The Anteroom

Jim Monahan’s Top Ten Predictions for 2013 Revisited

Part of the fun in making New Year predictions is looking back to see how you did.  In January 2013, I made ten predictions in the Anteroom blog.  Overall I did ok, but didn’t exactly bat a thousand.  So, below I re-post these with my attempt to rationalize any misses and brag about where I was right.

Look for my 2014 predictions next week.


Crystal Ball

Jim Monahan‘s Top Ten Predictions for 2013 Revisited

1.  Budget Expectations:  They are very high.  Everyone hopes to see their program restored, but without a major overhaul of revenues that will not happen.  The emerging themes will be: (1) integrity in the budget process, meaning – “don’t raid dedicated funds”; and, (2) setting priorities for restoration – “only half of what you think is going to get fixed will, and it will be for folks taking care of the most vulnerable.”

I was more right than wrong on this one.  Expectations were high.  The LCHIP dedicated fund was restored, but the renewable energy fund was robbed of $13 million.  Restoration was stronger than I thought it would be.  However, I missed predicting that the budget would get 24 votes in the Senate.

2.  Obama Care (aka the Affordable Care Act, ACA):  The tasks associated with its implementation will be huge and the volume will be overwhelming for agencies, the budget and to a lesser degree – the House and Senate.  Nonetheless, it will lurch through the agency and budget process in 2013.

Lurching through the process seems about right.

3.  Medicaid Expansion:  Although a part of the ACA has its own course to run and the numbers look big and scary to some in the House and Senate, the upside will be too positive to pass up.  Here again, this will play out in the budget and will likely be the last big issue in the Committee of Conference in late June.

Medicaid Expansion is not over yet.  It was the last issue in the Committee of Conference, and it will continue as a major issue in 2014.

4.  Mental Health:  Again, it will be part of the budget, but with the crisis in hospital emergency rooms, the Sandy Hook shooting, lawsuits and other crises of the day, the pressure is building.  The Department of Health and Human Services (DHHS) recent news release about opening 12 beds at the New Hampshire Hospital is not enough to take the pressure off.  (by the way, even under this plan, those 12 beds will not actually open until July 2013).

I am very happy that this predication was correct.  The Governor’s questions during the House and Senate budget process bravely presented a major investment in the Ten Year Mental Health Plan.

5.  Managed Medicaid:  Although this topic is already getting boring, the inability to form networks, Managed Medicaid Information Systems (MMIS) challenges, and potential legislation trying to delay or stop Phase II will make the challenges of implementing Managed Medicaid in 2013 pretty dim.  In addition, things come to a head in May when rates need to be re-set for 2014.

The concern about difficulties with new rates in May never amounted to much.  While there were delays, MMIS did go live in December 2013.  So, I will take a loss on this prediction.

6.  MMIS:  The switch over is April 1, 2013, and the Hewlett Packard system stops making provider payments on March 10th.  Not likely to go well and could lead to a terrific financial meltdown as DHHS and providers fight over how to get paid.

The MMIS roll-out went off better than I (and others) predicted.  I guess the extra five years delay paid-off.

7.  Public Service of New Hampshire (PSNH) Migration/Death Spiral:  The newest rate increase will most probably lead to a rush of residential customers migrating into the market (look for 100,000 or 25% of residential accounts by June).  This leaves fewer customers to pay an ever-increasing cost.  PSNH will try and get some type of bailout, but will quickly learn that the industry and market have changed too much for them to be helped by the legislature.  This might lead to a divestiture conversation.

Right on the mark (if I do say so myself)!

8.  Northern Pass Transmission (NPT):  They have to take some steps to advance the ball on this project, as the financial communities’ expectations are too high.  However, they have real problems associated with: the Forest Society blocking the route; a well-organized environmental/legal effort (which was able to coalesce over the past two years while the NPT failed to progress); and, historically low gas prices, which have stripped the economics from the project.

Although the project did struggle to draw a new line on the map and claim they have a new route, pretty much all of the challenges they had when this prediction was made remain the same.

9.  Hospitals/Disproportionate Share Hospital (DSH) Program Issues:  Everyone wants a deal, but their expectations are different.  If a deal is struck, it will be a complex one to move through the legislature, especially if not every hospital is happy.  If there is no deal, Managed Medicaid fails and everyone blames the hospitals.  Meanwhile, the core issue of rates too low to sustain the system remains.  But, too many have too much at stake to let this crisis linger.

There was no grand deal, but enough was worked-out to encourage hospitals to join the Managed Medicaid networks.  The rest of a potential deal on the Medicaid Enhancement Tax (MET), and a new federal Medicaid waiver allowing for additional funds is still active, but this issue was not resolved in 2013.

10.  Highways:  Some effort will be undertaken to get needed funding into the highway and betterment programs.  A minor increase in the gas tax combined with a slow ramp-up on registration fees will happen.

Technically, I got this one wrong for 2013.  However, the issue still has some legs and will continue in 2014.