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New Study Gives Medicare Advantage Edge in Quality of Care

Medicare Advantage is the best bet for seniors looking at their options as the open enrollment period begins, according to a new study published by the “Journal of the American Medical Association (JAMA) Health Forum.”

Medicare Advantage, also known as Medicare Part C, gives seniors a choice about how to get their medical services delivered over the traditional fee-for-service Medicare plan. According to the JAMA study, that choice also gives seniors better value and better care.

Examining data from nearly two million Medicare beneficiaries, the JAMA-published study concluded that “those enrolled in MA had lower rates of hospital stays, emergency department visits, and 30-day readmissions.” Additionally, the study noted that “[a]mong Medicare beneficiaries with complex care needs, those enrolled in MA had lower rates of acute care utilization, suggesting that managed care activities in MA may influence the nature and quality of care provided to these beneficiaries.”

Medicare Advantage provides health care plans offered by approved private coverage providers. Unlike government-run fee-for-service Medicare, Medicare Advantage plans can cover additional services that seniors rely on and depend upon, such as prescription drugs and routine eye and dental care.

The option currently enjoys broad bipartisan support in Washington, with all four members of New Hampshire’s federal delegation calling for more support for Medicare Advantage earlier this year. Sen. Maggie Hassan was part of a group of 62 lawmakers who signed off on a letter supporting the program.

“We write to express bipartisan support for the Medicare Advantage program and the high-quality, affordable care it provides to over 27 million older adults and people with disabilities,” the letter read, signed by members as ideologically diverse as Sens. Mazie Hirono (D-Hawaii) and Tommy Tuberville (R-Ala.)

In September, both Reps. Annie Kuster and Chris Pappas joined the House of Representatives in passing a bill on a voice vote to make it easier for seniors using MA to get approval for treatment and prescriptions.

Traditional fee-for-service Medicare does not limit seniors’ out-of-pocket costs and copays. As a result, beneficiaries pay nearly $2,000 more per year in total healthcare-related costs than those enrolled in Medicare Advantage plans.

Because Medicare Advantage relies on the private sector, some more progressive politicians oppose the option and have tried to limit its expansion or even kill it entirely. The progressive magazine “The American Prospect” wrote about Medicare advantage, and their opposition to it, in a piece headlined “The Dark History of Medicare Privatization.”

Last week, Hassan, Pappas, Kuster, and Sen. Jeanne Shaheen signed a letter urging the Centers for Medicare and Medicaid (CMS) to protect eligible New Hampshire Medicare beneficiaries subject to aggressive and potentially predatory marketing tactics related to the sale of Medicare Advantage (MA) plans or other insurance products.

However, based on the data, it appears seniors are satisfied with both the coverage and the quality of care received.

According to the non-partisan Kaiser Family Foundation, Medicare Advantage enrollment has doubled over the last 15 years. Currently, 32 percent of Medicare-eligible Granite State seniors choose Medicare Advantage over traditional fee-for-service Medicare.

Reports from the Better Medicare Alliance, a research and advocacy group, indicate 95 percent of Medicare Advantage beneficiaries are satisfied with their network of care and a full 88 percent say Medicare Advantage gives them more flexibility and choice.

A separate study published by JAMA found Medicare Advantage beneficiaries received 9.2 percent fewer “costly, potentially harmful” low-value services than fee-for-service Medicare enrollees. In other words, Medicare Advantage beneficiaries received better-quality care.

 

Vax Exemption Bill Could Cost NH Billions, Critics Warn

New Hampshire is going to lose billions of dollars in federal funding and cripple its health care system if the legislature passes a bill to expand vaccine exemptions, health industry officials warned Wednesday.

The Senate Health and Human Service Committee heard testimony on HB 1210, which would mandate that all New Hampshire employers give nearly automatic exemptions to vaccine requirements to employees who request them. Critics of the bill concede the state has the power to regulate businesses that way if they choose. The problem, the critics say, is the federal government has its own vaccine requirements in order to receive Medicaid and Medicare funding.

Forcing hospitals, nursing homes, and other healthcare providers to hire unvaccinated healthcare providers could cost the state billions in lost federal dollars.

