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New Hampshire State House

Testimony on HB 693, a $10,000 Annual Tax on Licensed or Registered Medical Professionals

Jan 31, 2019 by AFP

January 30, 2019

Rep. Lucy Weber, Chairman

House Health, Human Services and Elderly Affair Committee

Legislative Office Building, Room 205

Concord, NH 03301

Re: HB 693-FN-A

Dear Chairman Weber and Members of the Health, Human Services and Elderly Affair Committee,

I am writing today in opposition to HB 693-FN-A, an act relative to aid to persons funded by Medicaid and for persons who are uninsured and establishing a special fund. This legislation would levy a $10,000 annual tax on licensed or registered medical professionals or a $10,000 per licensed or register professional annual tax on facilities that opted against taking patients without health insurance or covered by the state’s Medicaid program.  I apologize that a prior commitment will keep me out of state for the public hearing.

Before discussing the negative consequences of the legislation, there are two important considerations for the Committee.

First, it is critical to understand the continuum of licensed and registered medical professionals is very broad.  It travels from doctors of medicine and dentistry, though other skilled professionals such as psychiatrists, psychologists and alcohol and drug addiction counselors, to massage therapists, athletic trainers and body art practitioners, several of whom would never know the insurance status of their customer base.

Second, the federal Centers for Medicare and Medicaid Services would undoubtedly view this levy as a new provider tax and would be unlikely in the extreme to offer federal Medicaid matching funds, either through enhanced Medicaid rates or through the disproportionate share hospital (DSH) program for any additional payments to providers as a result of this legislation.

Given these factors, the value of adding a new tax on health professionals is bad policy in a number of dimensions.  First, it will drive up the cost of care, particularly for the many New Hampshire families who pay out of pocket.  As the Committee has heard earlier this session, New Hampshire has the highest usage of high deductible health plans in the nation, and the highest family deductible.  These increased costs will magnify an existing problem even further.

In addition, New Hampshire already faces a shortage of medical professionals.  This legislation would exacerbate this problem by giving some practitioners a disincentive to work here, as they could be subject to a $10,000 annual tax.  The would also likely severely disincentivize occasional medical practitioners, such as those who work part-time in New Hampshire as well as those individuals winding down their practices, but who keep a small group of existing clients.  Beyond this, some specialties, such as geriatrics, often tend not to take Medicaid or uninsured patients.  This legislation would have the effect of driving many of these practitioners not to continue to practice in New Hampshire or to choose another state to practice.

Finally, the $10,000 per head cost for facilities would act to discourage new and innovative approaches to treating patients, as well as harming existing facilities.  If these facilities don’t open in New Hampshire or existing facilities here leave, it will reduce competition and choice, which will harm patients by making health care lower quality, higher cost and less accessible.

For all these reasons, we encourage the committee to find HB 693 Inexpedient to Legislate, to send a clear message that we value our health care providers and want to promote choice and competition.

Thank you for your consideration on this important issue for New Hampshire’s health care system.  If you have any questions, please feel free to contact me at or 603-303-9297.


Greg Moore

State Director

Americans for Prosperity-NH