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Medicaid expansion vote worries state’s health care providers

Senate President Peter Bragdon, a Milford Republican,  sits for an editorial review board at the Monitor; Thursday, February 24, 2011.

(Alexander Cohn/ Monitor staff)

Senate President Peter Bragdon, a Milford Republican, sits for an editorial review board at the Monitor; Thursday, February 24, 2011. (Alexander Cohn/ Monitor staff)

Mental health centers and local hospitals that were encouraged earlier this year by the House’s vote to expand Medicaid are troubled that some Senate Republicans intend to halt that move.

Last week, the Senate Finance Committee voted, 4-2, along party lines to take expanded Medicaid out of the state budget and instead study expansion’s impact on the state. Senate President Peter Bragdon, a Milford Republican, proposed a $200,000 study commission in place of expansion, citing skepticism that the federal government will honor its promise to pay the bulk of the expense.

Jay Couture, president of the New Hampshire Community Behavioral Health Association, said expanding Medicaid under the Affordable Care Act would provide the state’s 10 community mental health centers an additional $13.6 million over two years for the uncompensated care they must provide.

“We are working to outreach to senators to help them understand what the impact will be,” Couture said. “There hasn’t been a full Senate vote yet. There is always hope.”

Steve Anhen, president of the New Hampshire Hospital Association, described the move as a step in the wrong direction.

“We are disappointed,” he said. “We think (expanding Medicaid) is really, really important for families and patients and for hospitals. There is someone sitting in an emergency room right now who is uninsured and would be covered by the Medicaid expansion.”

Anhen, Couture and other health care providers said expanding Medicaid insurance to more people will allow them to seek preventive, less-expensive care they now put off because they can’t afford it. Instead, they said, the uninsured go to emergency rooms when they are too ill to put off care any longer, making treatment more costly and often less effective.

Both Anhen and Couture said they remained eager to work with senators, who both said have otherwise been supportive of increased state support for hospitals and mental health centers.

The vote by Senate finance prompted New Hampshire Citizens Alliance, a progressive political action group, to organize a protest rally at 4 p.m. Wednesday, outside O Steak and Seafood on South Main Street, to coincide with a fundraiser Bragdon is having inside the restaurant.

And Health and Human Services Commissioner Nick Toumpas, who favors expanding Medicaid, has asked Senators for a chance to speak with them further before the full Senate votes on its budget.

Bragdon could not be reached for comment Friday.

It’s estimated that expanding Medicaid, a major part of the federal health care overhaul, would extend health coverage to 22,300 people in New Hampshire who would otherwise remain uninsured under the Affordable Care Act.

Gov. Maggie Hassan and the House included expanded Medicaid in their budgets, citing the $2.5 billion offered by the federal government over the next seven years.

With expansion, the federal government is expected to pay 100 percent of the cost for three years, between 93 percent and 95 percent for the next three years and at least 90 percent in subsequent years.

Hassan and House Democrats have said that level of assistance and the ability to provide health coverage to more people is worth the anticipated $27 million to $85 million state officials and others have said expansion might cost the state over seven years.

Bragdon and his three Republican colleagues on Senate finance, Sen. Bob Odell, a Lempster Republican, Sen. Chuck Morse, a Salem Republican and Sen. Jeanie Forrester, a Meredith Republican, disagreed. They voted with Bragdon to study expansion instead, saying there is too little evidence that expansion will lower costs or improve health care outcomes.

In a written statement, Hassan said that vote would cost families health care and the state jobs.

“They are rejecting health coverage for tens of thousands of working families, rejecting 700 jobs, and rejecting more than $92 million in savings for our state,” she said in a written statement. “Uncompensated care at our hospitals’ emergency rooms and health centers increases costs for everyone.”

Hassan’s statement continued. “Senate Republicans have made the wrong decision for our families, our economy and the ongoing efforts to innovate and strengthen our health care system,” she said. “I urge New Hampshire’s senators to rise above ideology and move forward with accepting these critical dollars that will strengthen the health of our people and our economy.”

On Friday, Toumpas said he hopes additional meetings with the Senate will allow him to answer questions raised by Bragdon and the others last week.

“It’s just a matter of an opportunity to sit down and be able to provide what we perceive as the facts and have a dialogue about what is obviously a very significant issue.”

Sen. Sylvia Larsen, a Concord Democrat who sits on the Senate Finance Committee, voted against Bragdon’s proposal. She called it the “wrong choice” for the state’s economy and working families.

“Why would we reject $2.5 billion dollars in federal funds when we know we will see millions of dollars in savings to our state budget?” Larsen said. “Why turn down 100 percent federal funding when we know at the same time our citizens will benefit from critical preventative health care or mental health care in the community instead of relying on expensive and last-minute emergency room care that drives up all our costs?”

Sen. Molly Kelly, a Keene Democrat, said Friday that she fears mental health services, within the state budget and those that would be offered through Medicaid expansion, are in jeopardy. She noted that the House turned down the casino bill, eliminating that revenue source, and the Senate has killed increases to both the cigarette and gas taxes. Rejecting federal money to expand Medicaid, she said, would further hurt health care for those who cannot afford it now.

“The budget is still in flux and it’s not over,” she said. “I will do what I can to work with the finance committee and do what we were sent here to do.”

She said the Senate’s job is not to write a Senate budget but, rather, a “people’s budget.”

The state’s 10 community mental health centers try to cover costs of their uncompensated care with appeals to donors or fundraising. Under expanded Medicaid, the centers would receive money for the uncompensated care they are required by law to provide.

“Even if we don’t pay now, we pay later,” said Peter Janelle, executive director of the Mental Health Center of Greater Manchester. People who seek treatment early for mental illnesses have a better chance of recovery and are less likely to require intervention from the police or criminal justice system, Janelle said.

Like other centers, the Manchester mental health center, seeks donations to cover the cost of uncompensated care. The center is holding its annual 5K road race June 20, and will use all proceeds to pay for uncompensated care. It also uses earnings from an endowment created 10 years ago for charity care.

Expanded Medicaid would allow the center to continue that charity care as donations and endowment earnings have taken a hit by the downturn in the economy.

But economic reasons aren’t Janelle’s only argument for expanding Medicaid coverage to more of New Hampshire’s residents. “It’s the right thing to do,” he said.

(Annmarie Timmins can be reached at 369-3323, or on Twitter @annmarietimmins.)

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