Paula Minnehan, with the New Hampshire Hospital Association, said if the bill passed, her members would be in danger of losing certification from the Center for Medicare and Medicaid Services, and the funding that comes with that to care for patients.

“This bill is in direct conflict with CMS requirements.,” she said. “The funding at risk for New Hampshire hospitals alone is $2.3 billion.”

That figure does not include county and private nursing homes, community health centers, medical specialists, primary care practices, and other parts of the healthcare system that rely on federal funding.

Kate Horgan, with the New Hampshire Association of Counties, said the bill could also cost county nursing homes millions, and that financial pain would also radiate out to the private facilities that contract with counties for services. Rockingham County alone would lose $30 million in federal funding.

“You will be putting the entire long-term care system at risk,” Horgan said.

The bill would impact hospitals, county nursing homes, primary care doctors who accept Medicaid and Medicare patients, and potentially private contractors who perform services for state and local governments. New Hampshire’s hospitals could lose as much as 70 percent of current revenue, leading to bankruptcies, closures, and loss of care for many New Hampshire residents. 

The bill’s prime sponsor, state Rep. Tim Lang (R-Sanbornton), said all he is trying to do is codify into law the current standard procedure for medical and religious exemptions, while also adding an exemption for non-religious “conscientious objectors” to vaccines.

“This is probably the most misunderstood bill in this session,” Lang said. “This isn’t about vaccine mandates; this is strictly about procedure.”

The federal government does not recognize the “conscientious objector” exemption for vaccine requirements and adding it to state law would push New Hampshire out of line with federal standards.

Lang’s take on the current procedure employers must follow isn’t reality, according to Andrea Chatfield, an employment attorney with the Human Resources State Council of New Hampshire. Instead, the bill would take away rights from employers, hinder their ability to have a safe workplace, and open the businesses up to potential liabilities and lawsuits, she said.

“This bill completely strips rights from employers,” Chatfield said. “The bill does not understand the reasonable accommodation process.”

David Juvet, with the Business and Industry Association, said the bill goes so far as to negatively impact other aspects of managing a safe workplace. Businesses couldn’t enforce a “no shoes, no shirt, no service” rule for customers, and it would end the handwashing requirement for employees.

“This is not the most misunderstood bill of the session. If we oppose it, it is not because we misunderstand, it means we understand it all too clearly,” Juvet said.

Some Republican HB 1210 supporters privately grumble the healthcare industry is playing Chicken Little, predicting the sky will fall. They say it is unlikely the federal government would cut off an entire hospital from Medicare funding over a few unvaccinated employees.

Steve Ahnen, president of the New Hampshire Hospital Association, says they’re wrong.

“According to the Centers for Medicare and Medicaid Services’ most recent guidance on vaccine requirements for hospitals and other health care institutions that participate in the Medicare and Medicaid program, ‘The sole enforcement remedy for non-compliance for hospitals and other acute and continuing care providers is termination,'” Ahnen said. “If passed, HB 1210 would put their Medicare and Medicaid funding at risk.”

Debby Scire, president of New Hampshire College and University Council, argues the impact of the bill would be felt far beyond healthcare. She argues that, as written, the bill would end all vaccine requirements, not just for COVID-19.  That is a potential health disaster for college campuses, she said.

“As written, it means college could not impose MMR (Measles/Mumps/Rubella) and meningitis vaccine mandates,” she said.

Anne Marie Mercuri, an immunization expert with the New Hampshire Department of Health and Human Services, said a meningitis outbreak would be devastating for the state.

“This bill places New Hampshire residents at increased risk of disease, disability, and death,” she said.

DHHS is opposing the bill as it risks public health through increased infections, as well as causes the state’s health system to become suddenly and severely underfunded.

The committee is set to vote on the bill during an executive session next week.

Bolduc’s ‘Reckless’ Comments About Russia Spark Criticism, Calls to Withdraw

Gen. Don Bolduc’s appearance on Fox News was meant to highlight his military bona fides. Instead, it sparked a backlash from a respected Pentagon reporter and a call for him to drop out of the U.S. Senate race from at least one prominent Republican.

