Jonathan P. Baird

Article printed in the Concord Monitor – 06/05/2005

As our Legislature wrestles with the budget deficit, a variety of fixes have been suggested. Many center on cutting Medicaid, a joint federal-state program that provides health services to especially vulnerable populations. Medicaid serves around 95,000 people in the state.

These legislative proposals include cutting Medicaid reimbursement rates to hospitals, counties and other medical providers, putting an asset test on the Healthy Kids program and imposing monthly premiums on Medicaid recipients.

The proposals have been put forward in the name of fiscal responsibility. But it is not fiscally responsible to make proposals that ignore significant adverse effects on the health-care system as a whole. A better characterization would be passing the buck.

The suggested Medicaid measures mask cost shifting that ultimately harms consumers of health care along with private businesses. This cost shifting is a budget boomerang that needs to be more widely understood.

The clearest explanation I have seen about health-care cost shifting comes from Doug Hall of the New Hampshire Center for Public Policy Studies. In 2003, Hall reported that New Hampshire Medicaid reimbursed only 77 percent of actual expenses incurred by hospitals. That means taking any Medicaid patient is a losing proposition.

Of course, hospitals will not simply eat the loss. They shift costs to private insurance and private-pay patients to compensate for lost revenue. Hall compares the revenue structure of a health-care provider to a hydraulic system. He says push down on one revenue source and another must rise to compensate.

When public programs like Medicaid fail to pay real cost and do not increase their payments consistent as costs rise, insured and private-pay patients will have to make up the difference. In publications, both Hall and the Business and Industry Association have well described this reality.

Hall reports that in 2001 New Hampshire hospitals shifted $198 million in costs onto insurers and self-pay patients. This amounts to a 23 percent surcharge over the true cost of health care.

Legislators who propose further Medicaid reimbursement reductions are not thinking through the consequences of their actions. Their acts will cause a ratcheting up of costs outside Medicaid while weakening that program.

It is ridiculous that the state has built the Medicaid program on the expectation that health-care providers should donate their services for Medicaid recipients without fair compensation. This amounts to undermining the program. It is not a recipe for any long-term survival.

The problem has gotten much worse during the last decade. Ten years ago, New Hampshire paid much closer to the actual cost of Medicaid patients. According to the New Hampshire Hospital Association, we are now last among the states in the adequacy of Medicaid payment. Our reimbursement rates are nearly 20 percent lower than the national average.

Further underpayment of Medicaid has additional dark sides. More medical providers will limit access of Medicaid patients in the future because of the steeper financial loss. When care is denied, the patient in need will still be there. If the patient gets care, the likely place will be an ER and the likely result of the delay will be more expensive treatment due to a worsened condition.

I am no expert, but I expect the Medicaid cost shifting is approaching a breaking point. Public rates are too low and private rates are too high. Something will have to give. Yet the government, in effect, looks away.

At its best, New Hampshire is a genuine community based on a shared sense of caring. A community must take care of its members. We need an organized way of helping the sick and infirm. It undermines our community when Medicaid is significantly under-funded.

Fiscal responsibility requires adequate public funding, in part, so that the private system does not pass on even more exorbitant price increases that would turn health care into an even more unaffordable commodity than it is at present.

In stepping back from the immediate crisis, I find it embarrassing that our neighbor Vermont can actively consider universal health care while we remain mired in a dispiriting, backward-looking legislative debate that will deny care to more citizens. It is time New Hampshire moved in a different direction.

Article printed in the Concord Monitor – 03/23/2005

The Legislature is poised to take up again the issue of raising the state’s minimum wage. House Bill 665, which has many sponsors, including Rep. Sandra Keans, Rep. Terie Norelli and Sen. Dick Green, proposes to raise the minimum wage from $5.15 an hour to $6.65 an hour over a three-year period. The bill proposes yearly 50-cent increases.

This will be the fourth attempt at the state level to raise the minimum wage over $5.15 an hour. It has been eight years since the last increase. Last year, the House speaker broke a tie vote to kill the bill. Before that, the House had passed an increase, but the bill died in the Senate.

The reasons to raise the minimum wage are both moral and practical. As an economic justice issue, it is fundamentally about fairness for low-wage workers. There is a core value in America that if you work hard, you should be treated fairly and you should have adequate resources to provide for your family. That means full-time workers should be paid enough to feed their families and put roofs over their heads without government assistance.

The current minimum wage fails to protect low-income families against hunger and homelessness. A wage of $5.15 an hour does not provide enough income to pay for basic necessities. Finding affordable housing in New Hampshire on that wage would be a miracle.

A minimum wage increase is not a guarantee against economic hardship. No doubt, families will still struggle. But an increase would provide more tangible help to pay for food, rent or medicine. Having a little more money might prevent an eviction, a utility shutoff or repossession of a car needed to get to work.

During the last eight years, while the minimum wage has stagnated, the cost of living has risen. Consider gas prices or rents. When the minimum wage does not keep pace with living costs, its value erodes.

The value of the minimum wage in 2005 is less than it has been in 46 out of the last 48 years. The minimum wage is worth only 33 percent of the average American wage, its lowest level since 1949. The minimum wage was instituted in 1938 and reached its peak value in 1968.

There has been one unrecognized cost in the erosion of value of the minimum wage. More people need to seek town, city or state government to survive because their wages have not kept up with the cost of living.

Welfare, food stamps and fuel assistance see more applicants. Government ends up subsidizing the businesses that pay bottom-of-the-barrel wages.

Polls and referendums find raising the minimum wage is overwhelmingly popular. In the last election, in two red states that voted for George Bush, voters approved ballot measures to raise the minimum wage by $1, to $6.15 an hour.

