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Sunday, April 8, 2012

Proposed bills address NH health care

CONCORD – The fate of the Affordable Care Act lies in the hands of the U.S. Supreme Court. Yet, before the justices issue their ruling, New Hampshire lawmakers are busy trying to get ahead of the health care reform bill, and other federal health programs.

New Hampshire lawmakers are considering a variety of proposals that would affect how the state implements the controversial health care law or prevent participation.

One bill would include New Hampshire in the federal lawsuit over the health care reform bill, which was heard last month in the Supreme Court, while another proposal would prohibit the state from implementing a state health care exchange.

The exchanges, a key provision of the federal law, serve as an insurance marketplace for businesses and consumers to shop for coverage plans. Under the act, the federal government will institute the exchange in states that have failed to launch their own by 2014.

“They’re trying to get us to voluntarily pay for their program that they’re going to force us to do anyway,” said Rep. Andrew Manuse, R-Derry, who sponsored the legislation.

Beyond these bills, however, yet another proposal, HB 1560, would allow New Hampshire to bypass the Affordable Care Act and other federal health care programs.

If it passes into law, HB 1560 could allow New Hampshire to join an interstate Health Care Compact, which would enable members to enact regulations that supersede federal health care law.

Supporters say the bill, which passed the House of Representatives last month, could allow state lawmakers to preserve health care coverage for seniors and other residents should Medicare and Medicaid falter at the federal level.

“This is seeking to get a conversation going in case something happens at the federal level,” said House Majority Leader D.J. Bettencourt, R-Salem, who sponsored the health care compact bill. “If we don’t have that conversation now, we’re going to put ourselves into a position … we’re not going to be prepared to deliver services to our seniors.”

But, health care advocates argue that such a measure could allow state lawmakers to ignore federal mandates and cut back on medical coverage for some of the state’s most vulnerable residents.

If it passes the state Senate, the bill would require federal approval from both houses of Congress to go into effect.

“This could take away all the guarantees and securities people have in regard to their medical care,” said Lisa Kaplan Hose, policy director at N.H. Voices for Health, a statewide health care consumer and advocacy organization.

“You’re talking about people who are relying on Medicare or Medicaid, who could see their benefits drastically change or completely go away,” she said. “The consequences could be drastic.”

Meaningful or broken?

Interstate compacts, permitted under the U.S. Constitution, typically address transportation and infrastructure, among other matters, between states. But, over the last several years, lawmakers in six different states have passed the health care agreements.

The compacts, which require federal approval, are not likely to go before Congress until after the November elections. But, if they pass into law, state legislators could use federal money, accepted in one lump sum through a block grant, to implement their own health care programs.

Such local control could enable lawmakers to better control costs and to provide alternatives to the federal programs, which have mounted a $1 trillion liability, supporters said.

“There is no doubt our current health care system is on an unsustainable path,” Sen. Chuck Morse, R-Salem, wrote this winter in a prepared statement. “However, opponents of meaningful reform routinely dismiss innovative ideas like this one out of hand in favor of propping up a broken system.”

Still, opponents fear federal funding would not meet the medical needs of New Hampshire residents.

Under the legislation, the funding awarded to New Hampshire would be based on a cost-of-living equation rather than on actual medical need, and this could leave lawmakers facing significant deficits, according to Tom Bunnell, director of the Health Policy Institute at the University of New Hampshire School of Law.

To bridge the gap, lawmakers, no longer bound by federal requirements, could then cut back on health programs or services, Bunnell said, or they could raise the eligibility requirements for state residents, leaving them without care.

Currently, about 220,000 state residents are enrolled in Medicare and 130,000 are on Medicaid.

“Basically, Medicare could be subject to the whim of the legislature,” said state Rep. Cindy Rosenwald, D-Nashua, former chair of the House Health and Human Services committee. “That could have a heavy effect on our most senior residents.”

Even more damaging, lawmakers may not be required to use the federal money for health care and could direct it to other areas.

The exchange proposal doesn’t include specific details about the health care services state officials would implement in place of the federal programs.

A House committee recommended that the legislation be held up for further study, but lawmakers moved the proposal forward.

It’s set to be considered in the Senate over the coming weeks.

“This bill is completely scant of how the legislature would go about doing this,” said Jeff Dickinson, advocacy director at Granite State Independent Living, a Concord-based social service agency that works with people with disabilities.

“What will (the programs) look like if the state were to go this route?” Dickinson asked. “It’s really irresponsible to the citizens of the state.”

Questioning the quality

Other bills facing the Legislature have prompted further questions about the quality of care at state medical centers, according to health care advocates.

Republican lawmakers have introduced a pair of bills proposing to alter or eliminate the certification process for state hospitals.

The bill sponsors introduced the legislation earlier this year, promising to build up the medical industry in the state by bringing jobs and economic investment by repealing the certification process.

“We have a regulatory process in place which stifles competition and prevents new entries, specifically specialty care centers,” said Rep. Marilinda Garcia, R-Salem, sponsor of HB 1642, which proposes to exempt for-profit, specialty hospitals from the certification process.

Garcia introduced the bill after learning that one group, the Cancer Treatment Center of America, was considering bringing a specialty care hospital to Salem. The project could bring with it as many as 500 jobs and more than $5 million for the local economy, she said.

“I welcome providing more options for specialty care in New Hampshire,” Garcia said.

But, medical providers across the state fear the legislation could come at a steep cost for hospitals and patients alike.

Many for-profit medical centers serve only patients with full private insurance coverage, opponents said. In New Hampshire, this would leave traditional community hospitals to serve those patients on Medicare or Medicaid, who are unable to pay for their own medical care, according to Steve Ahnen, president of the N.H. Hospital Association.

This would force hospitals to absorb any costs not covered by the federal programs, Ahnen said – possibly at the cost of other hospital programs or services.

Currently, Medicare reimburses about 82 percent of charges billed, while Medicaid reimburses about 52 percent.

“Every hospital in the state of New Hampshire takes care of patients without regard to pay or without regard to the insurance they have,” Ahnen said Friday. “But, (these for-profit institutions) say they can’t be all things to all people. … That’s a very dangerous precedent to set.”

To prevent this “cherry-picking” of patients, authors of HB 1642 included a provision that would require 65 percent of patients served in the specialty centers to come from out-of-state. “I’m sorry, but if that (remaining 35 percent) is going to cause our hospitals to collapse, we’ve got bigger problems,” Garcia said.

But, with hospital budgets already crunched, those numbers can add up quickly, according to Frank McDougall, vice president of government affairs at Dartmouth-Hitchcock Medical Center.

Last year, Dartmouth-Hitchcock served 88,000 Medicaid patients, taking a loss of more than $60 million, McDougall said last week. Further loss of privately insured patients could force the hospitals to cut back on services available.

“It threatens our mission,” McDougall said. “We take all patients regardless of their ability to pay, and now we’re taking the biggest whack. How backwards is this? … It’s absolutely tragic.”

Jake Berry can be reached at 594-6402 or