In the past two days, Democratic presidential candidate Hillary Rodham Clinton has criticized an Iowa plan to transition to managed Medicaid and said New Hampshire residents in particular would be harmed by the proposed mergers of health plan giants.
Clinton argued that the planned merger between Anthem and Cigna could raise market concentration in New Hampshire, the state with the first presidential primary, to "excessive levels."
She failed, however, to follow up with a reason why. A request for comment to Clinton's campaign was not immediately returned.
Iowa leads off the primary voting season with its caucuses on Feb. 1, followed by New Hampshire's primary on Feb. 9.
Clinton's comments were immediately criticized by industry, who pointed to medical loss ratios and an arbitrary cap on profits as ways to curb outlandish profits.
But details aside, giving New Hampshire a shout out was a smart move, according to Jayme Simões, president of New Hampshire-based health policy consulting group Louis Karno & Company Communications.
“Her comments show she is honing in on an issue that people are paying attention to,” Simões said.
Competition among the state health plans is important in New Hampshire as Anthem dominates 60% of the market, according to Tom Mahrer, a regional director for the Healthcare Leadership Council. Cigna is a smaller player in the state, covering roughly 6% of the market.
Clinton's comments could make her stand out to voters as her leading competitor, Sen. Bernie Sanders of Vermont, has yet to comment on the potential merger, and Republicans are focused on repealing the Affordable Care Act, he said.
Still, Clinton's best bet to sway voters in New Hampshire is to continue railing on rising drug prices, Mahrer said.
“With insurance company mergers, there's no immediate impact,” Mahrer said. “There's just the inference that in the future ... maybe you will see premiums increase as a result.”
In what some view as an effort to gain voters in the Hawkeye State, Clinton announced she opposes Republican Iowa Gov. Terry Branstad's decision to privatize the state's Medicaid program.
In August, Iowa's Department of Human Services awarded Medicaid managed-care contracts to AmeriHealth Caritas, Anthem, UnitedHealthcare and WellCare Health Plans, which moves the state's $4.2 billion Medicaid program into the hands of private insurers.
Critics including the Iowa Hospital Association say that will block access to care for Medicaid beneficiaries and affect reimbursement to providers, as the plans are for-profit private companies.
Clinton is leading the polls in Iowa, way ahead of Sanders.
“I'm not sure voters have paid much attention yet," said Jeff Link, a Democratic strategist based in Iowa. “But this could be a very big issue going forward. I think providers in the state are very nervous about the scope and pace of the Brandstad changes.”
One expert says the attacks makes her look like a hypocrite.
“Perhaps (Clinton) would like to explain why in her state, New York, they have more people in these managed-care systems than Iowa has residents?” asked Tim Albrecht, an Iowa-based Republican strategist with Redwave Digital.