Gov. Sununu On House Bill Dismantling Obamacare: "I Wouldn't Have Voted For It."

May 15, 2017

Credit Allegra Boverman for NHPR

Governor Chris Sununu has called the GOP's American Health Care Act a "huge win" --  for moving the conversation forward on repealing and replacing Obamacare. As for the content of that House bill, Sununu said on The Exchange: "I don't think anything in this bill is a huge win. I have reservations. I wouldn’t have voted for it myself."

Sununu called the GOP House plan unaffordable and said his hopes lie in the U.S. Senate for a better version.

"I have a lot more faith in the Senate to work together to find compromise....As contentious as it is, as politically polarizing as it is, I don’t think you’re going to find that polarization on the Senate side frankly.  That’s why I’m confident that what comes out on the Senate side will likely be substantially different, and hopefully for the better."

His message for the Senate?  "Give us flexibility; give us funding.  I can spend the federal government’s dollars better than they can." 

For the full interview, which includes discussion of SB3 and voting laws, RGGI, and marijuana decriminalization, listen here

CONVERSATION HIGHLIGHTS: 

The GOP plan would allow insurers to charge much more for older people than younger people. That’s a big concern for a state like NH.

Absolutely. You have to have a balance in the system. I believe -- and frankly I believe the President of the United States believes -- that Washington should provide a fundamental foundation but at the end of the day it’s the governors that have to implement it. We’re on the front lines, talking with folks, understanding their needs as individuals. That’s the big difference....But we need to make sure they are listening to us, that they have our ear, that they are providing those flexibilities.

All major health care organizations in the country oppose the AHCA -- the American Medical Association, the American Hospital Association, the insurance trade group called America’s Health Insurance Plans. All said they have huge concerns.  What does that say that these providers oppose this?

I’m glad they agree with me.  I’ve talked to a lot of other governors, and a lot I’ve talked to have the same reservations. Look, you have to have the discussion. You can’t just have the administration impose their will unilaterally  upon the people of America. So, there’s a great process here.  Now it'll go to the Senate and my guess is the bill that comes out of the Senate, assuming one comes out, won’t look anything like this one.  And hopefully for the better. People’s voices are being heard. They’re working across the aisle, especially in the Senate. 

Should states be allowed to opt out of essential benefits such as treatment for substance use disorder?

I would want to make sure we had it in New Hampshire, but there are some states where that is not considered an issue.  That’s their choice to make, and I don’t think it’s up to the federal government or the governor of New Hampshire to tell some other state what’s important to them and their people. That’s states' rights. That’s individuality. Most states do not have the substance abuse crisis we have here in New Hampshire

Why should substance abuse and mental health treatment not be universally required?

I firmly believe the federal government should lay a platform, should lay a basic funding foundation for us, but I don’t think the federal government should be universally mandating a whole lot. I think it’s up to the states to have that ability because if you start down that path, are they going to universally mandate bariatric surgery, or whatever it is? We can go down the whole list. And when does the list stop? So my philosophy is let the states decide.

There's concern about Medicaid Expansion being phased out.

I share that concern. You have to look at where the cost would be. The big issue is, it provides great access to health care. Under the current plan I believe a lot of those folks would be subsidized, which is good. But to what tune, and to how much? We’ve kind of pushed the limit in making sure the cost of Medicaid doesn’t fall directly on the state taxpayers of New Hampshire. That’s a very good thing, and I give a lot of credit to the insurance companies and hospitals and folks that are filling in that gap in funding. As that gap grows, if it were going to continue to grow, we’re going to have problems. There’s no way to fund that and not just in New Hampshire. As the costs go up, someone’s got to pay for this stuff. 

Being more of a business guy myself, I'm a big believer in the free market. I believe when you let a place like New Hampshire design a system that works really well for the people of New Hampshire, that’s how you start getting those costs to drop. But you’ve got to have buy-in from the federal government in some way. If we want the expanded Medicaid part of this, of course you’re going to need the buy-in from the federal government.

What's behind the recent upset with Dartmouth-Hitchcock over its N.H. Hospital contract?  

The quality that comes out of Dartmouth-Hitchcock is exceptional. It’s not an issue of quality of service. I think they have amazing doctors there. I think they’re a tremendous asset to the state and we want to make sure they continue being a partner with us. 

The contract went into effect in November. Part of that was telling us where you are on the staffing requirements. We pay every month for 11 psychiatrists. I don’t believe to date we’ve actually had 11 psychiatrists, and we’re paying for them.

We only recently realized we weren’t meeting those numbers. We thought we had to meet a number of 10 psychiatrists. So there was some confusion.  I think there was some failure on the part of the state. I took action, and I asked the CEO of N.H. Hospital to step aside, so we could put better management in there, better communications.

What was going on between Dartmouth-Hitchcock and the former CEO of N.H. Hospital is still a bit under question.  I asked him to step down on our side.  The reporting requirements,  given to the executive council on a biweekly basis, always said that they needed 10 but that’s not right; they need 11. People think it’s a small thing but that’s not right. We made such a big deal out of being transparent and up front and being good communicators with each other. That’s all we’re really asking Dartmouth-Hitchcock for. I think this will be worked out.

Exchange listener, Maureen, asked: Do you feel it's appropriate, as Governor of New Hampshire, to make such derogatory remarks about Dartmouth-Hitchcock's integrity and trustworthiness in the media as you've made recently? Do you consider the impact of your remarks on current and potential patients, as well as current and potential employees?

Did you and Commissioner Meyers respond too abruptly, angrily?

No.  I think we’re talking about real issues that matter to the state. Dartmouth-Hitchcock has a $ 30 million contract with the state. They’re a vital part of the mental health care system. While they’ve done well, as a state, we have to do a lot more. We have a real crisis on our hands.  If they’re going to be a partner we need to make sure we’re getting good information, reliable information, that folks are being up front about all the details of the service. You have to be good communicators. 

I’ll hold anybody’s feet to the fire. If you’re doing business with the state of New Hampshire you have to be forthright, up front. You have to be good communicators, and it starts with one-on-one interaction. It isn’t about lawyering up on either side, or anything like that. You have to get the right people in the room and work the details out.  I feel  confident we’ll find a viable solution. They are partners. I hope they’ll stay a partner of ours and we can keep moving forward together. We’ll work those details out.