Debate over work requirement threatens bipartisan support for Medicaid expansion

New Hampshire Union Leader

March 06-- Mar. 6--CONCORD -- A fragile bipartisan consensus on expanding Medicaid coverage to an additional 50,000 New Hampshire residents is unraveling, as Republicans protest a Senate bill to water down, some say neutralize, a work requirement for able-bodied adults in the program.

A Senate committee on Tuesday voted 3-2 along party lines to advance Senate Bill 290, which would, among other things, terminate the work requirement if it results in more than 500 people losing their government-funded health insurance.

Democrats amended the bill just before the committee vote in the hope of addressing some of the concerns raised by Republicans, removing the original bill's exemption for people 50 and older for example.

But the changes were not enough to mollify Republicans, many of whom view the proposed changes to the work requirement as a betrayal.

"Absolutely a betrayal," said Sen. Jeb Bradley, R-Wolfeboro, one of the chief negotiators in the Medicaid compromise, along with Senate Majority Leader Dan Feltes, D-Concord.

"I can't express how angry I am," said Bradley. "We went out of our way to try to build the cooperation and Sen. Feltes has just blown it up."

The primary sponsor of the bill is Sen. Cindy Rosenwald, D-Nashua, but it has several Senate and House Democratic co-sponsors, including Feltes.

Deal was struck

Most GOP-controlled state legislatures voted against expanding Medicaid as part of the Affordable Care Act. New Hampshire Republicans, with legislative majorities, agreed to go along with the most recent five-year extension of the program from 2019 to 2023 only if a work requirement was implemented.

Now that Democrats have the legislative majority, attempts to water down the work requirement or eliminate it entirely, as a House bill would do, will make future cooperation difficult, according to Bradley.

"The bipartisan cooperation that we painstakingly built involved six of us," said Bradley, alluding to himself, Feltes, Rosenwald, Senate Majority Leader Chuck Morse, R-Salem, DHHS Commissioner Jeffrey Meyers and Sen. James Gray, R-Rochester.

"And now two of them (Feltes and Rosenwald) are eviscerating that cooperation. And that makes it impossible to function in this building. It just makes bipartisan cooperation really difficult in the future."

A major factor motivating the Democrats' efforts to modify the work requirement has been the experience in Arkansas, where 18,000 people, about a quarter of expanded Medicaid recipients in the state, were kicked off their health insurance coverage, mostly for being unable to comply with the administrative aspects of the work requirement.

"The Trump administration's recent changes to our bipartisan work requirement and the 18,000 people recently kicked off of their health care in Arkansas drive SB 290," said Feltes, who challenged Bradley's assertion that Democrats have not sought compromise.

"We've met on multiple occasions with the Governor's office, the Department of Health and Human Services and other stake holders in an effort to come to a consensus," he said. "Any suggestion that we aren't interested in making progress is not true and disingenuous."

House bill shelved

A House committee on Wednesday voted unanimously to shelve a separate House bill, HB 690, that would have eliminated the work requirement entirely, aware that such a move would only further antagonize Republicans.

"The Health and Human Services Committee basically was concerned about the damage to the bipartisan coalition that would be done by repealing the work requirement at this time," said committee member Rep. William Marsh, R-Wolfeboro.

"We have no guarantee the House will not change again in the next five years, and our hospitals and doctors are expecting stability in the program, so we voted to retain the bill."

The vote in committee to retain was unanimous, 21-0.

Democratic Rep. Jerry Knirk of Freedom, said he wholeheartedly agrees that people who can work, and are getting cash assistance or food stamps, should work.

"But health insurance is different," he said. "None of us can use it to pay our rent or buy groceries. It's there as a safety net. That's why I don't like the idea of a work requirement that's been tied to it, but I'll honor the agreement that's been made."

Republican Mark Pearson of Hampstead warned of voter backlash if the work requirement is eliminated or watered down to become a requirement in name only.

"The reason we were able to pass the expansion is the work requirement," he said. "It we take it out now, I could see a groundswell of people in the next election who would feel angry, betrayed and say 'to hell with the whole thing.'"

Ads target Feltes

Bradley offered a similar warning.

"This program has to be reauthorized in four years, and if bipartisan cooperation on this issue is eviscerated, what's going to happen four years from now?" he said. "The very people they think they are protecting are the ones who could get hurt the most."

Meanwhile, Republicans are targeting Feltes as someone who wants to "roll back work for welfare," hoping to make a campaign issue out of the controversy if the Concord Democrat decides to challenge Republican Gov. Chris Sununu in 2020.

A newly formed political action committee, A Better NH, launched its first radio buy on Wednesday with a 30-second spot highlighting the effort to redefine the work requirement and attacking Feltes.

The narrator urges listeners to "Tell Feltes, no free rides on health care," and provides his cell phone number.

"Republicans should spend more time working to protect the health care of Granite Staters and less time making radio ads," said Feltes.

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