The battle lines on the fight over the future of New Hampshire’s Medicaid expansion are well-defined as the issue comes up for a vote in the state Senate tomorrow.
On Wednesday’s episode of The Exchange, State Sens. Jeb Bradley and Andy Sanborn — a vocal proponent and opponent of the expansion, respectively — sparred over a number of elements of the program, including its effects on the state's drug crisis.
“But for Medicaid expansion, 6,000 people have received care under the substance abuse benefit,” Bradley said. “It’s about 40 percent of the money that we’ve allocated for substance abuse treatment in New Hampshire. Without that money, our public health crisis of heroin, I believe, would be even worse than it already is today. And it’s terrible today.”
Sanborn, for his part, took issue with this and other arguments commonly made in favor of continuing the expansion.
“Look, there has been absolutely no evidence at all that this program is working,” Sanborn said.
While Sanborn acknowledged that emergency room visits are down for the uninsured, he noted that there are also fewer uninsured — and emergency room visits, overall, are up.
“We have to remember, the opioid crisis has only gotten worse since Medicaid expansion has come,” the senator added. “It’s actually working in the opposite direction. We need to look at that much more closely.”
Looking at the numbers alone, it is true that more drug overdoses are happening now than before the Medicaid expansion took effect. But the drug crisis, Bradley pushed back, stretches back long before the program went into effect and is driven by a number of factors.
“The heroin crisis has been with us a long time,” said Bradley, who chaired the state’s opioid task force, of which Sanborn was also a member. “There are a lot of different things that have led us as a state to get where we are.”
Medicaid expansion, Bradley said, has allowed the state to bring in funding for substance abuse programs that it wouldn’t be able to replicate on its own.
“Medicaid expansion is part of the cure,” Bradley said. “It’s not part of the problem of the heroin crisis.”
Outside of the program’s impact on New Hampshire’s drug crisis, the conversation also looked at a proposal to incorporate work requirements as a condition of coverage and how the federal government’s commitment to the program may change depending on the outcome of the presidential election.
New Hampshire's Medicaid expansion program went into effect in 2014 and has since provided coverage to more than 48,000 residents. A proposal on the table would extend the program through 2018, using contributions from hospitals and insurers to offset what the state would have to pay to sustain the coverage as the federal government pulls back some of its funding.
The full conversation — including input from the New Hampshire Hospital Association, an Antrim resident who is enrolled in the program and a U.S. News reporter who’s been following Medicaid expansion trends across the country — can be heard here.