At a time when the provisions of the federal Affordable Care Act are being stripped away in Washington and statehouses across the country, the New Hampshire Senate is moving toward shoring up the Medicaid expansion in the Granite State.
After a couple of hours of debate, the Senate has voted to move forward with Senate Bill 313, which would rewrite and reauthorize one of the key state-controlled provisions of the Affordable Care Act, also known as Obamacare, in New Hampshire. Where previous legislation had carried two-year terms, SB313 sets the terms for the Medicaid expansion in New Hampshire for five years.
The bill came out of a bipartisan commission that included Senate Majority Leader Jeb Bradley, R-Wolfeboro, Sen. Sharon Carson, R-Londonderry, and Sen. Dan Feltes, D-Concord, along with members of the House of Representatives and medical and insurance industry representatives.
Bradley, who was the chairman of the commission, argued at length in favor of continuing the Medicaid expansion.
“This has been a good bipartisan, bicameral effort to get to the place that we're at,” he said. “Senate Bill 313 has a lot of reform in it, good reform. It also has a lot of constants in it. Here are the things that stay the same from our past efforts: no new taxes, no new fees, no general funds.”
Bradley said that if the federal funding for the benefits in the program were to fall short, the bill would automatically wind down operations in a six-month period, ensuring that there would be no need for a bailout. The bill also moves to a managed-care model, which Bradley suggested would likely lead to another insurance provider taking part in the individual market, which would drive costs for consumers down as much as $200 million.
He also talked about wellness incentives designed to avoid unneeded trips to emergency rooms.
“[The bill creates] incentives for patients and incentives for the managed-care companies so that we push people to the appropriate level of care,” Bradley said. “There are an awful lot of things that people should be using walk-in clinics for as opposed to emergency rooms.”
One of the key provisions of SB313 is the creation of the Granite Workforce pilot program. This will take $3 million from the Temporary Assistance to Needy Families program to try to help New Hampshire residents find employment.
In addition to educational and training services, there’s a $2,000 incentive for employers who hire participants in the pilot program. If the new employee manages to stay on the job for three months, the employer gets another $2,000. Another commission will generate a report for the legislature to recommend if the pilot should be continued.
Bradley argued that the history of the Medicaid expansion in New Hampshire showed a track record of helping people regain financial independence.
“One of those statistics that I find particularly compelling is that all of the 50,000, plus or minus, people that are consistently enrolled in Medicaid, only 15,000 of them have been on the program since its inception, of the 130,000 people that have been on it at one time or another,” he said. “To me, that's success. As their lives have changed, as their lives have improved – exactly what we want to see happen – they have transitioned off of this helping hand into other forms of insurance. That’s success, and that's why we should reauthorize this.”
Sen. Gary Daniels, the chairman of the Senate Finance Committee, was unswayed by Bradley’s arguments. The Milford Republican insisted that New Hampshire was swimming against the tide of current events by taking steps to shore up a doomed Affordable Care Act.
“Why are we completely scrapping the Medicaid expansion program and rewriting?” Daniels asked rhetorically. “The answer is, the past ... version failed. It failed the group market. It promised that additional resources from the federal government would result in a reduced or stabilized help insurance cost; they haven't seen that. It promised to help stabilize the individual marketplace; it has had just the opposite effect. Placing poor people whose claims cost 44 percent higher into the individual marketplace has resulted in the individual marketplace being pushed into ... death spiral resulting in a 52 percent increase [in premiums] in 2018.”
Daniels argued New Hampshire's Medicaid expansion program should never have been authorized and that the bill should be defeated.
A number of amendments were offered up to adjust the provisions of SB313, including one by Sen. Andy Sanborn, R-Bedford, that would set the bill’s provision to expire in two years instead of five. Sanborn said that committing to a five-year term when the future of government-sponsored health care is so unsettled would be a mistake.
“I think today, 14 states across America have brought forth legislation challenging the Affordable Care Act,” he said. “Now that the federal government has eliminated several mandates, requirements and taxes, there is barely a person in America – with the exception maybe of a bunch of people in this room today – who don't seem to recognize the fact that the Affordable Care Act is ending. It is unsustainable, it is unaffordable [and] the federal government is slowly and surely unwinding it.”
Sanborn’s amendment was defeated, as were all the amendments aside from one put forth by Bradley that corrected an inadvertent omission of a clause.
Sen. Lou D’Allesandro, D-Manchester, said that despite any flaws, the bill would do a great deal of good.
“Like any piece of legislation, it's not perfect,” he said. “But it's something that's needed and something that the people of the state of New Hampshire will appreciate.”
Republican Gov. Chris Sununu released a statement after the passage of the bill praising the move.
“The Granite Advantage Health Care Program is a New Hampshire plan that protects taxpayers and the General Fund, saves the federal taxpayers approximately $200 million, provides 50,000 Granite Staters with healthcare, and stabilizes our individual market,” Sununu wrote. “I applaud the Senate for overwhelmingly passing this fiscally responsible plan today, and would like to thank [Senate President Chuck] Morse and Bradley for their leadership in this critical effort.”
The final vote on SB313 in the Senate was 17-7 in favor. Republicans in the Senate were split 7-7, and all 10 Democrats voted for the bill, which now must pass in the New Hampshire House before it can go to the governor for his signature.