October 21. 2013 9:40PM

Rep. Cindy Rosenwald: We have a good, compromise plan for NH Medicaid expansion


Last Tuesday, the bipartisan committee studying the expansion of health care coverage to low income adults and families issued a balanced recommendation that reflects reasonable compromise and cautious governance. As a member of the commission, I am proud that we were able to work together to find some common ground in a manner that maximizes health care access for our citizens and communities, strengthens our medical system and minimizes risk to the state budget.

Our recommendation to extend health insurance to nearly 60,000 low-income, working Granite Staters maximizes consumer choice and use of the private insurance market. New Hampshire is ahead of a number of other states in that we have already elected to make use of a system of care delivered through contracts with private managed care organizations. Consumers have a choice among plans, and the carriers have the experience in coordinating an often fragmented health care system that will result in efficiencies and savings.

In addition, our commission’s recommendation is to expand New Hampshire’s premium assistance program that keeps Medicaid-eligible individuals on insurance offered by their employer instead. Not only will this prevent people from dropping private insurance for Medicaid, but it will also allow them the stability of not needing to change doctors when their incomes fluctuate.

The commission’s recommendation is fiscally responsible as well, respecting the interests of New Hampshire taxpayers. We aim to begin the expansion as soon as possible to take maximum advantage of 100 percent federal funding for three years, providing a significant investment into our state’s health care infrastructure. The increased use of the premium assistance program is expected to save as much as $35 million in the current budget.

We will also protect the state’s financial risk, as we shift the risk to the private market through our managed care contracts. These contracts offer savings already incorporated in our current budget.

The commission recognized that, despite nearly 50 years of the federal government living up to its promised financial contribution to Medicaid, there are those who doubt the promised funding level for Medicaid expansion. Therefore we recommend a “trigger” to discontinue expansion if federal funding levels were to be reduced by Congress.

We will trust the commercial market to implement its own successful business models as long as we realize our expected efficiencies. Improved data collection, required by contract, will give both our department of health and human services and the carriers information on health outcomes as they are expected to be affected by prevention, access to primary care and coordination of health care.

The carriers have the opportunity to offer wellness incentives or cost-sharing requirements as appropriate. In any case, the risk is theirs in the managed care environment. The commission also recognized the potential value to encouraging the managed care companies to participate in the new marketplaces as early as 2015, increasing competition, broadening their attractiveness to more residents, and increasing stability of coverage. This is an innovative model being implemented in other states with potential benefit for us too.

Finally, the Medicaid Expansion Commission’s recommended pathway supports our health care providers. In decreasing the number of uninsured Granite Staters, we reduce the amount of uncompensated care delivered by our hospitals, health clinics and mental centers by a projected $117 million in this biennium alone. This is an enormous help for our critical health care safety net providers. Beyond reducing uncompensated care, the recommended expansion of the premium assistance program helps providers with commercial market reimbursement rates which have traditionally been higher than public payers such as Medicaid and Medicare.

Working hard over the past 3 1/2 months, we have agreed to a recommendation the way the public wants us to: by putting our heads together and listening to each other, across the aisle and across the other states. We have recommended a balanced, responsible approach to decreasing the rate of uninsured New Hampshire residents. As someone who worked on the House vision of Medicaid expansion last winter, it’s not where I expected to end up. We’ve made several compromises, resulting in a uniquely New Hampshire solution that I believe is better for our state and our communities.

Rep. Cindy Rosenwald is a Democratic state representative from Nashua.