In Florida, over 70 percent of voters supported the increase. In Nevada, over 68 percent supported it. In these states, hardly liberal bastions, the minimum wage increase won in every county in both states. A new poll by the nonpartisan Pew Research Foundation found that 82 percent of Americans stated that raising the minimum wage was an important priority. Only 6 percent opposed an increase.

In New England, all our surrounding states have raised the minimum wage above $5.15. Vermont is at $7 an hour, Massachusetts $6.75 and Maine $6.35. The latter two states are considering additional increases. Rhode Island is at $6.75, and Connecticut leads at $7.10.

Having observed the debate over this issue over the years, I believe most opponents of the increase in New Hampshire do not think there should be any minimum wage. They see a wage floor as intrusive government regulation of the marketplace.

There has been no consistency in opponents’ arguments. Arguments have included: not enough people would be affected; too many people would be affected; and small business would be hurt.

Having a minimum wage protects the value of work and the idea that work should be rewarded fairly. Without an hourly wage floor, employers could exploit the lack of bargaining power of low-wage workers. Nothing in the market would prevent a down spiral in worker pay scale. Pretty soon, some employers could be offering the equivalent of Third World wage

Congress will not act on the issue. Even though Congress has given itself cost-of-living pay raises five years in a row, the U.S. Senate failed to step up when it recently defeated the minimum wage amendment to bankruptcy legislation.

A modest minimum wage increase like that presented by House Bill 665 makes good economic sense, and it is the right thing to do.

Article printed in the Concord Monitor – 02/22/2005

The Legislature will soon debate two bills that seek reconsideration of laws that allow judges and police officers to seize guns in domestic violence cases. Rep. Howard Dickinson, a Republican from Center Conway, is sponsoring a bill to study gun seizure law, and Rep. Richard Kennedy of Contoocook is promoting a bill to reshape the law itself.
Neither bill deserves support. When the Legislature reformed the domestic violence laws several years ago, the issue of guns and domestic violence got extensive review. There was testimony from all sides at a public hearing in Representatives Hall.
After months of deliberation, legislators decided that people who committed domestic violence forfeited their right to possess guns for the 12 months of their restraining order. Unless the abuser poses a continuing threat, courts will return the guns after the year is up.
There is no good reason to revisit this law now.
The reasons for the seizure law are straightforward. The most important is public safety. Gun seizures may save lives. Removing guns lessens the chance of homicide and suicide by taking one risk factor out of the equation.

Domestic violence commonly features heightened emotional volatility. Out-of-control anger may not be far from homicidal rage. In a heartbeat, in the context of an argument, guns can turn domestic violence into homicide. Taking the guns makes it harder to murder.

It is not as though we lack experience with domestic violence-related homicide. Two-thirds of our homicides in New Hampshire are connected to domestic violence. That is a long-standing pattern consistent with national figures.

Women are far more likely to be killed by a spouse, an intimate acquaintance or a family member than by a stranger. Most often, it happens during an argument. Guns are the most common murder weapon.

It is hard to miss the almost routine homicide stories that appear in the media with numbing regularity. The story varies little: A current or former boyfriend or spouse shoots an abused girlfriend or wife. Then the boyfriend or spouse kills himself, explaining he would rather die than see his ex with a new lover.

I received my own education on the role of guns in domestic violence cases from my former client, Karen. She and her ex-husband had an ongoing custody battle after their divorce.

Karen’s ex-husband always had multiple weapons on his person, including guns and knives. He wore a shoulder holster and an ankle holster. He maintained a large gun collection in his mobile home. It was like every day he was preparing for a battle.

Gun display was his form of intimidation. He had previously threatened Karen while holding a gun to her head. He made death threats. To the great distress of his son, he shot and killed the family dog. He used weapons to communicate physical menace and to try and keep Karen in line.

He also specialized in psychological abuse. He consistently belittled Karen and called her demeaning names. Everything was always her fault. He never could see his responsibility.

Years after the divorce, he continued to stalk Karen. He would park across the street from her apartment and monitor her whereabouts, her activities and her visitors. He kept a log detailing what he observed, including descriptions of visitors, their license plate numbers and speculation about Karen’s activities of which he disapproved.

During the course of the case, I obtained a copy of the log he maintained. It included almost daily entries and read like he was a private investigator or a police officer. After the court issued a restraining order against him, he contacted me and claimed he was the victim of an elaborate plot hatched by his ex-wife and her supporters.

In an article in the Monitor in early January, Rep. Dickinson stated there is excessive paranoia about guns and they may have nothing to do with a couple divorcing. He believed the gun seizure laws demonstrate too much caution. He also expressed concern about the lack of care given to valuable guns after they are confiscated by the police.

Such comments trivialize domestic violence and the well-documented role guns have played in homicide and intimidation. No right, including state constitutional rights about guns, are absolute. Domestic violence abusers lose their right to possess weapons because of their behavior, not their beliefs.

I am curious if the legislators sponsoring the study bill think convicted felons or those with severe mental illness should still have access to weapons. Maybe they want a study committee about that, too.

Rep. Kennedy’s bill reads like a Batterers’ Protection Act. He proposes raising the burden of proof in all civil domestic violence cases to make it harder to prove abuse. And, surprise, he wants to make it far harder to remove weapons. His bill would be a comfort to abusers everywhere.

These bills are sour grapes. Some pro-gun legislators did not like the law change requiring removal of weapons if the court finds abuse. Giving a domestic violence abuser a gun makes about as much sense as putting a drunken driver behind the wheel. In this instance, it appears that pro-gun legislators care more about their precious guns than precious lives lost.