My Turn: In expanding access to health care, sustainable financing is key
As someone who has been deeply involved in New Hampshire health care delivery and financing for more than a quarter century, I have observed the health consequences and crushing financial strain of patients without health insurance. People may forgo needed preventative care and treatment, go without needed medications and often end up in emergency departments, the most expensive place to receive treatment. An established primary care relationship would have avoided any needless morbidity or mortality, all of which sap the strength of our families and the economic vitality of our communities. With this perspective I’d like to impress upon those pursuing a legislative solution to increased access to health insurance how important it is to craft both the access and sustainable financing to ensure that an initial achievement remains sustainable.
In crafting the New Hampshire plan for expanded health insurance coverage, the saying that comes to mind is “measure twice and cut once.” This also describes the challenge for the New Hampshire Legislature. We have only one opportunity to achieve this in a responsible and sustainable way, thus maximizing benefits for our state while minimizing risks. It is vitally important to all of our fellow citizens that we get this right.
There appears to be a growing political consensus that expanded health insurance coverage represents the fundamental building block for improving health care for the citizenry. However, the benefits of such an expansion alone will prove illusory without a sustainable financing plan behind it.
As an individual citizen, I call upon our elected state leaders to expand health insurance coverage through a New Hampshire solution that adds to the New Hampshire Advantage. Other states have crafted state-centric plans and have sought and obtained the necessary waivers from the federal government on a speedy basis. From my perspective, the key elements of such a plan would include:
1. Strengthening New Hampshire’s private insurance market for those currently with and without coverage, through use of private insurance to cover newly eligible (and those currently eligible where there is the flexibility and capacity to do so). We are a relatively small state, which makes it hard to support options in insurance coverage. Retaining individuals in the private market helps us contend with that challenge versus adding to it.
The state commission on Medicaid Expansion’s recent recommendation for a mandatory Health Insurance Premium Payment Program for cost-effective employer-sponsored insurance is consistent with this; there also might be at some point possible opportunities beyond the newly eligible.
2. Promote the highest level of coverage continuity (i.e. avoid “churning”) to promote health and the cost to individuals and the state. It is sensible to have continuity with your provider and insurer so that investments in health promotion and medication therapy can be more readily sustained. The commission’s recommendation for mandatory HIPP is on target in this regard; it would be beneficial to avoid churning more broadly as well.
3. Improve budget predictability for the state by financing premiums versus services. In doing so, the state will have the benefit of fixed unit costs in the coverage it supports. The commission’s recommendation extended beyond HIPP could also be of value in this regard.
4. Ensure protection to the state from any potential financing changes from the federal level. Arguably, the more coverage that comes from tax credits and private coverage reduces future exposure to the state should federal policy shift. The commission’s recommendation extended beyond the HIPP participants could also be of value in this regard.
5. Secure a federal match to finance this expanded coverage that is competitive with other neighboring states. Our state is in optimal position now to negotiate the parameters of expanded coverage that will drive the feds’ and state’s effective participation to support sustainable implementation. The commission’s recommendations for waivers appears to prioritize initiation of coverage and underrates the important leverage in securing maximum flexibility and an enhanced federal match like our neighboring states.
Expanding coverage represents a one-time opportunity to do it right to ensure a sustainable system that protects patients and taxpayers. We can and should come together to achieve a plan with these elements. Moreover, we should allow a relatively short time, in the scheme of things, to secure the available beneficial waivers from the federal government, as some other states have recently done. That will prove the key “measurement” in the future level of success we get from expanded coverage as individuals and for the generations to follow.
My appreciation is extended to all of those in Concord who are working toward increasing access to health insurance for my home town and the state as a whole.
(Henry D. Lipman is senior vice president for financial strategies and external relations for LRGHealthcare in the Lakes Region.)