February 24, 2024

By GARRY RAYNO, InDepthNH.org

CONCORD The states’ 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 vote of 193 to 166 after supporters of the program defeated more than 25 bills proposed to change the program or to turn the bill into a Christmas tree by adding bills passed by the Chamber and killed by the Senate.

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

The state’s two-year operating budget that the House passed last month contains only a two-year extension to the health insurance program for states working in poverty and earning too much money to qualify for regular Medicaid services but not enough to afford individual or family health care plans.

A number of opponents of the plan have sought to include a job requirement although about 70% of the approximately 70,000 participants work and more are in the program so they can return to work. Many of these amendments would also have allowed community service to replace work.

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

But that hasn’t stopped many of the bill’s opponents from bringing their amendments to the House.

Rep Barbara Comtois, R-Center Barnstead, said her amendment would make people work for something that would help them get back into work.

Government programs should give people a helping hand and not a helping hand, he said, echoed by many advocates of the job requirement.

The Senate passed the bill unanimously earlier this year. The bill would eliminate the program’s expiration date, but Senate Speaker Jeb Bradley R-Wolfeboro later said the Senate would agree to an eight-year extension but was concerned that the House amendment would it would have approved for only two years, which would have been more expensive and not provide consistency for businesses and health care professionals.

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

Other amendments would have attached the cannabis legalization program approved by the House this year, as well as another bill related to the government’s emergency powers.

House Republicans first sought to extend the program for six years, with Representative Erica Layon, R-Derry, saying health care is a changing landscape and it’s too early to make the program permanent.

Without a sunset, it’s a much higher hurdle to make it the best possible program, Layon said, noting that extending it for six years hits a sweet spot for managed care contracts.

But Rep. Joe Schapiro, D-Keene, said the program serves tens of thousands of rock-hard statesmen by providing affordable health care, preventive care and some specialty care while reducing uncompensated care to hospitals and other providers and lowers the transfer of costs to the premium insurance.

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

And she noted that the program is an essential lifeline for people being treated for substance abuse and mental health issues.

This program provides security for low-income residents and health care workers, he said, at a time when the health care system is under significant strain.
JR Hoell, R-Dunbarton introduced a series of amendments related to the general health care system in the state saying regulations are crushing the system with too few doctors and too few beds. He also proposed removing the severability clause from the statute, so if one section of the law is rejected by the courts, the entire bill would be at risk.

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

They all failed, the biggest failure being the addition of the Cannabis Legalization Act.

Supporters of the bill also defeated several attempts to introduce the bill. After about a dozen amendments had been heard and debated, Weber successfully proposed limiting the debate to just a short speech on both sides and a vote.

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

We have already approved Medicaid expansion with a sundown provision and Medicaid spending has grown to more than one-third of our state budget and continues to grow as a percentage of our state budget, said Rep. Jim Kofalt, R-Wilton. Such a large, complex and costly program deserves regular review and reauthorization by the elected representatives of the people.

House Majority Leader Jason Osborne R-Auburn focused on the vote to limit debate on the many bills yet to be heard.

House Republicans today introduced a series of amendments to make New Hampshire’s Granite Advantage health care program a better program. Unfortunately House Democrats didn’t want to hear all the ways this program is flawed and our ideas for improving it, Osborne said. Instead they moved to limit the debate, trampling on the historic traditions of this once august body, and betrayed our historic bipartisan budget compromise that was previously voted on by voice.

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

After the session, House Democrats released a statement saying, “The expansion of Medicaid has provided health care 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 best for its existence.

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

Granite Staters’ health care should not be made subject to unreasonable requirements or arbitrarily terminated 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’re glad we were able to cast a strong vote today.

The bill had broad support from business organizations and healthcare professionals, all of whom said a long-term extension would provide stability and consistency and allow for investment in healthcare infrastructure.

The program began in 2014 to provide health coverage to states working in poverty under the Affordable Care Act. Lawmakers previously failed to agree on any plans, but a bipartisan group of senators worked to find a compromise, which is essentially the same as the one that is in place today.

The program now has approximately 70,000 residents in the program and has increased during the COVID pandemic as eligibility has expanded to cover more people.

Garry Rayno can be reached at garry.rayno@yahoo.com.

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