Recovery coach says expanded Medicaid saved him

New Hampshire Union Leader

March 14--For Philip Spagnuolo, expansion of Medicaid in New Hampshire was a lifesaver, helping to rescue him from the potentially fatal effects of addiction.

Spagnuolo was on Medicaid from February 2016 until January of this year. In that time, he was able to get counseling, therapy and medical care that allowed him to overcome his substance abuse disorder.

Now a licensed recovery coach at Navigating Recovery of the Lakes Region in Laconia, Spagnuolo has become an advocate for recovery and for the New Hampshire Health Protection Program, the Granite State's own version of expanded Medicaid under Obamacare.

On Monday, the former construction site supervisor joined New Hampshire's two Democratic U.S. senators, along with representatives of the health care industry, at Concord Hospital to oppose the "repeal and replace" plan for Obamacare that is now working its way through the Republican-controlled House of Representatives.

All the speakers had a lot to criticize in the plan, but the potential cutbacks to expanded Medicaid, which had added 50,000 Granite Staters to the health insurance program for low-income families, drew the most concern.

New Hampshire had about 130,000 individuals on Medicaid before the income levels were changed under Obamacare to expand eligibility. The state now has more than 187,000 individuals enrolled in either traditional or expanded Medicaid.

The Republican proposal to convert federal support for Medicaid from per-patient reimbursement to a block grant that states can use as they wish will inevitably mean serving a smaller population, according to Democrats.

Many Republican governors, including Gov. Chris Sununu, welcome the block grant approach as a way to let each state devise its own plan, suited to its unique circumstances and needs. Sen. Maggie Hassan told the gathering on Monday that the block grants will be inadequate to sustain the expanded Medicaid program.

"The House bill will impact health care seriously, but what it would do to Medicaid expansion ... it would in fact repeal it," said Hassan. "That will make health insurance out of reach for thousands of Granite Staters, and it hurts the ability of those on the front lines to save lives and fight this (opioid) epidemic."

Spagnuolo described himself as living proof of the value provided by recovery services funded through Medicaid.

"Not only am I standing here today, substance free, but I have become a recovery coach, and helped found a recovery center in Laconia," he said. "About 90 to 95 percent of the people who come through our doors are on Medicaid. Without that, they would not be able to get the services they need; they would not be able to have the productive life that I have been able to have, doing something good for our community."

Sen. Jeanne Shaheen said that 118,000 Granite Staters could lose coverage under a full repeal of Obamacare, including expanded Medicaid, but a spokesman for her office later clarified that that number does not account for the impact of the GOP replacement program. "We don't have a precise estimate for New Hampshire at this point," he said.

A more accurate estimate is expected in the Congressional Budget Office analysis of the GOP replacement plan.

The Shaheen-Hassan news conference at Concord Hospital came after a weekend in which Trump administration officials promoted the GOP replacement plan as one that would cover more people at lower cost.

Hassan said the plan might lower costs for healthy, young people, but would raise it for older Americans through what she called an age tax. "It will allow insurers to charge older Americans five times more than what they charge younger Americans," she said.

Also on hand to reinforce what Shaheen and Hassan had to say were Brendan Williams, president and CEO of the NH Health Care Association, which represents long-term care providers; and Robert Steigmeyer, president and CEO of Concord Hospital.

Williams said any plan that shifts costs to the elderly will hit New Hampshire particularly hard.

"We are the state with the second oldest population," he said. "People are not going to stop aging in the state of New Hampshire. Children are not going to stop being born with disabilities in New Hampshire. These needs are going to continue to exist, notwithstanding some of the partisan dreams the GOP has seen fit to include in this bill ... It is immoral and we will fight it."

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