“Don Bolduc made reckless, dangerous, irresponsible comments regarding the escalation of the Ukraine war which renders him unqualified to serve as a U.S. Senator,” said Republican Corky Messner. “There are 100 Senators who will be called upon during these times to make critical decisions. Bolduc cannot be trusted to make those decisions.”

Messner defeated Bolduc in the 2020 GOP primary before going on to lose to incumbent Democrat Sen. Jeanne Shaheen. He was outraged by Bolduc’s comments on “The Next Revolution with Steve Hilton” Sunday night. And he wasn’t alone.

In the interview, Bolduc repeatedly claimed there were direct military actions the U.S. and NATO could take against Russian forces in Ukraine. He suggested the CIA or military could “get in there on the ground” in Ukraine, using “indirect fires and direct capabilities” to attack Russian targets. At one point, he said the U.S. could use “special operations troops in a way that we get in there,” though without “boots on the ground.”

His comments were viewed as so extreme, Fox News Pentagon correspondent Jennifer Griffin called them out when she appeared on the show a few minutes later.

“I have to respond to comments from Gen. Bolduc,” Griffin said. “He really was way off the mark talking about what the U.S. really could do on the ground.

“Clearly, Brig. Gen. Bolduc is not a student of history. He’s a politician. He ran for Senate in New Hampshire and failed. He is not a military strategist. To suggest the U.S. would put an indirect fire or special operations or CIA on the ground to give Putin any excuse to broaden this conflict is extremely dangerous talk at a time like this.”

“I was surprised to hear it,” the host replied.

It was not Bolduc’s first media misstep. In November, he was roundly criticized for calling Republican Gov. Chris Sununu a “Chinese Communist sympathizer” whose family business “supports terrorism.” Bolduc also claimed he drove the governor from the U.S. Senate race.

Messner says enough is enough.

“Politician Bolduc has a reputation for outrageous, divisive political comments which demonstrates that he has very poor judgment. In the past, Bolduc’s comments could be laughed off, walked back, or cleaned up by his supporters,” Messner said.

“But now, Bolduc’s extreme comments are dangerous to all Americans, your sons and daughters, Ukraine, Europe, and the world. Politicians must have the prudence and judgment to avoid statements that potentially could push the Ukraine conflict to a wider war. Don Bolduc does not have that prudence and judgment.

“I am calling for politician Don Bolduc to withdraw from the New Hampshire U.S. Senate race and to end his campaign.”

Not surprisingly, the Bolduc campaign is not ready to fold up its tent. Asked about Jennifer Griffin’s criticism, the campaign declined to comment.

UPDATE: After this article was published, Bolduc’s spokesperson Jimmy Thompson sent this statement:

“If recent world events have taught us anything, it’s that American leadership matters on the international stage. As usual, Senator Hassan has been missing in action, and needs to be replaced. But you can’t defeat a career politician like Senator Hassan with another career politician like State Senator Morse or Town Manager Smith. It’s going to take a true outsider like General Bolduc, and that’s why he is the frontrunner in this race.”

 

Families, Students Push Back on Efforts to Repeal EFAs

New Hampshire parents and students crowded the State House Tuesday to testify against Democratic Sen. Jay Kahn’s bill to repeal the state’s Education Freedom Accounts.

“I implore you, do not eliminate the Education Freedom Accounts, this program helps so many students and their families,” said Emma Jackson, a sophomore at Holy Family Academy in Manchester. 

Jackson, like many students who testified, has been able to go to a private school for the first time thanks to the EFA’s. The program “funds students instead of systems,” as school choice advocate Corey DeAngelis of the American Federation for Children puts it. The state’s share of a child’s public school funding follows the student to other education options like private or home schooling.

The program, in its first year, has more than 1,600 participants.

“Currently, most of the families that are using the Education Freedom Accounts are low-income families,” said Kate Baker Demers, executive director of the Children’s Scholarship Fund of New Hampshire.

Baker Demers said low-income families have struggled for years to get their children into schools where they can learn. They have also struggled to get their children the right education materials. Now they have the freedom to make the best choices for their families, she said.

