CONCORD — The state's health care providers from hospitals to community health centers and from physicians to nurse practitioners turned out Tuesday to support the expansion of Medicaid eligibility under the Affordable Care Act.
At the Commission to Study Expansion of Medicaid Eligibility meeting, the state's health care providers said expansion is a critical step to transforming the state's health care system and will provide more appropriate health care for those now using very expensive emergency room services for their health care.
The commission has heard national and state experts over the last seven weeks, but Tuesday's meeting was reserved for the state's health care providers and the public to testify about Medicaid expansion. Several hundred people were at Representatives Hall, most to support expansion.
"I do not believe Medicaid expansion will solve the state's medical problems or the state's budget problems," said Claire Monier of Goffstown representing AARP-NH. "But I do believe it will help those 45 to 65 years old who do not qualify for Medicaid: those who lost their jobs and their health insurance."
The battle over expansion has fallen largely down partisan lines as Democrats favor expansion and Republicans oppose it.
Expansion is supported by Gov. Maggie Hassan and the Democratically-controlled House, while the Republican-controlled Senate said it needs far more information and time before deciding. In June, budget negotiators agreed to form the commission with a deadline of Oct. 15 to make recommendations.
A special session is likely to act on the recommendations before Jan. 1 when the federal government begins paying 100 percent of the cost of those newly eligible under expansion.
Americans for Prosperity released a statement calling attention to a Forbes analysis by columnist Avik Roy published Tuesday that says New Hampshire hospitals would lose millions with Medicaid expansion.
"According to the analysis, New Hampshire hospitals would stand to lose $228 million from 2014 to 2020 if Medicaid is expanded while overall, New Hampshire providers can expect to see a $45 million loss in net income if the expansion is approved," said Greg Moore, AFP-NH state director.
Several speakers at the meeting discredited the article, which claimed if New Hampshire decides to expand Medicaid, it would be impossible to avoid a sales or income tax.
The article states if Medicaid is expanded to include low-income adults, many with private insurance would be eligible for Medicaid, which pays health care providers much less than private insurers. But providers said the article is based on out-of-date assumptions.
Henry Lipman, chief financial officer of Lakes Region General Hospital, represented the New Hampshire Hospital Association.Over the last four years, he said hospitals have seen a dramatic increase in the uncompensated care for services they provide patients who cannot pay. That increase is not sustainable, he said, and drives up private insurers' premiums.
"A hospital emergency room is not the place to receive primary care, but an increasing number of people are doing just that," Lipman said. "Rather we should be encouraging people to get the right care, at the right time and the right place, and we believe Medicaid expansion will help us achieve that."
Concerns have been raised by some that expansion will stress the current primary care system, making patients wait longer for appointments. But Dr. Frederick Kelsey of Plymouth representing the NH Medical Society said "In a nutshell we have the capacity." He noted a survey by the society indicates the current system could handle 2.1 million patients, which is far more than the state's population.
Rep. Jack Flanagan, R-Brookline, lamented that health care costs have risen so high many people can no longer afford insurance or to pay for services. However, Medicaid expansion is not a panacea, he warned.
"I know there are genuine hardships, but I don't know where you can come up with the money" Flanagan said. "This may be the camel's nose under the tent to come up with an income tax."
If New Hampshire decides to expand Medicaid eligibility to 138 percent of the federal poverty level, state health and human service officials say that will add 49,000 people to the program over the next 7 1/2 years, while the federal government will pay $2.4 billion to health care providers. The state is expected to spend about $18 million for expansion over the period.
Under Medicaid expansion, the federal government would pay 100 percent of the cost for the first three years and then gradually reduce its share to 90 percent by 2014 and thereafter.