NH Medicaid is Set to Bankrupt Hospitals

From NH's East to West borders, northern and southern-most boundaries the recently passed state budget  has sent waves of terror throughout our healthcare system as huge cuts to social welfare programs, especially Medicaid Reimbursement, threaten to bankrupt even the most prominent of our hospitals.

Reimbursement rates and uncompensated care as been a huge issue for NH's medicaid program since as long ago as 2008 when Boston Children's Hospital started refusing to accept NH Medicaid due to its low reimbursement rates, which had the hospital paying half of each patients care.

If a child was sick enough to require care at Boston Children's, if they needed a bone marrow transplant or emergency trauma care, they are still welcome to receive treatment, as a self-pay.

I wrote about the possibility of devastating budget cuts earlier in "How America's Financial Crisis can Kill You." 

http://baldiesblog.blogspot.com/2011/06/budget-cuts-hurt-how-americas-financial.html, which included a letter from The Presidents of Dartmouth Hitchcock Medical Center to their employees and a letter to our representatives  their Board of Director's. 

Well, those desperate attempts came a little too late. If hospital's throughout NH predicted this was going to be a problem they could have acted sooner, joining ranks, organizing bus trips to protest, showing the power in numbers they have that oppose the cuts. 

But none of that was done, just some quiet, polite letter writing. Even after the budget has passed, there has hardly been the severe anger and backlash I expected. I guess the movement to protect hospitals, including all providers and patients, needs a leader.

Now NH medicaid is officially charity due to the States' new budget that passed last week without Gov. Lynch's signature.

We'll call it scary charity. 

Our republican run senates' budget promised not to increase taxes and instead cut hospital funding, mostly by lowering medicaid reimbursements rates to the point hospitals are now paying for the luxury of treating medicaid patients. 

No, they didn't raise taxes on regularly folks, they created a hidden tax on hospitals. A form of cost shifting and  underhanded taxation that preys on the weakest: the sick, the disabled, the elderly and needy, those who can't advocate for themselves due to physical inability or inadequate knowledge. 

Here is the latest letter to Dartmouth employees from the VP of government relations:

D-H leadership pledged to keep you informed about New Hampshire's budget negotiations and the potential impact to our patients and to Dartmouth-Hitchcock. For that purpose, we have created a special tab in Center View Online, called "Budget." <http://centerview.hitchcock.org/Budget.html>

I am writing to you now to provide an update and to ask for your help in urging NH Governor Lynch to veto the NH State budget.

On June 16, the legislative conference committee on state budget legislation agreed on a New Hampshire budget that would harm our patients and jeopardize our ability to fulfill our mission. We expect this budget will be passed by both the House and Senate tomorrow, June 22. At that point, the budget will be sent to Governor Lynch, where he can either sign the bill, allow it to pass into law without his signature, or veto it.  Should the Governor veto the budget, it will then go back to the House and Senate for a vote to either override or sustain the veto. If that happens we will reach out to you again to help us secure enough votes to sustain the veto which would cause the budget to go back to the legislature to be restructured.

We need to be very clear: this budget is extreme. It makes the numbers work at the expense of New Hampshire residents. It does not avoid new taxes. It does precisely the opposite; it places the burden for additional revenues on those who can least afford it by cutting needed programs and imposing payment requirements (essentially a tax) on hospitals.

Dartmouth-Hitchcock, as the state's largest provider and New Hampshire's de-facto safety-net hospital, has taken increasing financial hits from the state over the past decade. New Hampshire's Medicaid reimbursement rate is the second-lowest in the country, behind only Mississippi. We had already estimated an unprecedented loss of $60 million this year due to uncompensated or inadequately compensated care; these cuts will increase that to $100 million.

Dartmouth-Hitchcock cannot sustain a $100 million loss without an impact on our patients and our employees. We would be faced with cutting services to our patients and negatively impacting our employees, perhaps through layoffs.

Securing the Governor's veto is the key first step in improving the budget for our patients.

We're already making tough decisions to reduce costs and make care more affordable, while maintaining the high-quality, patient-centered services and care that people expect of us. This budget proposal goes too far. It fundamentally threatens our ability to meet the needs of patients throughout the region who need our care.  We are determined to oppose anything that undermines our ability to care for patients. We are determined to stand up for the services we provide and for the people who deliver them.

Here's what you can do: Contact Governor Lynch and urge him to veto the budget. Tell him that this budget will be harmful to our patients and to Dartmouth-Hitchcock's mission.

Here's the scenario:
Dartmouth-Hitchcock served over 43,000 NH Medicaid patients in FY 2010. It cost Dartmouth-Hitchcock $88 million to care for those patients. NH Medicaid's regular payments to DH totaled $28million, which means that D-H lost $60 million treating NH Medicaid patients. The proposed state budget eliminates an Uncompensated Care Payment to D-H and imposes a 5.5% tax on our net patient service revenue. That means that D-H will have to pay the State of NH approximately $40 million a year. Dartmouth-Hitchcock's total loss on NH Medicaid will then be $100 million a year! No organization, no matter how big, can sustain a loss of that magnitude without making significant changes in how they operate.

Please express your concern about this.  You can call or email Governor John Lynch at:
State House phone: 603-271-2121
Email:  <governorlynch@nh.gov>

This budget is bad for patients. Critical services will be cut; patients will have to wait longer for necessary care or seek care out of state.

This budget is bad for Dartmouth-Hitchcock. Staggering Medicaid losses will jeopardize our ability to fulfill our mission and continue our role as New Hampshire's safety net health care provider.

This budget is bad for our people. New jobs won't be added and existing jobs could be lost.

This budget is bad for New Hampshire consumers. These disproportionate cuts create a "hidden tax" to consumers who will see health insurance premiums rise.


Emails and phone calls to Governor Lynch's office can begin as early as today and continue until he makes a decision.  (The budget is scheduled to take effect on July 1.)  We are hoping to generate thousands of phone calls or emails to the Governor's Office. We encourage all employees -- including those who live in Vermont -- to contact Governor Lynch. Keep your message brief and polite.  Include your name, your position and where you work.

Thank you for your continued commitment to the patients and families we serve.

***

This is a coward's move to attack the states' weakest residents through cuts to hospitals, mental health services, NH's catastrophic health program, etc., and at the same time, suggest cutting the cigarette tax.

Outrageous. 






It's like the big bully stealing the smaller kid's lunch government style, but now the bully is our representatives and the smaller children are NH's neediest citizens and middle class, including my family me and so many others who struggle financially to receive what will now be substandard, bare basic care.

There is something we may be able to prevent though.

The new health law now requires health insurers to spend at least 80% of premiums on health care.  This provision, called the Medical Loss Ratio (MLR) protects consumers and limits adminstrative costs. 
The National Association of Insurance Commissioners (NAIC) has proposed legislation that would dismantle this important protection. If passed, health insurance companies could move large administrative expenses such as brokers fees off-the-books making administrative expenses look deceptively low while protecting profits and large executive salaries.
Tomorrow, NH Insurance Commissioner Roger Sevigny will meet with other state commissioners to decide if they will recommend weakening consumer protections for consumers to the NAIC.
Please email or call NH Insurance Commissioner Roger Sevigny and urge him to vote “no” on dismantling the MLR. Insurance companies shouldn’t be able to pad their profits at the expense of our care.
Click here to send an email.
Click here to call.