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Mark Fernald: Trumpcare Hurts The Granite State

What Trumpcare Means for New Hampshire:  Thousands lose their health insurance, hospitals take a financial hit, and the wealthy get a tax cut.

The Congressional Budget Office has now officially ‘scored’ Trumpcare and has estimated that 23 million will lose their health insurance.

Medicaid expansion under the Affordable Care Act has made it possible for nearly 50,000 citizens of New Hampshire to get health insurance. The vast majority of these newly insured are the working poor.  Their employers offer no health insurance, and they could not afford health insurance on the private market.  People making $18,000 a year could not afford a $6,000 health insurance policy before the Affordable Care Act.

If the Republican healthcare plan becomes law, nearly all of the newly insured will lose their coverage.

The expansion of Medicaid in New Hampshire has brought over $100 million per year into New Hampshire.  That new money has flowed to the bottom line of our healthcare providers, primarily our hospitals, which bear huge burdens providing free care for people without health insurance.  One study concluded that Medicaid expansion has cut the cost of uncompensated care over 40% in those states that expanded Medicaid.

Under Trumpcare, New Hampshire healthcare providers would lose hundreds of millions of dollars over the next decade, jeopardizing the financial health of some of our hospitals.

At the heart of Trumpcare is a big tax cut for the wealthy.  The Affordable Care Act included the Net Investment Income Tax, a new 3.8% tax on unearned income (such as interest, dividends, and capital gains) received by couples with incomes over $250,000 a year.  Trumpcare would repeal this tax.

The Net Investment Income Tax corrected a flaw in the original financing of Medicare:  the system is funded by a payroll tax on the wages of working Americans, rather than by a tax on the incomes of all Americans.  Part of our paychecks supported Medicare, but dividends, interest, and capital gains did not.

The importance of this flaw cannot be overstated.  Medicare is a program that benefits Americans who reach the age of 65.  It makes sense to pay for it the way we pay for the rest of the federal government—based on our incomes, not just on our W-2 earnings.

(Social Security is different.  It is paid for with a payroll tax, and the benefits you receive depend upon how much you pay in.  With Medicare, your benefits are not based on the Medicare taxes you have paid.)

Warren Bufffet is paid a modest salary by his company. The vast majority of his income is dividends and capital gains that are not subject to the Medicare payroll tax.  Year after year, before the Affordable Care Act, Warren Buffett paid less in Medicare tax than many wage-earning Americans.

To his credit, Warren Buffet has spoken out against Trumpcare as a tax cut for people like him who do not need it.  According to Buffett, repealing the Affordable Care Act—and the Net Investment Income Tax—would have saved him about $680,000 in 2016.

Repealing the Net Investment Income Tax will cost the federal government about $60 billion a year.  Trumpcare offsets that revenue loss with huge cuts to healthcare spending.  Medicaid expansion would be phased out, while health insurance subsidies for the working poor would be eliminated.

Here in New Hampshire, if Trumpcare becomes law, the health of tens of thousands of our fellow citizens will decline as they lose their health insurance.  The financial health of our hospitals will also decline, as the number of uninsured people increases.

Republicans have spent years railing against “Obama tax hikes” without mentioning that the target of their wrath is a tax that corrected one of the great inequities in our tax system.  The health of millions will be harmed to benefit the wealthy few.

The Republican plan is now in the Senate, where it is being revised in secret. Most senators pay the Net Investment Income Tax, as they have large stock portfolios, and family incomes over $250,000.  We will see which senators vote to give themselves a tax cut—while taking health insurance away from millions—and which senators will vote against a personal tax cut and for affordable healthcare.

Mark Fernald is a former State Senator and was the 2002 Democratic nominee for Governor.  He can be reached at mark@markfernald.com.

HHS Secretary Tom Price Visit NH Trying To Peddle The AHCA

Today, Health and Human Services Secretary Tom Price came to New Hampshire to host a roundtable discussion on the American Health Care Act and it impact on access to healthcare and substance misuse treatment in New Hampshire.

The AHCA has very little support, except for those inside the Republican Party, for its cuts to programs designed to help states combat the growing opioid addition.  This include NH’s Governor Chris Sununu.

Over the weekend, Republican Governor Chris Sununu praised the recently passed Trumpcare bill, calling it a “great message” to the American people and saying he was “glad they pass something.” The governor also wanted to see Congress give him the power to opt-out of providing coverage for substance abuse treatment.

New Hampshire has the third-most per capita deaths by drug overdose and the Drug Enforcement Agency (DEA) called the state “ground zero” for the opioid epidemic. Sununu is welcoming Trumpcare architect, Health & Human Services Secretary Tom Price to the state on Wednesday to discuss the opioid crisis just days after the governor expressed interest in cutting off coverage for substance abuse victims.

“It’s a mystery what exactly made Governor Sununu throw his support behind the most recent and cruelest version of Trumpcare, but it could do with the amendments that allows states to deny coverage and hike up premiums for more Americans,” said NHDP Chair Ray Buckley. “Sununu’s idea to give states the option to deny coverage for substance abuse treatment is heartless. The governor’s purely ideological stance would weaken New Hampshire’s ability to combat our largest and most urgent issue.”

This weekend, the New Hampshire Hospital Association called the bill “a significant step backward.” New Hampshire Health Care Association said they couldn’t “imagine how care in New Hampshire ultimately survives this blow,” and the CEO of Catholic Medical Center said the bill would “result in dramatic increase in uncompensated care costs.”

