Health Care, Business Leaders Urge House to Pass Permanent Medicaid Expansion

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Paula Tracy photo

Steve Ahnen, president and CEO of NH Hospital Association, is pictured next to a poster of supporters of permanent Medicaid expansion at a news conference Tuesday.


CONCORD – Healthcare, business, and elder affairs leaders across the state spoke strongly in favor of a permanent expanded Medicaid program without a sunset clause saying it will save the state money in the end and help with better health outcomes for residents.

The Granite Advantage Health Care Program, New Hampshire’s Medicaid Expansion, which, since its inception in 2014, has provided insurance coverage to nearly 220,000 Granite Staters in need, is set to expire. It’s most recent, four-year term ends in 2024.

About 90 percent of the cost of the program comes from the federal government, with $530 million projected in 2023.

A short-term reauthorization which may be being considered in the House as an option would fail to provide the stability and security that families, health care providers, and insurers need, advocates said.

Allowing for another few years extension on to the program will likely cost more money as insurance companies would likely hike rates at least 10 percent for short-term contracts, Health and Human Services officials have warned.

Americans for Prosperity oppose the continuation of the program with some saying the program should at least require those receiving it to work. The present program does not have a work requirement.

About 70 percent of recipients do work, and the other 30 percent have a good reason they cannot work, said Christina FitzPatrick, state director for AARP New Hampshire. Health considerations are among the reasons, she noted.

The bill, sponsored by 19 state senators, passed the upper chamber easily.

Speaking as well at a press conference Tuesday in the Legislative Office Building to urge the House to support permanent authorization were Michael Skelton, president, and chief executive officer of the Business and Industry Association; Heather McGrail, president and CEO of the Greater Manchester Chamber of Commerce; Steve Ahnen, president and CEO of NH Hospital Association and Ed Shanshala, CEO of Ammonoosuc Community Health Services.

The House Health and Human Services Committee is expected to take up Senate Bill 263 (the Medicaid Expansion bill) Wednesday.

Skelton said the bill is among the highest priorities of the BIA this session because it helps businesses attract and maintain a skilled workforce in the Granite State.

He noted the approach in the bill, while removing the sunset on the program, allows the legislature to revisit authorization at any time in the future.

Ahnen gave an example of hospital emergency rooms that used to see diabetics weekly who no longer visit because the program allows them to better manage their health.
This, he said, helps alleviate some of the stress in those emergency rooms, leads to better health outcomes to individuals who seek preventative care and costs the state and its people, in the end, less money.

He said the program is “in the right place at the right time to receive the right care and it is making a difference.”
Ahnen said since the program’s inception, hospitals have been seeing a 64 percent reduction in uninsured in their emergency rooms, and about a 50 percent drop elsewhere in the hospitals.

Chamber leaders also rallied around the bill including leaders of the New Hampshire Commerce Corridor, a group of southern New Hampshire chambers formed in the pandemic to help position the region for future prosperity.

McGrail, of Manchester, said the group and its members, in many cases small businesses, strongly support expanded Medicaid authorization without a sunset.

She said it would add stability and prevent cost downshifting. She said it also helps with workforce development, ensuring that families get through “times that are hard.”

Ed Shanshala, CEO of Ammonsoosuc Health Care Services which provides community health care for southern Coos County and Northern Grafton County, gave an example of the importance of the existing program.
“So if an individual can’t come to see us for primary preventive health care, let’s say they have diabetes and it is not well cared for, and probably around that $200 a visit, – $150 to $200, – if he goes to an emergency department for something that is emergent but could have been prevented, you are looking…at $750 to $1,500” for the visit and over $2,000 a day in the hospital’s intensive care unit.

“The patient experience is pretty rough,” he said, and while he said he trusts his colleagues in the hospitals for a quality health care outcome, “it is downstream and it is expensive.”

With this program, they don’t have to wait until it is emergent and can go see their own doctor.
Who would pay without the program, he was asked.

“We would, We are all in it…it is going to drive the cost of business up,” on those who have healthcare.
“It’s an invisible tax and I thought this state was a place that didn’t like taxes,” Shanshala said.
Ahnen said the greatest impact is for the individual but also for the operations of an emergency room and their need to care for the unavoidable.

“It’s much better for the patients and it is much better for the system,” he said. “Healthcare is a continuum.

“Having long-term reauthorization provides for that stability for the state.”
The bill could make it to the House floor as early as next week.
A copy of the bill is here

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