Granite Advantage Program Clears First House Hurdle

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Paula Tracy photo

New Hampshire House met Thursday in Representatives Hall at the State House.


CONCORD — The state’s Medicaid expansion program cleared its first hurdle in the House unscathed after three hours of debate Thursday.

The Granite Advantage Health Care Program cleared the House by a 193-166 vote after program supporters defeated more than 25 proposed amendments to change the program or to turn the bill into a Christmas tree by adding bills the House passed and the Senate killed.

One of the key issues this session with Senate Bill 263 is whether to remove the statute’s sunset clause to make it permanent and that is not likely to be settled as the House Finance Committee will review the bill before the House takes final action.

The state’s two-year operating budget the House approved last month contains only a two-year extension for the health insurance program for the state’s working poor who make too much money to qualify for regular Medicaid services, but not enough to afford individual or family health care plans.

A number of plan opponents sought to include a work requirement although about 70 percent of the approximately 70,000 participants work and others are on the program so they can return to work. Many of those amendments also would have allowed community service to substitute for work.

Rep. Lucy Weber, D-Walpole, reminded proponents of work requirements that the Supreme Court found such requirements unlawful because Medicaid is a health care program and a work requirement is a separate entity.

But that did not stop many bill opponents from bringing their amendments to the House floor.

Rep. Barbara Comtois, R-Center Barnstead, said her amendment would make folks work for something which would help them get back into the workforce.

“Government programs should be giving people a hand up and not a hand out,” she said, which was echoed by many proponents of the work requirement.

The Senate approved the bill unanimously earlier this year. The bill would remove the sunset date on the program, but later Senate President Jeb Bradley, R-Wolfeboro, said the Senate would agree to an eight-year extension, but was concerned the House amendment only would approve it for two years, which would be more costly and not provide consistency for business and healthcare providers.

The House responded by writing over 30 amendments to the bill, many of which would essentially end the program or change it to reduce the number of people eligible for it. 

Other amendments would have attached the cannabis legalization program the House passed this year, as well as another bill dealing with the government’s emergency powers.

House Republicans first tried to extend the program for six years, with Rep. Erica Layon, R-Derry, saying health care is a shifting landscape and it is far too early to make the program permanent.

“Without a sunset, it is a much higher hurdle to make it the best program it can be,” Layon said, noting extending it for six years “hits a sweet spot for the managed care contracts.”

But Rep. Joe Schapiro, D-Keene, argued the program serves tens of thousands of granite staters by providing affordable health care, preventive care, and some specialty care, while reducing uncompensated care to hospitals and other providers, and lowers cost shifting to insurance premiums.

He said the longer the managed care contracts, the greater the savings to the state when it negotiates with insurance administrative providers.

And he noted the program is an essential life line to people being treated for substance abuse and mental health issues.  

“This program provides security for low-income residents and health care providers,” he said, at a time when “the health care system is under considerable stress.”
J.R. Hoell, R-Dunbarton, introduced a number of amendments dealing with the overall health care system in the state saying regulations are crushing the system with too few physicians and too few beds. He also proposed removing the severability clause in statute so if one section of the law is rejected by the courts, the entire bill would be at risk.

Others tried to increase the number of people in an immediate family when determining an individual’s eligibility for the program as well as domestic partners and unmarried roommates.

They all failed, the biggest failure was adding the cannabis legalization bill.

Bill supporters also defeated several attempts to table the bill. After about a dozen amendments had been heard and debated, Weber proposed successfully to limit debate to just one short speech on either side and the vote. 

Republicans defended their attempts to change the bill saying Medicaid is a growing state expense.

“We already passed Medicaid Expansion with a sunset provision, and Medicaid spending has grown to over one-third of our state’s budget, and continues to grow as a percentage of our state budget,” said Rep. Jim Kofalt, R-Wilton. “A program this big, this complex, and this expensive deserves a periodic review and reauthorization by the people’s elected representatives.”

House Majority Leader Jason Osborne, R-Auburn, focused on the vote to limit debate on the numerous amendments yet to be heard.

“House Republicans put forward a number of amendments today in order to make the New Hampshire Granite Advantage Health Care Program a better program. Unfortunately House Democrats did not want to listen to all the ways this program is flawed and our ideas to improve it,” Osborne said. “Instead they moved to limit debate, treading roughshod on the historic traditions of this once august body, and betrayed our historic bipartisan budget compromise that previously passed on a voice vote.”

The budget contained a two-year extension for the program.

After the session, House Democrats issued a statement that said, “The expansion of Medicaid has provided healthcare to over 200,000 Granite Staters – our friends, neighbors, and colleagues are served by this program and the health of the entire state of New Hampshire is better for its existence.”

They said despite the Republican attempts to block the bill, House Democrats and other supporters held strong.

“Granite Staters’ healthcare should not be contingent on unreasonable requirements or arbitrarily ended after a random number of years,” according to the statement. “Medicaid patients, providers, and so many in the healthcare and business community believe this program should be permanent and we are glad to have been able to deliver a strong vote today.”

The bill had wide support from business organizations and health care providers, who all said a long-term extension would provide stability and consistency and allow for investments in the health care infrastructure.

The program began in 2014 to provide health care coverage to the state’s working poor under the Affordable Care Act. Lawmakers first failed to reach agreement on any plan, but a bipartisan group of senators worked to come up with a compromise, which is essentially the same as what is in place today. 

The program now has about 70,000 residents on the program and increased during the COVID pandemic when eligibility was expanded to cover more people.

Garry Rayno may be reached at

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