Two new reports analyze ways in which Trumpcare would damage Granite Staters. Kaiser Family Foundation’s analysis of the AHCA found that a 60-year old in New Hampshire making $20,000 a year would pay 607% more in premiums than under the ACA. New Futures calculated the cost of substance abuse in New Hampshire as upwards of $2 billion annually, underscoring the need for federal assistance. Rather than increase federal money, Trumpcare would cut Medicaid by $880 billion and phase out Medicaid Expansion by 2020.

Sununu also asked for the power to opt-out of providing mental health coverage. The Trumpcare bill that just passed the House offers two key opt-out provisions. One provision would allow states to opt out of guaranteeing “essential health benefits” and the other would effectively allow insurance companies to charge an unlimited amount in monthly premiums to those with preexisting conditions.

In advance of Secretary Price’s visit, Congresswoman Annie Kuster wrote to the Secretary and inquired about the Trump Administration’s commitment to ensuring coverage for those with preexisting conditions, protecting rural hospitals, supporting treatment and recovery services for substance misuse, and avoiding cost increases for older Americans.

“I was glad to have the opportunity to express my concerns about the American Health Care Act with Secretary Price this afternoon,” said Congresswoman Kuster. “In New Hampshire, Medicaid expansion offered through the ACA has played an important role in getting thousands of Granite Staters seeking recovery services the treatment and care they need. Nearly every participant at today’s listening session highlighted the critical need to continue Medicaid expansion in our state. The Republican healthcare bill poses a serious threat to efforts to address the opioid crisis in New Hampshire and across the country. I hope that after hearing from people in New Hampshire, Secretary Price will have an appreciation for the importance of preserving access to treatment and recovery services that were established by the ACA. Rather than pursue partisan efforts to repeal the ACA, I urge my colleagues to come together in good faith to work to improve access to healthcare for all Americans.”

Senator Jeanne Shaheen said the AHCA “decimates Medicaid” and removes requirements for insurance companies to “cover substance misuse” treatments.

“Considering Secretary Price played a lead role in crafting the Republican leadership’s healthcare repeal bill, I hope that he will take to heart the significant concerns of Granite Staters who are extremely alarmed about the impact that this legislation would have on their lives,” said Senator Shaheen.

“Today, Secretary Price said the Trump administration’s focus is to provide coverage and care to every American, but his words don’t match the administration’s actions. The Republican leadership’s healthcare repeal bill decimates Medicaid, and eliminates the program’s expansion and the federal requirement that insurance plans cover substance misuse treatment.  Taken together, these policies would not only take a wrecking ball to our state’s progress to address the opioid epidemic, but put us in a far worse position than ever before. These tools are fundamental to New Hampshire’s efforts to provide treatment to Granite Staters who desperately need it. Needless to say, a listening tour would have been much more appropriate prior to pushing this healthcare repeal legislation through the House of Representatives without any hearings,” Shaheen added.


Senator Maggie Hassan is also opposed to the AHCA and is “deeply concerned” about the cuts to the office “tasked with coordinating the federal government’s response to the substance misuse crisis.”

“While I appreciate Secretary Price’s visit to New Hampshire to highlight the heroin, fentanyl, and opioid epidemic devastating our state, there remains a troubling disconnect between the Trump Administration’s words and its proposals, which would significantly harm our ability to combat this crisis. The Trumpcare proposal being pushed by Secretary Price would be devastating to those on the front lines of this crisis – from slashing the traditional Medicaid program, to ending New Hampshire’s bipartisan Medicaid expansion plan and undermining the requirement that insurance companies cover substance use disorder treatment. I am also deeply concerned by reports that the White House is considering effectively eliminating the office tasked with coordinating the federal government’s response to the substance misuse crisis.”

“I hope that Secretary Price listened closely and learned from the discussion in which participants largely focused on the importance of Medicaid expansion and the critical role it plays in our efforts to combat substance misuse and save lives.”


As the day moved on, Secretary Price continued his listening tour but decided to lock out local media outlets.

Congresswoman Carol Shea-Porter blasted them in her statement.

“If an HHS Secretary hosts a so-called ‘opioid listening tour’ and doesn’t allow the public or press to hear it, does it make a difference? People in New Hampshire are tired of hearing all talk on the opioid crisis and no action from Washington Republicans – and in fact, Secretary Price has spent the last few weeks pushing policies that would send us backwards in this fight. Perhaps Secretary Price kicked the press out of his roundtable because he knows his support for kicking millions off health care and ending key heroin-fighting programs is indefensible. Maybe he didn’t want to face the Granite Staters who now have access to treatment for opioid misuse, but who would lose coverage under the Republican health care bill, which repeals the Affordable Care Act’s Medicaid expansion. Or maybe he didn’t have an explanation for why just last week, the White House proposed drastic cuts to the Office of National Drug Control Policy, the office that has been coordinating the federal response to the opioid emergency, and proposed ending the award-winning New England High Intensity Drug Trafficking Area program. Secretary Price and the Trump Administration should get to work on concrete actions that show a real commitment to turning this tide, and to making sure nobody in New Hampshire loses their health care.”

The AHCA would kick an estimated 24 million off their healthcare. It would gut Medicare and give massive tax breaks to the ultra-wealthy.


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