The American Health Care Act, the replacement for the Affordable Care Act proposed by House Speaker Paul Ryan, would be a disaster for New Hampshire. Because doctrinaire Republican conservatives hate it and Republican governors and members of Congress in states that benefit under Obamacare do too, the bill is unlikely to pass. But if it or something similar did become law, New Hampshire would fare worse than most states.
Ryan’s bill would drastically reduce federal Medicaid funding by shifting the cost to states, albeit over several years. The lion’s share of Medicaid money is spent to care for the elderly, particularly those in nursing homes or on home health care. New Hampshire, demographically, is tied with Vermont as the second oldest state in the nation, behind Maine. In 2012, before the expansion of Medicaid under Obamacare, New Hampshire spent just under $1.2 billion on the program that pays for health care for low-income, elderly and disabled adults. Half of that comes from the feds, half from the state.
Shifting a substantial portion of Medicaid expenses to the state would mean one of two things: Thousands of people, most of them mothers with young children, would have to be kicked off Medicaid and waiting lists created for nursing home care or taxes would have to go up. Lawmakers probably couldn’t wring all that much more out of existing taxes so they would have to look to a broad-based tax.
New Hampshire, per capita, has one of the most serious opioid addiction problems in the nation. As the New Hampshire Hospital Association points out, downshifting federal costs to the state would undermine the Medicaid expansion that added 48,000 residents to the rolls of the insured. Many of them would lose coverage under plans put forth by House Republicans. Medicare expansion is the primary source of funding for the substance abuse treatment programs created to combat the opioid crisis.
More than one-third of the state’s residents are over age 50. They would pay more under the Ryan plan, a lot more. Federal subsidies under the Affordable Care Act are based on age, income and the cost of health care in the area. The Ryan plan, which has the support of President “Nobody Knew Health Care Could Be So Complicated” Trump, replaces the subsidies with tax credits that are much less generous.
The maximum tax credit for seniors would be $4,000, twice the amount of the credit for the young. But, while insurers are currently allowed to charge older buyers no more than three times the rate charged young, healthy buyers, the Ryan plan raises the limit to five times the rate charged youths.
“It is sending seniors a two-foot rope to get themselves out of a 10-foot hole,” Georgetown University professor Sabrina Corlette was quoted as saying.
The tax credits are not factored to account for differences in the cost of health care in different states or markets. Residents of every state get the same amount. But New Hampshire’s health care costs are among the highest in the land. Ouch.
Reducing the number of people with coverage under Medicaid means hospitals would be forced to provide even more uncompensated care. That money has to come from somewhere. That somewhere is taxpayers and the insured, who will see their premiums rise. That makes health insurance even less affordable and contributes to the elimination or reduction of employer health care benefits.
Last week, the American Medical Association, the American Hospital Association and the AARP all came out against the Ryan plan. It deserves to fail, but the president and most congressional Republicans remain pledged to repeal and replace Obamacare.
Instead, they should improve it, rename it, declare victory and turn to building something rather than destroying something that, while imperfect, has improved the lives of millions of Americans.