Full court press on for permanent expansion of Medicaid [The New Hampshire Union Leader, Manchester]

Apr. 4—CONCORD — Health care advocates packed a committee room Tuesday to endorse the permanent expansion of Medicaid coverage for low-income adults.

The testimony came two days before the House of Representatives will vote on a proposed state budget trailer bill (HB 2) that would extend the program for two more years.

Last month, the state Senate unanimously passed a separate bill (SB 263) that would erase a Dec. 21, 2023 end date for the program, a change Gov. Chris Sununu said he supports.

Senate President Jeb Bradley, R-Wolfeboro, said that since its inception in 2014, expanded Medicaid coverage has helped reduce the uninsured population in the state, which he said saves residents with health insurance from having to pay a "hidden tax" through higher premiums.

"I hope the question you will ask that the Senate asked which was, has Medicaid expansion worked, and I believe the answer is a resounding yes," Bradley told the House, Health, Human Services and Elderly Affairs Committee.

Thanks to the Granite Advantage Health Care Program, hospital spending on uncompensated care dropped from $173 million in 2014 to $69 million in 2021, said New Hampshire Hospital Association President Steve Ahnen.

"As a result of this coverage, these patients are now able to receive the right care, at the right time, in the right place," Ahnen said.

Medicaid Director Henry Lippman said 70% of those on the program are working, which is the ninth-highest rate in the country.

Lippman said his department is helping an estimated 30,000 residents who got Medicaid coverage during the pandemic but no longer financially qualify to remain on it.

The Biden administration will end the automatic coverage by terminating the public health emergency on May 11.

The expansion provided adults with coverage if they make up to 138% of the federal poverty level — $20,120 a year for one person and $41,400 for a family of four with no coverage.

Greg Moore, state director of the fiscally conservative Americans for Prosperity, said the program has created an incentive for low-income adults to work less so they can continue to receive this benefit.

"The question is whether people will work further, take a job that pays more, get more hours," Moore said.

The program has contributed to the health care workforce shortage, Moore maintained, as coverage for the 92,000 adults on this program cost more than $500 million last year.

This utilization along with an exodus of workers during the COVID-19 pandemic has strapped capacity in the health care system, he said.

"Provider shortages used to be occasional and in unique fields; now we see them as widespread across the state," Moore added.

State Rep. Leah Cushman, R-Weare, also questioned why the Legislature would permanently expand coverage when a Congressional Budget Office report recommended the federal government cut back its 90% reimbursement rate to the states.

Sen. Cindy Rosenwald, D-Nashua, said even if lawmakers pass this bill a future Legislature can choose at any time to exit by informing the federal Centers for Medicare and Medicaid Services that it no longer wants to participate.

"The 90% federal contribution is not by regulation; it is in federal statute. It can only be changed by an act of Congress," Rosenwald said. "I really don't see any change in the federal matching support for this program."

Supporters note the Medicaid expansion law contains a provision that allows the state to wind down participation in the program should Congress change its level of federal support for it.

The state's 10% match, which will cost $50 million next year, comes not from the state budget but through payments mainly from insurers and liquor sale revenues.

State Rep. Jess Edwards, R-Auburn, chaired the working group on the House Finance Committee regarding the Department of Health and Human Services budget and defended the two-year extension.

"Currently the federal government is paying a 90% match. That's the kind of money you can't turn down," Edwards said. "This feels like the heroin dealer giving you some free hits until you get hooked and then charges you full price. We need to have a sunset date."

Mark Bonta, claims director with Genfoot America in Littleton, said he saw firsthand how Medicaid expansion helped him recruit and employ recovering drug addicts, many who have become productive citizens.

"The success of Medicaid expansion gave them the support they needed," Bonta recalled.

Others testifying Tuesday in support of the bill included the National Alliance for the Mentally Ill in New Hampshire, New Futures, Easterseals, Business and Industry Association, Greater Nashua Chamber of Commerce and the Roman Catholic Diocese of Manchester.

Advocates put together a storybook profiling people they said benefitted from the program.

Former state Sen. Tom Sherman, the 2022 Democratic nominee for governor, said prior to retiring as a gastroenterologist he treated patients who used the coverage to get their homes, jobs and lives back.

"This doesn't keep people off work. It actually gets them back to work and off public assistance," Sherman said.

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