“The families that are using them are extremely grateful and think it is right and just that they have access to their education funding,” she said.

Kahn, a Keene Democrat, is concerned that the success of the program will spell trouble for taxpayers down the road. He said the program is costing more than $8 million this year and is expected to double next year. On top of that, Kahn said, the state has cut funding for public education by more than $80 million in the current two-year budget. 

“Every child deserves access to an adequate education, but this isn’t the way to do it,” Kahn said.

Meanwhile, per pupil spending on k-12 education has risen during Gov. Chris Sununu’s administration to the highest level ever.

New Hampshire’s public schools lost more than 8,000 students in the last year as more parents grew frustrated with COVID-19 imposed-remote learning, among other problems. Baker Demers said parents realized during the pandemic that there are more options than their local public schools that fit their family needs better, and those options were finally within reach.

“They didn’t have these options without the EFAs,” she said.

Some Democrats opposed to EFA’s, like Rep. Marjorie Porter (D-Hillsborough) send their own children to private schools while opposing allowing state funding to follow low-income kids to these same schools.

“I certainly understand the need for families to find an alternative to public schools to meet the needs of their children,” Porter testified. “My own two children attended the same public school where I taught. My daughter was fine with it, but not so my son. He was experiencing difficulties, so we sent him to a local private school until he was middle school age. It was good that we had that option.”

Porter has filed a bill in the House to prevent local property taxes from going to religious schools, harkening back to 1870s efforts to stop Catholic schools from receiving public funding. A 2020 U.S. Supreme Court ruling found a state cannot prevent money from going to religious schools if it offers parents grants for education. 

Rep. Rosemarie Rung (D-Merrimack) mocked families who need the grants on Twitter, calling EFA’s handouts.

“My parents sent all 4 of their kids to Catholic school on a USAF officer salary and they would never, ever expect a government handout to do so,” Rung wrote on Twitter.

Baker Demers said low-income families deserve equal opportunities when it comes to education, and EFAs provide those opportunities.

“That’s the point, to overcome those inequalities,” she said.

“These are students who struggled in their old learning environment for a variety of reasons from bullying, learning difficulties, or health concerns,” said Sarah Scott from Americans for Prosperity New Hampshire. AFP-NH was heavily involved in the passage of EFAs and the Americans for Prosperity Foundation spent last summer spreading awareness of the new program to parents.

Families, Scott says, “are ecstatic to have been given the chance to have their children learn in a setting that helps them to thrive.”

Kahn said EFA’s downshift costs for public education onto local property taxpayers, an assertion advocates deny. Sen. Denise Ricciardi (R-Bedford) said the tax money is following the child through the system, and it will not result in higher taxes.

That is true in part because, while state funding follows the student, local funding remains in the schools. As a result, every student who uses an EFA leaves behind around $10,000 or more for their former school to spend on the remaining students. More money, but fewer students.

Regardless of the math or the praise of parents, the state’s teachers unions still oppose the EFA program.

This is a multi-million-dollar example of failed leadership that will ultimately hurt our kids,” said Meg Tuttle, president of the NEA-NH, the state’s largest teachers union. 

Tuttle did not elaborate on how families choosing what they believe are better education choices for their children “will hurt kids.”

Senate Majority Leader Jeb Bradley (R-Wolfeboro) was a  prime sponsor of the legislation creating EFA’s last year. He made it clear this week he will fight to keep the program operating.

“Our Education Freedom Accounts have proven to be more successful than anyone imagined. Currently, 1,635 students are enrolled in the EFA program, giving working families the power to choose the best educational path for them,” Bradley said. “The pandemic has shown us the need for greater educational options, especially for families who traditionally could not afford the choices wealthier families have always had.  EFA’s provide that pathway. Students of hard-working families of modest means deserve the opportunity for education choices that best suit their needs.” 

Biden Uses Sununu’s Words to Blame GOP for First-Year Woes

Is Chris Sununu Joe Biden’s favorite Republican?

It sounded that way during the Democratic president’s press conference on Wednesday when he invoked Gov. Sununu’s words to make the case that he has been the victim of Republican obstruction.

