Capital Comments: N.H. Medicaid and the new healthcare law

Capital Comments from State Senator Bob Odell

A constituent that I hear from periodically wants me to introduce a bill to nullify the new federal health care plan.  He writes, “Obama Care must be nullified within our state to eliminate the vast, new, unconstitutional powers over health care …”

In the days following the election, some legislators, government officials, stakeholders like insurance companies and health care providers and the media are focusing on the implications for New Hampshire of the Affordable Care Act, which even the President has said is appropriate to call Obama Care.   About 100 of them turned out last week at the Department of Health and Human Services headquarters to be briefed on the part of the new law dealing with Medicaid.

HHS Commissioner Nick Toumpas introduced the program explaining that while the U.S. Supreme found the new law constitutional, the federal government cannot force states to increase the number of people on Medicaid, the program that provides services to indigent people.  Commissioner Toumpas said policy makers, the legislature and the Governor need to determine whether or not we will expand the number of people on our Medicaid rolls.

After support for public schools, Medicaid is the next largest spending line in the budget.  To serve about 120,000 Medicaid eligible New Hampshire residents, the state spends $600 million annually that is matched by another $600 million from the federal government.

The attendees at the briefing sat in a theatre style room with fold up wooden desk tops that are reminiscent of school classrooms.  They were put to good use as there was plenty of feverish note taking.  Everyone knows this is serious, confusing and complex business for the state.

Money is always in the forefront.  Given the Supreme Court decision in June, the federal government cannot penalize states that do not expand their Medicaid rolls.  The act as passed would have cut the money currently going to states for their Medicaid program unless they expanded it.

States are now left with options of whether or not to expand the number of people covered by Medicaid and when and how to handle that expansion if a state wants to go forward.   There are impacts whether or not the state goes forward with expansion but Thursday’s meeting was limited to the impact on HHS annual budgets.

A second meeting and presentation will be held before year end on the impacts of expansion on our economy, health care providers, other state agencies and health insurers.

The Lewin Group study, paid for by contributions from not-for-profits organizations, made the presentation on the state’s options.  One option is not to expand saving the state an estimated $114 million from 2014 to 2020.  That looks good in the short term, but by not expanding New Hampshire will leave $2.5 billion in federal money on the table that would be paid for health care expenses for the state’s uninsured.

The Affordable Care Act has the federal government paying 100 percent of the costs of the new people added to the Medicaid rolls for three years beginning in 2014. The federal government share drops to 90 percent after that with the state responsible for 10 percent.  Over seven years, the state puts up an estimated $85 million and our health care providers like hospitals will get the $2.5 billion in federal money over and above what is currently paid.

The Lewin Group report estimates that 58,000 of the 113,000 eligible for Medicaid under the new law would enroll.  There are possibly 22,000 residents who will enroll in Medicaid even if the state does not expand its program because if they do not they will be subject to penalties for not being insured.  With more people insured, the plan is that people covered by Medicaid will be less likely to use expensive emergency room visits in place of visits with primary care physicians.

Governor-elect Maggie Hassan has supported Medicaid expansion under Obama Care for those who cannot afford insurance but says we need to wait for the rest of the Lewin Group report before moving forward.  It is assumed the House would be supportive of expansion, too, leaving the decision possibly in the hands of the 24 member Senate.  Nullification is likely not an option.

*****
Introduction of bills has started in the Senate.  And the Republican majority is committed to concentrating on legislation that will help job creation and encourage business growth.  Three bills have been introduced, which were supported by both parties in the last legislature, had been voted on favorably in the Senate but through legislative chicanery ended up derailed in the last session.

I have re-introduced my bill to double the state’s research and development tax credit and make it permanent, something the state’s business community solidly supports.  Governor Lynch supported it and Governor-elect Hassan was a strong supporter of this tax credit when she was a Senator.  And it had strong support in both Houses of the legislature last year.

My bill failed when the House added an abortion related amendment to it, an amendment with language the Senate had all ready rejected, and thus the Senate would not accept the bill with that amendment attached.

Senator Jeannie Forester (Meredith) has introduced a bill again to simplify our state interest and dividends tax statute and Senator Jeb Bradley (Wolfeboro) has introduced once more a bill to overhaul our out-of-date corporate business laws.

Sen. Bob Odell (R-Lempster) was re-elected on November 6th to his sixth term representing District 8:  Acworth, Antrim, Bennington, Bradford, Croydon, Deering, Francestown, Grantham, Goshen, Langdon, Lempster, New London, Newbury, Newport, Springfield, Stoddard, Sunapee, Sutton, Unity, Washington, Weare and Windsor.

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