New Hampshire Department of Health and Human Services Commissioner Jeffrey Meyers predicted a sharp financial toll on the state’s Medicaid program if the federal Graham-Cassidy health care bill passes, and warned of funding shortages that could result from the bill’s block grant system.
Speaking at a Monitor editorial board meeting Wednesday, Meyers said that the proposed legislation could cause a loss of about $820 million in Medicaid funding between 2020 and 2026, citing calculations made by his office.
And he said other provisions of the bill, such as a mandatory cap on New Hampshire’s Medicaid enhancement tax, could produce deeper revenue cuts.
“We would lose very significantly under the block grant that Graham-Cassidy proposes, as it exists today,” Meyers said. “We would lose significant revenue, which means we’d match less money at the federal level and have less money for care, which would drive up health care costs in New Hampshire.”
The commissioner’s comments came days after Gov. Chris Sununu disavowed the legislation, and a week into fierce debate over a bill promoted as a last chance to dismantle the Affordable Care Act. Proposed by Sens. Lindsay Graham and Bill Cassidy, the bill would dramatically alter the structure of the Medicaid expansion allowed for under the 2010 act, shifting the money to states in the form of block funding grants.
On Friday, the prognosis for the bill appeared to dim, with Sen. John McCain vowing to vote against it and Sen. Susan Collins leaning toward a no – both crucial votes to the bill’s success. But with the outcome still up in the air, discussion continues to swell.
Supporters have touted the added flexibility given to states, and said the bill, which would benefit states that chose not to accept expanded Medicaid funds over states that did, would redistribute the federal funds more fairly.
But Meyers said the block grant system, as designed, would fall short of matching the funding needs of the Granite State for its expanded Medicaid population.
The $820 million loss was calculated by determining the difference between projected funding levels under New Hampshire’s present Medicaid expansion program and an estimate provided by Cassidy’s office of the state’s block grant allotment under the bill, Meyers said.
At fault is the bill’s funding structure, he added. Under Graham-Cassidy, New Hampshire’s Medicaid program would change from the present percentage-based model in which the federal government funds between 90 and 100 percent of all eligible recipients in the state, to a capped, per capita model that would kick into place in 2026. The per capita calculations would not take into account seniors, people with disabilities, and families with children.
Meyers said that those provisions would hurt New Hampshire disproportionately, likely necessitating cut-backs to eligibility under the state’s expansion program, which presently serves 50,000 people.
“Most of the block grant schemes that I’ve seen reduce funding significantly, and that would be a huge issue in New Hampshire, because then you’d have to either look at reducing services (or) changing the benefit array,” Meyers said.
First implemented in 2014, New Hampshire’s Medicaid expansion opened up eligibility for the federal program from the elderly and disabled to low-income adults with children. The program provides participants access to a range of health services including doctor visits and emergency care.
But Meyers said that many of the presently provided services are not technically required by law. In the event of increasing cuts to expansion funds imposed by Graham-Cassidy, he argued, the state would have to make tough choices on how to adapt the program.
“Pharmaceuticals, as an example, are not a mandated medical service, but I don’t think we want to talk about ending pharmaceutical benefits for people in the state of New Hampshire,” Meyers said. “So you’d have to start looking at cutting eligibility.”
A limit on the state’s Medicaid enhancement tax imposed by the bill would also hamstring the state, according to Meyers. The tax, which since 1991 has been imposed on hospitals to help pay for the Medicaid program, presently stands at 5.4 percent; the new bill would cap that to 4 percent, Meyers said.
“That would be a significant loss of revenue,” he said.
In criticizing Graham-Cassidy, Meyers echoes a bipartisan group of state officials. On Monday, Sununu followed New Hampshire’s all-Democratic in decrying the bill’s funding cuts, calling the bill “not practical” for the Granite State.
And in an interview with NHPR Wednesday, New Hampshire Senate Majority Leader Jeb Bradley called the funding in the bill inadequate.
But while Meyers has staked out firm opposition against the funding cuts imposed by the bill, he also stands with the governor in supporting increased financial flexibility to the states.
Present Medicaid rules, imposed by the Centers for Medicare and Medicaid Services (CMS), tie New Hampshire’s hands financially, Meyers said. The state must apply to CMS for waivers to use the funds for anything other than direct health insurance, a cumbersome process that doesn’t lend itself well to the creation pilot programs to combat the opioid crisis, he added.
“In a perfect world, states would have more flexibility,” he said. “And whether that’s through a block grant program or whether that’s through reforms to the ACA, I think it could be accomplished in many ways.”
But in the end, Meyers added, the New Hampshire DHHS – like the rest of the country this week – lies at the whim of Congressional forces.
“I’m an agency head and obviously I’m going to implement whatever federal law and state law directs me to do,” he said. “That’s part of my job.”
(Ethan DeWitt can be reached at firstname.lastname@example.org, or on Twitter at @edewittNH.)