A New Hampshire Union Leader editorial promoted inaccurate claims regarding the Affordable Care Act (ACA), including an exaggeration of the effects of the ACA on employee benefits, a false claim on rising premium prices, and a warning that Medicaid expansion would shift costs to hospitals, even as the hospital community praised the ACA for being financially beneficial.
Union Leader Claims Companies Are Likely To Reduce Benefits In Reaction To Rising Costs ACA
Union Leader: Organizations Will Be Forced To Cut Employee Benefits. The New Hampshire Union Leader cited CNN's report that the University of Virginia will no longer cover spouses (provided they can obtain insurance through their own employer) as proof that organizations will reduce benefits to most employees:
CNN counted three fees, one tax and the individual mandate as Obamcare provisions that “are certainly pushing up health insurance costs for employers...” The University of Virginia is dropping coverage for spouses who have their own insurance option because Obamacare will add $7 million in costs to its current coverage, university officials have said.
Though some companies were making similar changes before Obamacare, as CNN noted, “The ACA is definitely escalating the pace of change,” a health care consultant told the network. [New Hampshire Union Leader, 8/31/13]
Employers Overwhelmingly Opted To Continue Spousal Health Insurance Coverage
The National Business Group On Health: Only 12 Percent Of Employers Will Exlude Spouses From Coverage In 2014. A report by the National Business Group On Health concluded that despite an increase in termination of benefits for spouses covered by their own employer, only 12 percent of all businesses studied will expect to exclude spouses from coverage in 2014, up from 4 percent of businesses that did so in 2013:
[National Business Group On Health, March 2013]
Bloomberg: Shifting Cost From One Employer To Another Is Not Necessarily A Bad Thing. As a Bloomberg editorial suggested on August 22, what UVA and other organizations have done may not negatively impact spouses because they will maintain health care coverage and organizations will save money:
No one can blame companies for wanting to shift the cost of covering some workers' spouses to those spouses' employers. But such a shift needn't lead to any loss of coverage -- a happy outcome that Obamacare makes more likely, not less. [Bloomberg, 8/22/13]
Bloomberg: Organizations Will Shift Spousal Coverage Despite ACA Savings, Not Necessarily Because Of ACA Costs. Bloomberg's editorial also suggested that organizations that are shifting spouse coverage to their employers may be reacting to high premiums and rising health care costs that will be reduced by the ACA. Bloomberg looked at UPS's situation, which, like UVA, excludes spouses from coverage if it is offered by their employer, and concluded:
UPS also says its new policy is needed because of the “rising cost of health care in general.” Yet this cost is rising far more slowly than it was before the Affordable Care Act was passed. Annual premiums for employer-sponsored family health coverage are up only 4 percent this year, according to the Kaiser Family Foundation. Over the past decade, they have generally been rising about three times faster. And the slowdown appears to be occurring in part in response to the new law. [Bloomberg, 8/22/13]
Union Leader Claims Premium Prices Will Rise For Most Americans
The Union Leader: Premiums Will Rise For Most Americans. The Union Leader relied on an August 29 National Journal report to conclude that “the vast majority of Americans” will pay higher premiums due to the ACA:
National Journal reported last week: “For the vast majority of Americans, premium prices will be higher in the individual exchange than what they're currently paying for employer-sponsored benefits, according to a National Journal analysis of new coverage and cost data. Adding even more out-of-pocket expenses to consumers' monthly insurance bills is a swell in deductibles under the Affordable Care Act.” [New Hampshire Union Leader, 8/31/13]
Premiums Will Likely Remain The Same Under The ACA
RAND: “Nongroup Premiums Are Estimated To Remain Unchanged At The National Level.” The RAND Corporation's report, The Affordable Care Act and Health Insurance Markets, concluded that many Americans would see little change in premium prices, and stressed that premiums will vary based on several factors:
Our Analysis suggests that comparisons of average premiums with and without the Affordable Care Act may overstate the potential for premium increases. Sweeping statements about the effects of the Affordable Care Act on premiums should be interpreted very carefully because the law has complex effects that differ depending on individuals' age and smoking status, the actuarial value of the plan chose, individuals'' eligibility for federal tax credits, and state implementation decisions. Once we adjust for age, actuarial value, and tobacco use, nongroup premiums are estimated to remain unchanged at the national level and in many states. Further, after accounting for tax credits, average out-of-pocket premium spending in the nongroup market is estimated to decline or remain unchanged in all states considered and in in the nation overall. [RAND Corporation, Accessed 9/4/13]
