Brendan Williams, president and CEO of the New Hampshire Health Care Association, said the federal government currently matches a percentage of the state's actual Medicaid spending. The Republican plans would reimburse a fixed amount per person on Medicaid. Experts say the per capita system will result in major cuts in payments to the states.
The impact will hit nursing homes in the state hard because almost two thirds of their residents are on Medicaid. The percentage of residents on Medicaid is even higher in Coos County, which has the state’s highest percentage of elderly residents.
Williams said Medicaid rates are already low, covering about 64 percent of the cost of care, and many nursing homes run at a loss. Under the BCRA, he said individual nursing homes are facing an additional cut of about a $1 million each.
St. Vincent Acting Administrator Michael Takesian said 75 percent of the residents there are on Medicaid. He said Medicaid pays about 66 percent of the cost, leaving a gap of approximately $1 million. The most recent Medicaid rate was reduced, costing the nursing home about $20,000 for the next six months.
Despite the underfunding, Takesian said the local nursing homes continue to provide excellent care. He said St. Vincent is consistently rated one of the highest in the country for quality.
“That tells us we’re doing something right,” he said.
Donna Walin, director of nursing at St. Vincent, said it is increasingly challenging to provide that quality care, with most residents depending on Medicaid funding. She said people are also living longer and Williams noted some are suffering dementia and cannot be cared for at home.
The administrators said the tight funding makes it hard for nursing homes to compete for qualified staff. There is a shortage of health-care professionals statewide and that has driven up wages. It has hit Coos County nursing homes hard because the funding shortfall makes it hard to compete with better paying facilities.
Louise Belanger, director of the Coos County Nursing Home in Berlin, said the nursing home has had to offer incentives to get needed staff.
Roxie Severance, a long-time health care consultant in Coos County, said the Centers for Medicare and Medicaid Services is coming out with new regulations. She said the added regulations make it worse given the reduced funding. Williams said it cost $70,000 per facility to comply with CMS paperwork requirements.
Takesian said he sees a perfect storm brewing with increasing demand for nursing home services and qualified staff and the threat of reduced funding.
“We’re scrambling now — the next 10 to 20 years what are we going to do?” he asked.
The Congressional Budget Office estimated the original BCRA released in June would cut $772 billion from funding and lead to 15 million fewer people getting health insurance over the next 10 years. The CBO has not released its analysis for the revised bill.
Shaheen has opposed both the House and Senate health-care plans proposed by the Republicans. She charged the Republican leadership revised the original Senate bill by adding sweeteners such as $45 billion to fight opiods and is now trying to fast track the legislation. The senator said she is pleased that Gov. Chris Sununu has come out against the BCRA.
While admitting there are problems with the current Affordable Care Act or Obamacare, Shaheen said overall it provides better care for more people than the plans put forth by the Republicans. She said Congress has to be persuaded that the better way is to come together to fix the problems with Obamacare.