N.H. lawmakers Republican Senator Jeb Bradley and Democratic Representative Cindy Rosenwald have worked long and hard, in bipartisan fashion, on health care issues, including Medicaid expansion -- which is why they've been closely watching the national debate surrounding the U.S. Senate's health care bill.
For the full conversation, listen here.
Taking stock of Obamacare:
Senator Jeb Bradley: We've taken advantage of some things in Obamacare but like everything else, there's good and bad. We've seeing rising premiums; we've seen less choices; we've seen more government control on mandates that have led again to these rising costs. So again, good and bad, I think we've taken advantage, as well we should have, of the opportunity to insure other people, but now there's changes that are going to come and we don't know what that's going to be and we're going to need to react to that."
Much is at stake for New Hampshire:
Rep. Cindy Rosenwald: (The Senate bill) also offers states the option of either a Medicaid block grant, which is a fixed amount with some inflation built in, or per capita caps for individuals by expansion. So that leaves states with basically three choices: raise taxes, reduce the number of people who are covered, or reduce the benefits that are covered.
Sen. Bradley: 52,000 people are being covered in New Hampshire. But for that coverage, our mental health crisis, our opioid crisis, and the crisis just for individual people that we all know - our friend and neighbors - who don't have health insurance, would be much more significant. So, a lot's a stake here. We've got to do the best with the resources we have.
Some N.H. advantages:
Rep. Rosenwald: Well, I think we're a low tax state, but we're also a state where we have a relatively low number of people that are that low income that qualify. I wouldn't want to be Arizona or Florida or Louisiana; those states have hundreds of thousands of people who cannot afford health insurance. So, I think there are opportunities to look for ways to fill in the gap between what the income qualification is for the Medicaid expansion and the point at which the subsidies kick in under the current law. I think there are more opportunities and we can be smarter about it and I think there's a willingness to work.
Health care costs:
Sen. Bradley: I think that Affordable Care Act (Obama Care) didn't focus enough on cost, and both the House and Senate bills...didn't focus enough on cost. And costs become a very difficult discussion for Americans because you know so much of health care depends on what we do to ourselves -- over stressed, under exercised, over eating, smoking, drinking; you know a lot of those personal choices we make impact our health.
Rep. Rosenwald: I think Democrats and Republicans have to work together to look for and root out the causes of rising costs in the healthcare market. We can't just change insurance; we can't just reform delivery; we have to get our arms around the cost.
Hospitals in New Hampshire oppose the Senate health care bill, cite improvements under Obamacare, and worry about talk of reducing cost-sharing subsidies:
Steve Ahnen, President and CEO of the N.H. Hospital Association: We've certainly been willing to search to work to find solutions that help make the healthcare system better. Healthcare is transforming and we need find ways to continue to find ways to make sure healthcare is accessible, it's high quality, and it's affordable, but we believe this bill takes a step backwards and is not in the best interest of the patients and communities that we serve.
We've certainly seen a significant drop in the number of the uninsured that are showing up in emergency rooms, who are showing up as in-patient or out-patient -- well over 40 percent reduction of those uninsured patients that show up in the emergency room.
I certainly think that some of the things that have been talked about in terms of the cost-sharing reduction of subsidies, those things that help those folks that are unable to afford their co-payments and deductibles and things like that, that those payments are made certain for the insurers, that's created a tremendous amount of instability and uncertainty as to whether or not these payments are going to be made.
Some additional ideas: Associated health plans and a national market for health insurance.
Sen. Bradley: And I think that one of the things neither the House bill or Senate bill have yet tackled is some of the ways that we could lower the cost of health insurance by creating larger buying pools for American's as well.
I think we should consider things called associated health plans, so businesses could pool together in like-minded groups, like the "restaurant association" or the "realtors," to buy big groups of health insurance to cover more individual people like that, or to allow cross-state purchasing of health insurance."
We ought to have a national market for health insurance; now I know the regulation of health insurance has been at the 50 state capitals, but let's try this as part of the reform of Obamacare.