Distant Dome: Medicaid Expansion Should Not Be at Risk

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Garry Rayno is InDepthNH.org's State House Bureau Chief. He is pictured in the press room at the State House in Concord.

By GARRY RAYNO, Distant Dome

Over the last decade, Medicaid expansion, or the Granite Advantage Health Care program has been one of the most impactful and successful the Legislature has enacted.

The program had a rough beginning as the remnants of the O’Brien led House and their allies in the Senate did all they could to tank it before it could get off the ground.

However, a small group of bipartisan senators, with the blessing of then Senate President Chuck Morse, found common ground that allowed the state to participate and increase the number of residents covered under the state and federal health insurance program.

The group leading the way were Sens. Peggy Gilmore, Bob Odell and Lou D’Allesandro, and Morse was willing to get in front and push it through the Senate and the House, which at that time was Democratically controlled and eager to put something in place.

Once in place Granite Advantage opened the door for the state’s working poor who earned too much income to qualify for the regular Medicaid program, which is mostly single mothers and children, and too little to purchase insurance on the individual insurance market. The program currently serves about 90,000 Granite Staters.

When it began the federal government paid 100 percent of the costs and then its obligation stepped down to its current 90 percent where it is intended to stay permanently.

That is a great deal for the state which pays 50 percent of the cost of the regular Medicaid program.

Medicaid expansion has accomplished what the organizers said it would do, provide health insurance to many Granite Staters who otherwise would go without, lowered the uncompensated care for hospitals and other providers, lowered the costs of premiums for the individual market and for employers, and paved the way for a healthier and more reliable workforce.

Uncompensated care for hospitals was driving up the cost of insurance premiums as health care organizations charged insurers more to make up for the lost revenue of the free care provided to those without insurance and unable to pay.

Is it any wonder the business community wants the program to be permanent not only for its workforce benefits, but also for a more stable financial environment.

Despite Granite Advantage’s success, it could be teetering on the edge this week as the House takes up Senate Bill 263, which would make it permanent and passed the Senate on a strong bipartisan vote.

The program’s problems legislatively have not been in the Senate, but with House Republicans with some very close votes over the years and things added like a work requirement the Supreme Court said was unconstitutional, to pick up the needed votes for approval.

This year the issue is making the program permanent as a number of Republicans in the House only want a two-year authorization, which will make the program much more expensive without a five-year or more contract with managed care administrators and service providers.

Late last week the tensions between the House and Senate came out in the open as Senate President Jeb Bradley, the bill’s prime sponsor, said he believed they had an agreement for an eight-year extension with the House, but the only amendment in the House calendar was for two years.

The House Health and Human Services and Elderly Affairs Committee had split down party lines over the bill, with Democrats wanting the program to be permanent while Republicans on the committee wanted only a two-year authorization.

Bradley told members of the Senate Finance Committee Friday the Senate needed to respond to the House Republicans’ actions which he said was not the clear path to approval which he thought he agreed to with House Speaker Sherman Packard.

While many believed the bill was settled, and now it is not, might indicate something else is involved beyond Medicaid expansion.

Coincidentally one of the House’s priorities for both Republicans and Democrats, a bill legalizing the recreational use of marijuana, was killed by the Senate last week.

That should not really be a surprise to anyone, because the Senate has killed a number of bills that would legalize cannabis over the years.

But the surprise last week was Gov. Chris Sununu, who has until the end of the week, been opposed to legalizing pot.

But typical Sununu, he doesn’t want what the House worked tirelessly on this session, he wants what was last year’s legalization bill using the liquor commission to sell and regulate cannabis and he wants it done this session.

Could the shenanigans over the Medicaid expansion bill really be the House holding the bill hostage in order to convince the Senate to pass the legalization bill Sununu wants.

That might not be as large a stretch as it appears as three new Senators were House members last term and voted for the legalization bill using the liquor commission to distribute the marijuana and enforce rules.

The bill the Senate voted down, 14-10, was largely a party line vote with D’Allesandro voting to kill it and Sen. Keith Murphy, R-Bedford, voting not to kill the bill.

If the three Republican House members — Daryl Abbas, Timothy Lang and Harold Pearl — who voted for the bill last term, vote for it again, it would pass the Senate.

No one will probably publicly admit to this scenario, but some Republicans have floated it out.

Politics is politics, but this one may be a bridge too far.

At a time when the Medicaid rolls are being purged of those added during the pandemic who no longer qualify under the regular qualifications, such political gamesmanship does not look good.

And there are the about 90,000 or more who will still be on the Granite Advantage Medicaid rolls after the purge have skin in the game, as do hospitals, other health care providers and businesses and all benefit from the program.

They are not going to be happy if SB 263 goes down in the House.

What is going on is playing with people’s lives and their livelihoods and that is never a good picture for public viewing.

It reinforces the notion politicians don’t really care about their constituents, they only care about their re-election and their own agenda.

Let’s hope New Hampshire’s citizen legislature rises to the occasion, but you never can be sure.

The Granite Advantage program is too important and too successful to be held hostage to legalizing marijuana.

Garry Rayno may be reached at garry.rayno@yahoo.com.

Distant Dome by veteran journalist Garry Rayno explores a broader perspective on the State House and state happenings for InDepthNH.org. Over his three-decade career, Rayno covered the NH State House for the New Hampshire Union Leader and Foster’s Daily Democrat. During his career, his coverage spanned the news spectrum, from local planning, school and select boards, to national issues such as electric industry deregulation and Presidential primaries. Rayno lives with his wife Carolyn in New London.

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