Biden took to the lectern facing yet another loss on the legislative front as federal election laws he supports were preparing to go down to defeat in the U.S. Senate. His $5 trillion Build Back Better bill also remains stalled. Meanwhile, his poll numbers have fallen more in his first year in office than any modern president, and 70 percent of Americans say the country is on the wrong track.

Biden said he did not believe polls showing his support among independent voters had fallen to 25 percent, but he does believe he is doing a great job.

“I didn’t overpromise. I probably outperformed what most people thought would happen,” Biden said. In fact, he later added he plans to travel across America in the coming months and talk to the voters face to face, “now that the big problems are fixed.”

As for his high-profile legislative failures on Build Back Better and the federal voting laws, Biden said the blame belongs to the Republicans in the Senate. And he used Sununu’s words to make his case against the GOP.

“I did not anticipate that there would be such a stalwart effort to make sure that the most important thing was that President Biden didn’t get anything done,” Biden said. He then read an excerpt from an interview Sununu recently gave The Washington Examiner about why the New Hampshire governor decided not to run for Senate.

“They were all, for the most part, content with the speed at which they weren’t doing anything. It was very clear that we just have to hold the line for two years. OK, so I’m just going to be a roadblock for two years. That’s not what I do,” Sununu said, noting Republicans were trying to wait until they would hopefully win the presidency in 2024. “It bothered me that they were OK with that,” Sununu said.

“I said, ‘OK, so if we’re going to get stuff done if we win the White House back, why didn’t you do it in 2017 and 2018?’” Sununu asked, saying there were “Crickets. Yeah, crickets,” and that “They had no answer.”

It showed that the most important thing for the GOP was to make sure Joe Biden didn’t get anything done, the president concluded, demanding, “What are Republicans for? Name me one thing they’re for?”

 

 

In fact, Democrats control the Senate and they have the votes to pass Build Back Better, as well as the votes to break the filibuster and pass any legislation they choose. Republicans don’t have the votes by themselves to stop either measure.

But having a prominent Republican like Sununu making the case the GOP is the problem is a political gift to Biden.

Sununu declined to respond to requests for comment after the speech, but GOP strategists and activists in both New Hampshire and D.C. agreed it was a problem Sununu created for himself.

“Attacking Washington is fine,” one Republican strategist said. “Everybody hates Washington. But attacking Republicans in Washington, particularly Republicans in the Senate? Not smart.”

Sununu’s comments aren’t news in New Hampshire, echoing attacks he has repeatedly made on D.C. and the Congress. In fact, earlier in the day, Sununu expressed similar sentiments during an online video event with The Washington Post.

Explaining that he preferred to serve as a governor because you can “get things done,” Sununu said:

“You don’t do that in Washington. That’s not my gig. Nobody does it. Democrats don’t do it. Republicans don’t do it. They are often all too satisfied with just stopping a process. They’re all too satisfied with just being the party of no if they’re in the minority or being a roadblock.

“I think there’s no higher ground there,” Sununu added. “I think Democrats and Republicans are equally to blame for that.”

Music to Democrats’ ears, Republicans say.

“Sununu is myopic,” one D.C,-based GOP strategist told NHJournal. “He’s just thinking about triangulating and not about what he’s handing the Democrats.

“I know he believes he is such a brilliant campaigner, but he just got outmaneuvered by a 79-year-old with a 30 [percent] approval rating.”

Longtime Democratic strategist Terry Shumaker was pleased with Biden’s performance, and Sununu’s role in it.

“I thought he was terrific in a way regular Americans can relate to, especially saying several times in different ways, when you find out what Republicans stand for, please let me know,” he told NHJournal. “Quoting Gov. Sununu saying that all GOP senators want to do is obstruct Biden was a high point too.”

GOP U.S. Senate candidate, state Senate President Chuck Morse, responded to Biden’s comments by mocking the president’s attempt to push the blame onto the GOP.

