My Turn: Medicaid alternative is too expensive for families – and for the state
Last week, the state Medicaid commission heard a presentation about an alternative to a federally funded Medicaid expansion, presented by Avik Roy. As the commission was designed to do, it is taking this presentation into consideration as it deliberates over the vast amount of information it has received to-date. However, the plan outlined would place New Hampshire’s hardworking, low-income families into a precarious financial position. New Hampshire’s uninsured, low-income families cannot afford this alternative plan, and neither can the state.
The commission has spent untold hours hearing from consultants and experts on opportunities to move forward with Medicaid expansion. It will release a report by Oct. 15 reflecting its careful consideration of all the testimony it has heard. It is expected the commission will measure each option against critical principles such as affordability, quality of services, scope of coverage to include primary and preventive care, specialty and hospital care; as well as considering ways to maximize federal money, leverage existing state infrastructure, systems and structures already in place, and consider possible areas for cost sharing. Indeed this is a daunting task; however, commission members are skilled, experienced bipartisan legislators and public-policy experts well suited to make a recommendation.
The alternative plan released last week falls short on several key principles. It is unaffordable for low-income families. It would cover fewer individuals, serving only 11,150 out of 46,200 of New Hampshire’s people without health insurance. It recommends a concierge type of primary care that is not empirically tested. It recommends only catastrophic insurance coverage. It forgoes a significant federal investment. And it does not build on the investments the state and federal government have made in our state.
Under the plan, eligible people without health insurance would be required to pay over $6,000 in an annual deductible. This is unaffordable, as the population this is intended to reach make less than $12,000 a year. By way of example, let’s use a person who lives at 100 percent of the federal poverty level. This hardworking individual earns $11,490 per year. Using a generally accepted standard of housing affordability,
30 percent of an individual’s income is spent on housing, or $3,447. If that same individual had to pay over $6,000 in deductibles for health care using a catastrophic health insurance policy, the individual would have approximately $2,000 to pay for food, utilities, gas for their car, and clothing. It is unrealistic to believe that a person could live on $2,000 a year.
Beyond catastrophic insurance, this plan requires an individual to pay $100 per month to receive primary care through a concierge service. There is no financial provision to pay for care received between primary care and care that would be covered under catastrophic insurance. Medicaid, on the other hand, covers many health care needs, including primary and preventive care, specialist care, hospital emergency and in-patient care, hospice services, home health, nursing facilities, and prescription drugs.
For our current Medicaid population, the New Hampshire Legislature decided to invest in Medicaid Care Management. The three health plans selected to manage the care of current and future Medicaid patients are trusted managed care organizations with a proven record. Medicaid Care Management incorporates the patient-centered medical home model, an accredited and evidence-based model, which uses a team-based approach that results in high-quality, comprehensive primary and preventive care. Nearly all primary care providers in the state with expertise in caring for low- and moderate-income families use this well-tested, credible patient-centered medical home model. This alternative plan uses the concierge model, which is premised on physicians caring for fewer patients than conventional practices; thereby, reducing our access to primary care providers and, likely, may place a greater burden on our primary care workforce. New Hampshire should continue its wise investment in Medicaid Care Management and the patient-centered medical homes because they provide the right type of care at the right time.
Finally, this alternative plan leaves $2.5 billion in federal money on the table and will cost New Hampshire $320 million in state money over seven years. If the state chooses to expand Medicaid, nearly 60,000 (earning up to 138 percent of federal poverty level) uninsured New Hampshire residents will receive crucial health care coverage through the Medicaid Care Management program. Many health care providers and organizations have publicly supported this Medicaid expansion and have stated that New Hampshire providers have the capacity to treat our current and newly eligible Medicaid patients.
The Bi-State Primary Care Association supports the continued expansion of Medicaid Care Management for low-income people without health insurance in New Hampshire.
We look forward to the commission’s report to evaluate which public policy options, from the patient and provider community perspective, make sense as we work toward a path to provide access to affordable, quality health care for uninsured, low-income residents.
(Tess Stack Kuenning is president and CEO of the Bi-State Primary Care Association.)