New Hampshire hospital systems are facing large strains.
Martha Dodge, senior vice president at Elliott Health System, said the flagship Manchester location saw 311 more people in May needing an inpatient bed than it did the year before.
The biggest drivers, she said, were a lack of primary care providers and a lack of insurance.
“Our proportion of uncompensated care is going up with bad debt. We experienced a decrease in commercial payers and increase in government payers, which is less reimbursement, which makes it harder and harder to work harder with less money,” Dodge said.
Several other healthcare leaders and advocates shared similar stories during a roundtable discussion with Rep. Maggie Goodlander on Tuesday. But drastic changes to Medicaid eligibility and enrollment procedures, which go into effect at the end of the year, could put hundreds of thousands of Granite Staters at risk of losing coverage — and hospital systems under even greater stress.
With last year’s passage of H.R. 1, also known as the “One Big Beautiful Bill Act,” federal leaders cut nearly $1 trillion in funding for Medicaid over the next decade. The budget reconciliation bill also set in motion changes to eligibility, such as new work requirements and increased redetermination periods from every year to every six months.
The latter has leaders like Kara Morse of Riverbend Community Mental Health most concerned. She said the yearly redetermination is already a burden for most clients, even with the support of case management. The Concord-based health center is considering open office hours to help patients upload files for their applications.
“We’ve started to think about just redesigning how we help folks navigate their benefits,” Morse said, “just trying to not give them one more thing that they feel like is overwhelming.”
Matthew Houde, vice president of government relations at Dartmouth-Hitchcock Medical Center, said many of its primary care providers “meet people where they are” to provide care instead of requiring patients to come to the hospital. With the imminent threat of lost coverage, he said those efforts may have to be pared back.
The loss of healthcare coverage means delays in care, which ultimately leads to overwhelmed emergency rooms, said New Hampshire Hospital Association President Steve Ahnen. The hospital had 98 patients ready to be discharged Tuesday morning but could not do so because “there wasn’t a place for them to go,” leading to backed-up emergency waitlists.
“When we lose hundreds of millions of dollars in Medicaid funding, that impacts every patient, because if we no longer have the ability to serve a behavioral health patient, a substance use patient, a pediatric patient, it’s not just Medicaid patients that suffer, it’s every patient,” Ahnen said.
Goodlander said the two biggest things Congress can do is to restore funding to maintain a functioning healthcare system and to crack down on large for-profit health corporations. She said she has led legislation to reverse the cuts and is working on other bills to bring transparency to the system.
“No matter how you get your healthcare, your costs have already gone up, and they’re going to continue to go up,” Goodlander said in an interview. “I’m going to continue to work with anyone who will work with me to make progress, because this is existential, it’s about people’s lives and livelihoods.”
