My Turn: The human consequences of the budget impasse

For the Monitor
Published: 9/23/2019 8:00:10 AM

Will the last caregiver to leave New Hampshire turn off the lights? Recently published U.S. Census data, from 2017, shows an astonishing outflow of New Hampshire workers in the “health care and social assistance” category. We experienced a net loss of 6,759 residents who do that work in better-paying states. And just last year our state suffered a net loss of hundreds of licensed nursing assistants – the frontline caregivers in hospitals and nursing homes – in addition to 29% of our registered nurse graduates leaving for more welcoming states.

And there is seemingly no hope on the horizon for improving New England’s worst Medicaid reimbursement. Even the school year began with no end to the state budget impasse in Concord. School kids joined vulnerable seniors in suffering the effects of D.C.-like gridlock. It now appears possible even Christmas may come and go under a new “continuing resolution” – perhaps the 2019 legislative session will just roll straight into the 2020 one!

At this point, it’s clear any budget “compromise” will only further compromise the quality of Medicaid care. We already have New England’s worst Medicaid underfunding coupled with the nation’s second-oldest population. Funding increases in a Senate-passed bill had already been cut in half in the state budget Gov. Chris Sununu vetoed. It’s been proposed to cut that new funding again by a third.

Time and again New Hampshire policymakers have been warned about the dire consequences of their Medicaid neglect. Such warnings simply do not seem to matter, as policymakers stuff a “Rainy Day Fund” piggybank by ignoring care bills – something no New Hampshire family, let alone health care provider, can do with its own budget. While the state’s budget is frozen by political gamesmanship, care expenses are not. As of last month, New England’s Consumer Price Index for medical care had gone up 4.6% over a year’s time – in part because providers are also paying the trade war’s tariffs on imported medical supplies.

Around 64% of those in New Hampshire nursing homes are on Medicaid. These residents are older than the national average, and far more apt to have dementia. As a result, nursing homes here provide more direct care hours than the national average. Unlike other states, where a lack of demand, coupled with underfunding, has compelled nursing home closures, New Hampshire facilities have no shortage of demand. Indeed, with the competing service economy able to offer more money, providers cannot staff to meet demand, effectively taking beds offline.

Getting bargain motel rates from the state, some of the rare assisted-living facilities that serve Medicaid residents – like the decades-old, town-operated Carpenter Home in Swanzey – have already closed, being unable to responsibly staff, and meet resident needs, within scant state reimbursement. Such closures should have served as the proverbial canary in the coal mine, but we keep digging deeper along a dark path.

Residents and caregivers alike are hostages to the partisan fight over the state budget. They can respect that the two parties disagree on principles, but be forgiven – I hope – for the fact that whether business taxes are further lowered, or tax decreases are suspended, is irrelevant to them. Instead, their existential focus is on the threat of being displaced counties away from place-bound loved ones, especially in situations, not uncommon, where one elderly spouse resides in the community while the other is cared for in a facility. Instead, their focus is on losing jobs that, while not materially rewarding given the stinginess of Medicaid, are labors of commitment and love. Yet they’re treated like Oliver Twist asking for more gruel.

There is a sad poignancy in the World War II generation – including many still-living veterans – having believed so strongly in, and fought for, a system of government that has completely failed them when they need it most. Policymakers still rhetorically laud their valor and sacrifice, while marginalizing their health care needs. If only speeches and Twitter mentions paid bills.

Anyone who thinks there are no real consequences to the budget impasse should consider all of this. They should also consider those neighbors of theirs alone in their own homes needing in-home care but unable, due to an immoral level of Medicaid reimbursement, to find a caregiver.

Every surrounding state has made significant new investments in Medicaid care. All of us, even those who are younger, are but an accident or illness away from infirmity – whether it be temporary or permanent. If that happens to you in New Hampshire – and your resources have been exhausted by medical expenses – you might consider moving to a state that cares.

(Brendan Williams is the president/CEO of the New Hampshire Health Care Association.)

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