Medicaid Expansion Sails Through N.H. Senate, Heads For Uphill Climb In The House

Mar 8, 2018

After nearly two full hours of floor debate, the New Hampshire Senate green-lit a plan to keep New Hampshire's Medicaid expansion going for another five years.

A group of 17 Republicans and Democrats teamed up to advance the plan, while seven other Republicans voted against it. 

Among those opposed was Sen. Harold French, of Franklin, who said his vote shouldn’t be interpreted as a sign that he doesn’t care about the people covered through expanded Medicaid — one of whom is his own daughter.  

“The individual marketplace has gone up so much that I have another group of friends that for the first time cannot afford health insurance and this year are going without it,” French said, explaining that he couldn’t reconcile a “yes” vote with the idea that expanded Medicaid is contributing to rising premiums for everyone else.

The current plan to continue expanded Medicaid tries to guard against future increases by moving patients enrolled in the program away from subsidized plans on the individual insurance market and into managed care plans, with the rest of the state’s Medicaid population. This change was proposed by a bipartisan study committee that examined the costs and effectiveness of the program last fall, in the context of the state’s broader insurance landscape.

As written, the bill proposes several sweeping changes to expanded Medicaid, including the introduction of what lawmakers are calling “work and community engagement requirements” as a condition of coverage.

Supporters are adamant that the plan won’t require any new state taxes or fees, because it relies heavily on the federal government to foot much of New Hampshire’s share. But the plan does call for using money from the state’s substance abuse treatment fund, because advocates argue that the Medicaid expansion has been an important tool to fighting the state’s opioid crisis.

Bedford Sen. Andy Sanborn, who also voted against the extension, questioned that very talking point during Thursday’s debate.

“For those who sit and advocate that only Medicaid expansion can solve our opioid problem – only Medicaid expansion,” Sanborn said, “last time I’ve checked, it’s been four years, we’ve now spent two billion dollars, and it doesn’t look like it’s winning.”

The state says that, at any given time, about 7,500 people are getting addiction treatment in the program. About 53,000 people are enrolled overall.

During its marathon debate on the issue Thursday evening, the Senate considered — and rejected — a series of proposed amendments to the existing plan.

Sen. Dan Feltes  suggested setting aside $1.5 million in state money to “reduce barriers to work for childless adults age 25 and older” enrolled in the program. That failed along party lines, with Republicans cautioning against the extra spending.

Sen. Andy Sanborn suggested scaling back the timeline on the program to extend another two years instead of five. Sen. Jeb Bradley, the chief architect of the expansion plan, said the five-year extension is key to maintaining stability, both for patients enrolled in the program and providers offering coverage.

And finally, Sen. Bob Giuda proposed adding a mandatory physical, complete with drug testing. He said the absence of such a requirement opens the door to situations where people might not disclose substance use and, in turn, might not get the care they need.

But other senators, from both parties, cautioned that drug testing as a condition of public assistance coverage has been found unconstitutional elsewhere and would likely invite legal challenges.   

From here, the expansion bill now heads to the House – where it is likely to face a much tougher slog. The last time the program was up for reauthorization in that chamber, it survived by just one vote.

Gov. Chris Sununu will likely be among those nudging the House to approve reauthorization. On Thursday, he praised senators for passing the “fiscally responsible plan” and said he’s been working closely with federal officials to “demand increased innovation and flexibility in how our state runs Medicaid program” moving forward.