It wasn’t Republicans that have caused inflation to be the highest it’s been in 40 years. It wasn’t the Republicans that shut down the Keystone Pipeline and made us dependent on Russia and OPEC nations for our energy. It wasn’t Republicans that opened up our borders to anyone that wants to get into the country, including murderers and drug dealers,” Morse said in a statement. “Joe Biden, Maggie Hassan and the Democrats did that, and maybe instead of pointing the fingers at everyone else, they should fix the mess they’ve made of this country.”

 

Sununu Announces, Twitter Reacts

Gov. Chris Sununu’s decision to ditch Washington and run for a fourth term in the Granite State has political Twitter buzzing. Some tweeters are trying to figure out why, some are looking at the impact of Sununu’s bow out, and others are looking at what could happen next.

The New York Times’ Shane Goldmacher said Sununu’s decision not to run could be one of the biggest stories for the upcoming mid-term elections.

 

 

The news did not seem to go over well in Sen. Mitch McConnell’s circle. The Senate minority leader heavily recruited Sununu for months. Here’s McConnell’s former campaign manager, Josh Holmes, shortly after Sununu’s announcement. (Holmes co-hosts the popular “Ruthless” podcast, and Sununu was a featured guest over the summer.)

 

 

Fox New’s Laura Ingraham said no one should have been shocked, and blamed McConnell and other establishment Republicans.

 

 

The liberal magazine, The New Republic, echoed Sununu’s views on life in the U.S. Senate.

 

 

Dave Weigel, a Washington Post reporter, seemed to like Sununu’s path.

 

Raw Story’s Matthew Chapman blamed McConnell for botching the recruit.

 

New Hampshire Bulletin’s Annmarie Timmins raised a possible presidential run.

 

CNN’s Dan Merica took note of how Sununu made the announcement: By going after Washington.

 

The decision is good for the state Republicans, according to Chaz Nuttycombe with CNalysis.

Kyle Kondik with Sabato’s Crystal Ball sees it ultimately helping Hassan.

 

Speculation as to who might jump into the race is getting heated up and Drew Nirenberg, the communications director for Ohio Sen. Rob Portman, threw out a new name.

Corey Lewandowski to NHGOP Senate Candidates: You Can’t Beat Shaheen

Corey Lewandowski says he’s made his decision about a possible 2020 U.S. Senate race and, while he won’t say what it is, he does have a message for the New Hampshire Republicans already in the field:

Don’t bother. You can’t win.

“If I decide to get into this race, it’s going to send shock waves not just across New Hampshire, but through the country,” Lewandowski said on the John Fredericks radio show Thursday. “I wouldn’t do it if I didn’t think I would be successful.”

He doesn’t have the same confidence in the rest of the GOP field: Retired Gen. Donald Bolduc, attorney Corky Messner and former NH House Speaker Bill O’Brien.

“I hear the other [NHGOP] candidates can’t raise money for a litany of reasons. If I said today ‘I’m out of the US Senate race’… it’s not like they’re going to raise $10 or $20 million tomorrow. Let’s not kid ourselves.

“The only person who potentially can get in this race who has a national profile is Corey Lewandowski. And the only person who’s going to send Jeanne Shaheen home permanently, if I do get in the race, is going to be me.”

“People can argue it,” Lewandowski added, “but that’s just the truth.”

Lewandowski, who says he’s currently advising the Trump/Pence 2020 campaign, told Fredericks he’s discussed his possible candidacy with President Trump, Vice President Pence and Trump campaign manager Brad Parscale.

Lewandowski also predicted that impeachment would make Democratic incumbent Shaheen easier to beat in November. “I’ve weighed my calculation based on what impeachment will mean for a U.S. Senate race and I think Jeanne Shaheen is very vulnerable because I believe she will vote in lockstep with AOC and Speaker Pelosi to remove a duly-elected president.”

When Fredericks said it sounds like Lewandowski’s decided to run, the former Trump campaign manager didn’t disagree.

“Well, I’ve been brushing up on foreign policy,” Lewandowski said. “I’ve spent an enormous amount of time understanding some issues that I wasn’t as well briefed in as an incumbent U.S. Senator would be. If that gives you an indication of what my decision is, I’ll leave it at that.”