the last three years.  All of us have appreciated his steadfast leadership, his commitment to ethics, and his sincere friendship during his time as Senate President.  I look forward to working with Sen. Morse as he fills the big shoes President Bragdon is leaving behind.”

Senate President Bragdon has announced he will call the Senate back into session on Tuesday, September 3rd at 10:00am in order for him to officially step down from his position and to give members the opportunity to elect a new president.


Republican Party of NH - Weekly Newsletter

The NHGOP is doing everything in its power to protect the integrity of Granite State ballot boxes, but in order for us to keep up the fight, we need additional resources. Signing up for our Grassroots Giver program today will keep us working to stamp out the drive-through voting that is happing in our state and diluting our elections.


The NHGOP is there for us and our GOP officials all year long. Will you be there for the NHGOP? Sign up here to join our Grassroots Giver Program at $20 a month or $10 a month.


In addition to our sincerest thanks, Grassroots Givers also enjoy special programs and opportunities throughout the year. Please consider joining today!


Best Wishes, 


An Evening with Gov. Mitt Romney


Romney GOP Invite


Please note- General Admission tickets are sold out.



NHGOP Reception featuring Sen. Ted Cruz





Nashua Republican City Committee 2013 Steakout


ICYMI: UL (8/2): NHGOP legislators take credit for balanced budget, no fee hikes

Republican legislative leaders took much of the credit for what they said was a balanced budget that funds the state's needs without new or increased taxes.

A GOP "budget roundtable" organized by the New Hampshire Republican State Committee at Manchester City Hall was aimed at "talking about the positive aspects of the budget," said Senate Majority Leader Jeb Bradley, R-Wolfeboro, "how we protected taxpayers, didn't raise a single fee or tax and how we lived within our means and did so while meeting the needs of the state and a way that should allow for economic growth. "In typical Live Free or Die fashion," Bradley said, "people came together."



See the full story in the Union Leader here.

Restoring Trust in Government Dinner


Cheshire County GOP Picnic


You are invited to the Cheshire County GOP Picnic & BBQ


Sunday, Aug 4th
Wheelock Park, Keene


Bring friends and family to enjoy the summer weather, hamburgers, hot dogs, and meet some potential candidates!


RSVP to or (603) 363-9391