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NH HHS spending: What it's really about

Though you would not know it from the rhetoric coming from the governor's office and state Democratic Party headquarters, the Republican-led Senate Finance Committee proposes a higher level of general fund spending on the Department of Health and Human Services than the Democratic House approved. The rhetoric about dramatic "cuts" to HHS is just that, rhetoric.

As we pointed out last week, spending on HHS is very similar among all three proposed budgets: those of the House, the Senate Finance Committee, and Gov. Maggie Hassan. The Josiah Bartlett Center for Public Policy found that the total differences in general fund spending amount to a gap of 1.75 percent. The center noted that the biggest difference is in how much money each budget gives to state hospitals in the form of reimbursements for uncompensated care.

There is a long and complicated history to this reimbursement system. But the bottom line is that it is funded by Medicaid enhancement tax revenue that Gov. Maggie Hassan's office estimates to be very high in the next two years. The House figures that revenue will be lower, and the Senate Finance Committee pegged it lower still.

This year hospitals get $53 million in uncompensated care reimbursements. Gov. Hassan raises that to $159 million next year and $225 million in 2015. The House figures are $147 million and $172 million. The Senate Finance Committee's are $101 million and $52 million. These supposedly devastating Senate cuts amount to a $49 million increase next year, then a drop in 2015 to a whole $1 million below this year's level.

Ultimately, this is a debate about revenue, not spending. It certainly is not a debate about who cares more for the vulnerable.

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