N.H. health experts are not impressed with the new GOP health care plan

  • House Speaker Paul Ryan of Wis. uses charts and graphs to make his case for the GOP's long-awaited plan to repeal and replace the Affordable Care Act, Thursday, March 9, 2017, during a news conference on Capitol Hill in Washington. (AP Photo/J. Scott Applewhite) J. Scott Applewhite

Monitor staff 
Published: 3/11/2017 12:06:12 AM

New Hampshire health providers, hospitals and medical professionals are sounding the alarm over the President Donald Trump and Congressional Republicans replacement plan for the Affordable Care Act.

Their first glimpse of the new Republican American Health Care Act (also known as AHCA) reveals a plan that would make health insurance cheaper for younger and wealthier Americans and more expensive for the elderly and poor. It would also do away with expanded Medicaid in its current form in the next three years.

“The prism we look at this problem through is what’s best for our patients,” said Frank McDougall, vice president for Government Relations at Dartmouth-Hitchcock Medical Center in Lebanon. “It appears that the bill in its present form is not going to be good for our patients.”

The New Hampshire Hospital Association, American Hospital Association, American Medical Association and New Hampshire Medical Society have all released statements in opposition to the bill – saying it will decrease insurance access, especially for Americans who need it most.

“I don’t know too many groups that came out in favor of this bill,” said New Hampshire Medical Society President James Potter.

The New Hampshire Hospital Association estimates hospitals in the state will receive about $1.5 billion less in Medicare reimbursements between 2018 and 2026 from changes to the federal program, which it calls “devastating to their ability to serve the patients and communities who depend on them if people lose their coverage.”

However, almost all health experts in the state say they are still waiting for a final version of the bill, which has already passed two committees in the U.S. House, just a few days after being publicly released.

McDougall said the haste with which the bill is already moving through Capitol Hill is a bit unnerving.

“What this is, is repeal, delay and sort of replace,” he said. “I think it’s being rushed through the House.”

What’s in AHCA

Even though it has staunch backing from President Donald Trump, the AHCA is getting a lot of flak from both liberals and conservatives. Here are some of the reasons why:

In order for any health care plan to work, Congress needs to keep enough healthy people buying health insurance. This will prevent the marketplace being dominated by expensive sick people, which will raise costs for everyone.

Even though the Republican bill would repeal the Affordable Care Act’s individual mandate that forces people to either have health insurance or pay a small fine – it contains a provision for “continuous coverage,” which essentially gives insurance companies the ability to dramatically raise costs if a consumer has to drop insurance for some reason and wants to get it again later.

Conservative Republicans don’t like the bill’s other similarities to President Obama’s Affordable Care Act. These include mandating insurers to cover pre-existing conditions and essential health benefits such as preventative care and maternity services, and continuing the ban on annual and lifetime limits.

The Republican bill in its current form would also keep expanded Medicaid until 2020, another thing conservatives dislike. A proposal is already circulating in the GOP that would freeze Medicaid enrollment by 2017 – a move that’s sure to spark backlash among Democrats and moderate Republicans.

Another big sticking point is AHCA will continue to give out tax credits to help Americans subsidize the cost of health insurance (a continuation of an Obamacare policy).

The biggest change in these tax credits is they would be based on age, not on income, (like they were under Obama). That means younger and potentially wealthier people will get more money from the government to help them purchase health insurance, while older people get less.

AARP estimates that yearly premiums would go up by about $7,000 for a 65 year old earning $25,000 a year under the AHCA, an increase they say is far too burdensome for older Americans.

New Hampshire issues

The future of Medicaid Expansion is sure to be a big issue in New Hampshire.

Over 140,000 state residents get health insurance through Medicaid. About 48,000 of them got health insurance through the expanded Medicaid program made possible by the Affordable Care Act. And due to provisions in the ACA, all Medicaid recipients in New Hampshire can get mental health and addiction treatment services, which health officials say has been a big boost for a state facing a deadly opioid epidemic.

If Republicans change federal rules that require mental health and substance abuse to be covered the same way physical procedures are, health officials say that could have dire consequences for patients struggling with addiction in the Granite State.

“Right now, Medicaid has to provide for mental health parity with regard to coverage,” McDougall said. “This bill allows it not to be.”

He says it’s a consequence that’s “certainly bad for New Hampshire.”

No matter what, doctors and health experts are waiting to see what happens next in Washington.

“We think it’s the opening salvo,” Potter said.

(Ella Nilsen can be reached at 369-3322, enilsen@cmonitor.com or on Twitter @ella_nilsen.)

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