Yesterday the New Hampshire House Health and Human Services Committee held a public hearing on re-authorizing Obamacare’s Medicaid Expansion (they renamed it to the Health Protection Plan because a majority of Granite Staters disapprove of Obamacare). The hearing was to discuss House Bill 1696 which re-authorizes Medicaid Expansion through 2020.
The original plan was supposed to sunset when federal funds went below 100%. Legislators lied to New Hampshire. The federal funds will indeed be dipping below the 100% in 2017 but they were in the house pushing a re-authorization rather than the sunset it as promised.
Legislators now claim that they are going to use more gimmicks with the Medicaid Enhancement Tax. Hospitals and providers have said they’ll “make up” the difference as federal funding falls under the 100% mark to 95% in 2017 and then down to 90% by 2020. The cost differentials are huge. The general fund share goes from over $10 million in 2017 to over $47 million by 2020.
These costs only account for around 50,000 people. During the hearing, at least two different providers in support of the bill said that they saw up to 70,000 people on Medicaid Expansion since its inception. Of course, the Department of Health and Human Services has released no data about this medial welfare program yet. The data is supposed to be released sometime in the spring.
There is nothing in the legislation that guarantees hospitals and providers will actually pay for the Medicaid Enhancement Tax gimmick that legislators are claiming will make it so no state funds are used for the bill. Since the federal government is already onto these gimmicks and aren’t happy about it, they could be stopped at any time. Congress has already talked about ending these types of taxes.
The reality is that hospitals and providers won’t actually pay these taxes, they’ll push these costs onto those who pay for private health insurance. In other words, it will be a tax on the sick. If you use hospitals or providers for any services, your costs will increase in order to cover these “taxes” because that’s how taxes work.
The problem with this legislation is that there is nothing sun setting the bill if the Medicaid Enhancement Tax disappears or if hospitals and providers don’t pay. Which means that even when the federal funds are below 100%, Granite State taxpayers will be forced to somehow come up with that money in the form of an income and or sales tax. New Hampshire doesn’t currently have either in place.
Healthcare experts have already realized how poorly this could work out for states. There are rules and caps in the law that don’t allow hospitals and providers to pay over a certain amount. They know this. It won’t hurt the hospitals or providers which is why they say they’ll “pay” the difference. If these caps kick in, taxpayers are on the hook. From Forbes regarding the state of Utah who was attempting the same type of legislation:
Federal law prohibits states from holding providers “harmless,” meaning they can’t provide a direct or indirect guarantee that providers will receive their tax dollars back in the form of additional Medicaid spending. Basing the tax on how much Medicaid expansion funding providers receive could risk running afoul of this requirement.
If the provider taxes do not cover the entire Medicaid expansion bill, state taxpayers will be tapped to pay the remainder of the costs. Providers in Utah may even be willing to promise to pay these costs, knowing that their liability is capped by federal law, while state taxpayers don’t have that luxury and could be on the hook for overruns. Given the huge cost overruns other states are experiencing, Utah lawmakers should be extremely wary of these promises.
Basically New Hampshire State Legislators have sold Granite Staters down the river. Not only did they lie about killing this huge medical welfare program the first time around but they are fraudulently trying to sell this bill now by claiming residents won’t be paying for it. Taxpayers could be on the hook for over $47 million by 2020 and those are conservative estimates. Experts and opponents have been saying that Obamacare’s Medicaid Expansion will bankrupt the state since the very beginning. It looks like they are the only ones being honest.