Medicaid expansion: Supporters say much is at stake

Expanding Medicaid insurance to more low-income Granite Staters was a tough sell before it passed the New Hampshire Legislature nine years ago. Fiscal conservatives urged state lawmakers to reject predictions that more access to free or subsidized health insurance would lower medical costs and improve health outcomes. They warned it would instead discourage people from seeking jobs that offer benefits or high enough wages to buy insurance.

"We fight expansion of the welfare state because it makes people more dependent on government and creates perverse incentives against work, independence, and income mobility," wrote Michael and James Sununu, brothers of Gov. Chris Sununu, in a 2014 Nashua Telegraph op-ed.

Medicaid expansion passed with overwhelming bipartisan support that year. Lawmakers have voted twice to continue the program and must decide whether to do so again this year. If they don't, benefits are set to end for an estimated 50,000 to 60,000 people, health care leaders warn.

The program provides coverage for physical and behavioral health conditions and substance abuse treatment for people earning up to 133% of the federal poverty level. In 2022, an individual earning up to $18,075 a year or a family of four earning up to $36,908 would qualify. The federal government pays 90% of the program costs. The state covers the rest, in part with money from the alcohol fund, money from liquor sales set aside for treatment and prevention of substance use disorder.

Republican Senate president expresses confidence Medicaid will be approved

State Senate President Jeb Bradley, a Wolfeboro Republican who helped shepherd the initial Medicaid expansion through the Legislature, sounded optimistic Wednesday when asked if the program has become an easier sell after nearly a decade.

"I mean we've done it three times," Bradley said. "So I don't want to predict, you know, whether it'll be easy or hard. But I do think we'll get it done. I'll make that prediction."

Legislators will face significant and broad pressure to reauthorize benefits, this time without an expiration date.

Wednesday, health care and business leaders, mental health advocates, and social service agencies launched a campaign directed at lawmakers who will need persuading. More than 80 New Hampshire organizations have signed on, among them the New Hampshire Business and Industry Association.

David Juvet, senior vice president of public policy, said there is "strong support" among New Hampshire employers for continuing expanded Medicaid benefits. They are desperate for workers who are healthy enough to hold jobs, he said. And hospitals, among the state's largest employers, would lose millions, he said, in federal funding for medical care that may otherwise be uncompensated.

"It's not only the smart thing to do for New Hampshire," Juvet said. "It's the right thing to do."

Health care leaders at Wednesday's launch offered numbers to demonstrate the impact of expanded Medicaid.

Susan Stearns, executive director of NAMI New Hampshire, said that in 2021, more than 7,000 people used expanded Medicaid benefits for outpatient substance abuse treatment while more than 26,500 people relied on benefits for mental health medication.

"We know timely access to care not only improves outcomes but saves lives," she said.

Kris McCracken, president and chief executive officer of Amoskeag Health, said that since the expansion of Medicaid the number of the center's uninsured patients has dropped from 28% to less than 22%. In that time, the number of patient visits climbed from 43,000 a year to over 75,000, McCracken said.

Single mom who had heart surgery makes appeal for Medicaid

Amber MacQuarrie, a single mother of two from Dublin, urged lawmakers to renew expanded Medicaid coverage with a personal story.

While running a day care a few years ago, MacQuarrie became sick and was told she needed heart surgery. Around the same time, she learned her daughter had a genetic disorder that made walking difficult enough that she required a cane and then arm crutches.

With help from family, MacQuarrie was able to keep her day care open, allowing her to maintain her income and continue providing day care for parents who depended on her. Her expanded Medicaid benefits made it possible to have the heart surgery, she said, and care for her children and maintain her day care.

"My medical needs being met at that time meant that I could continue to contribute to society in New Hampshire, which in turn enabled others to continue to do so as well," MacQuarrie said. "Expansion is a significant driving force behind my family's ability to navigate our lives. Please don't make things harder for my family and the tens of thousands of others just like us. I, along with my kids, deserve to have our medical needs met no matter what they are."

This story was originally published by New Hampshire Bulletin.