Union Leader Claims Medicaid Expansion Will Place Fiscal Burden On New Hampshire Hospitals
Union Leader: New Hampshire's Hospitals Will Financially Suffer If Medicaid Is Expanded Under The ACA. The Union Leader citied a Lewin Group study that looked at the impact of Medicaid expansion in New Hampshire to claim that the state's participation in Medicaid expansion “would cost hospitals $228 million.” The editorial explained that the cost comes from low-income people dropping their insurance and applying for Medicaid coverage as they become eligible under the expansion. [New Hampshire Union Leader, 8/31/13]
Cherry Picking Hospital Data Downplays Overall Positive Benefits Of Medicaid Expansion
The New Hampshire Hospital Association Supports Not Just Hospitals, But Health Care Systems. A December 2009 report by the New Hampshire Hospital Association (NHHA) explains the collaborative efforts of treatment facilities that make up a health care system:
Traditionally, acute care hospitals have included inpatient care and emergency room services, 24/7. However, it is important to understand that acute care hospitals have changed. In response to diverse health care needs and to adapt to a changing, complex environment, acute care hospitals in New Hampshire are now systems of local health services that may include: primary care and specialty care physician practices; ambulatory surgery centers; health centers or clinics; assisted living or skilled nursing care facilities; home care or hospice services; rehabilitation therapy centers, etc. For example, primary care physician practices are more often becoming part of a “hospital system” because independent practices are not as financially viable. Assisted living facilities within a hospital system are often in response to an aging population. [New Hampshire Hospital Association, December 2009]
The Lewin Group: Health Care Systems Will See Uncompensated Care Reduced By $340 Million “With Or Without The Medicaid Expansion” And Increased Profits. According to the Lewin Group's study, health systems -- which include hospitals, physician groups, skilled nursing facilities, freestanding surgical centers and home health agencies -- in New Hampshire are likely to benefit from a significant reduction in uncompensated care as well as a 28 percent increase in profits under the Medicaid expansion model:
Using the Lewin Group Health Benefits Simulation Model for the state of New Hampshire and data provided by the New Hampshire Hospital Association (NHHA), we estimate uncompensated care (bad debt, charity care, and undercompensated care due to below-cost Medicare and Medicaid payments) for New Hampshire health systems, which include the hospital as well as other entities owned by the system, such as physician groups, skilled nursing facilities, freestanding surgical centers and home health agencies. Here, health systems in the state could see uncompensated care reduced by about $340 million (4 percent) under the ACA with or without the Medicaid expansion (Figure E-7). This is due to the take-up of commercial coverage anticipated in reaction of the individual mandate.
As shown in Figure E-8, we estimate that health systems would see an increase in net income of about $113.1 million under the Medicaid expansion assuming full implementation in 2014, which would represent a 28 percent increase from their current net income. [The Lewin Group, January 2013]
Kaiser Family Foundation: Medicaid Reimbursements Will Increase 50 To 99 Percent In New Hampshire Due To The ACA. According to a December 2012 report on Medicaid expansion by the Kaiser Family Foundation, Medicaid reimbursements will increase 73 percent on average nationally, and will increase between 50 and 99 percent in New Hampshire:
[Kaiser Family Foundation, December 2012]
Concord Monitor: Doctors And Hospitals Agree That Medical Expansion Is Financially Beneficial. According to the Concord Monitor, medical providers were in support of expanding Medicaid citing financial benefits and improved health care for citizens:
Medical providers - hospitals and community mental health centers, doctors and nurses - presented a united front yesterday in support of expanding New Hampshire's Medicaid program.
“We see it both as a public health and an economic imperative for our state,” said Henry Lipman, senior vice president for financial strategies and external relations at LRGHealthcare, to the state commission studying Medicaid expansion as it met in Representatives Hall. [Concord Monitor, 8/27/13]