Mental health centers seek new 'tax' to cover free care debts

Feb. 10—Leaders of the state's 10 community mental health centers Monday lobbied for a new tax on commercial insurance premiums to cover up to $20 million a year in free or uncompensated care they provide to lower-income families that can't pay for services.

Roland Lamy, executive director of the Community Behavioral Health Association, said nine of the state's mental health centers had huge losses in free care last year.

Much of this was due to the end of the so-called Medicaid wind down of bonus payments to states.

During the COVID-19 pandemic, Congress approved enhanced reimbursement rates paid to providers under the federal-state Medicaid health insurance plan that covers the low-income, disabled and many senior citizens on fixed incomes.

On average, 75% of the center clients are on Medicaid, Lamy said.

'When services are provided for free, there is no way to shift those costs onto other payors," Lamy said.

The state has in the past used these charges on insurers in similar ways to cover the cost of a vaccine program and a reinsurance pool, he said.

"We have a history of using assessments to deal with tricky health care challenges," Lamy said.

The group is not wedded to this concept but needs relief, Lamy said.

"This trend is concerning and unsustainable for our system of care. This bill is one solution," Lamy said.

Cynthia Whitaker, president and CEO of Greater Nashua Mental Health, said her agency consistently had been dealing with an annual $1 million loss in such free care.

Last year that shot up to $2.5 million.

Whitaker said she ended up covering the bill by taking money that had been set aside to build a new center.

"We are the safety net for community mental health, but we don't have safety net funding," Whitaker said.

Insurance Commissioner D.J. Bettencourt said he's "not a big fan" of the charges against insurance premiums.

"Insurance companies are going to incur that cost and pass it on to the consumer in some fashion. They are not going to just eat it. You have to appreciate that the consumer will feel it in some way," Bettencourt said.

State Sen. Debra Altschiller, D-Stratham, sponsored the bill (SB 136); Sen,. Dan Innis, R-Webster, had authored an identical one but asked the Senate Health Care Committee to kill his bill and work on Altschiller's

Andrew Hosmer, a lobbyist for Harvard Pilgrim Health Care, said commercial insurers operate on a small profit margin and can't afford to pick up the cost and remain financially viable.

"What this does is destabilize our health insurance system in our state, result in higher deductibles and not really benefit access," said Hosmer, the mayor of Laconia and former Democratic state senator.

"This is not what I think the state should be looking to do. This assessment, it's a tax on a company doing its best in a highly regulated market that his highly competitive," Hosmer said.

Anthem's Sabrina Dunlap said the insurer wants to work with providers and lawmakers on ways to help deal with uncompensated care but it too opposed this approach.

State health officials noted former Gov. Chris Sununu and the Executive Council approved last summer a $5 million relief package for these mental health centers, using federal American Rescue Plan Act dollars.

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