Tuesday is not just primary day in New Hampshire, it's also when the State Supreme Court will hear arguments in the case of Dartmouth-Hitchcock Medical Center vs. Nicholas Toumpas; Toumpas being the commissioner of New Hampshire's Department of Health and Human Services.
"We are at war with the State of New Hampshire right now," said John Clayton, vice president of communications at the New Hampshire Hospital Association (NHHA).
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NHHA represents 26 member hospitals, and 10 of those are currently engaged in the federal lawsuit regarding what Clayton claimed is "inadequate Medicaid reimbursement," or DSH, as in Disproportionate Share Hospital of reimbursement. Elsewhere, it's come to be known as Mediscam.
"After 20 years, in this case, the state decided not to return the money to the hospitals but instead to keep it," Clayton explained, adding "which we contend amounts to a whopping 5.5 percent tax on hospitals in New Hampshire."
The cuts are already taking a toll.
"There have been layoffs because of it. Obviously, that's affected some physicians more than others," said one New Hampshire-based physician requesting anonymity. "It is something that we need to be concerned about because anything that affects the financial health of our local health services is important. Hospital services certainly have shut down because of it – and that impacts patients."
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New Hampshire is not the only state to face such a lawsuit. California is another, wherein several physician groups sued the state over a 10 percent reimbursement reduction. These lawsuits point to a much larger problem, according to John Graham, director of health care studies at the Pacific Research Institute.
"The fact is that having a judge say that a state cutting Medicaid reimbursement rates violates federal law, well that's very exciting for the short-term but that is not a solution because the fiscal reality is the states just don't have the money," Graham said. "So this is a kind of judicial fantasy that is not going to work. The hospitals need to think of a different model for taking care of poor people. Relying on the never-ending cash flow of Medicaid payments from state and federal government, those days are finished."
Toumpas and the New Hampshire Department of Health and Human Services' Public Information Office did not respond to interview requests for this article.