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NH Democrats rip into Republicans’ alternative plan to expanding Medicaid

State House Bureau

September 12. 2013 10:49PM

CONCORD — Democrats Thursday blasted an alternative plan to expanding Medicaid, saying it will cost the state more money, cover fewer people and provide inadequate coverage.

Republicans responded by saying the proposal needs more work and Democrats are using the scant details of the plan to scare people instead of trying to reach compromise.

“This isn’t really a plan at all,” said Senate Minority Leader Sylvia Larsen, D-Concord. “It would cost our state almost $3 billion more, only covers one quarter of the uninsured people that Medicaid includes, would give very poor coverage to those people, and that poor coverage would cost these folks more than half of their annual income so they could never afford it anyway.”

Avik Roy of the Manhattan Institute for Policy Research, who proposed the plan, told the Medicaid expansion study commission Tuesday that for $46 million a year, the state can provide an alternative to Medicaid expansion.

The state would provide catastrophic insurance to about 23,000 adults who would be eligible under Medicaid expansion, and set up a primary physician network that would be paid $100 a month per patient for basic health care and preventative services.

The plan would require co-payments and would have a $6,000 deductible, some of which would be subsidized through health savings accounts.

Larsen said that plan “makes no sense.”

But Senate President Chuck Morse, R-Salem, who Tuesday called the plan a real opportunity for a New Hampshire solution, said Thursday the proposal was a different option to be discussed although work remains to be done.

“But no plan exists yet, and claims of unrealistically high deductibles and co-payments are nothing but scare tactics being used by an opposition party unwilling to consider any alternatives to their government run health care plan,” Morse said.

He said both Republicans and Democrats want the same thing: increasing access to health care for the state’s low-income population, but the two parties disagree on how to do that.

Republicans want to explore using private insurance to cover some of those eligible under expansion.

“I expect the bipartisan Medicaid Commission will give a private insurance alternative equal treatment in their deliberations over the coming week,” Morse said. “Those conversations will help us understand if this is an option that will work for New Hampshire patients, providers, and taxpayers.”

But Morse said he would like Democrats to tone down their rhetoric so there is an open and honest discussion of the complex issue.

Democrats said the Roy plan puts too high a burden on the state’s poor, requiring those earning $12,000 a year to spend more than half of their salary on health care before they receive basic services.

“These are working people. They are people with low incomes. These are wait staff, janitors, school bus drivers, hairstylists, teachers’ aides, grocery store clerks, construction workers, and landscapers,” said House Majority Leader Steve Shurtleff, D-Concord. “These are taxpayers. They are playing by the rules and they deserve access to high quality, comprehensive coverage that they can actually afford.”

Tess Stack Kuenning, Bi-State Primary Care Association President and CEO, said the proposal leaves a huge gap between serious catastrophic coverage and basic coverage. The proposal does not cover medications, day surgery, treatment for chronic conditions or mental health services, she said.

The coverage would be far worse than private insurance or Medicaid or Medicare, Kuenning said.

Larsen said Democrats are willing to compromise and have already, agreeing to a managed care program for Medicaid.

She said Democrats are willing to talk about expanding the existing Health Insurance Premium Program, which pays the premium for existing private employer provided coverage.

But she said the Roy proposal is not acceptable and she hopes to convince several Republicans to join the Democrats and defeat the plan if it comes to a vote.

She said the state will lose $1 million a day in federal Medicaid money after Jan. 1 if the state rejects expansion.

Larsen said she believes Morse wants to find a compromise that will work.

“We look forward to continuing to work with them to find the right approach to bringing in these federal funds, helping our state economy, growing jobs, and giving people access to affordable, high-quality coverage,” Larsen said.

The Medicaid Expansion Commission meets twice next week to begin discussions on expanding the program under the Affordable Care Act.

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