CONCORD — A plan to continue New Hampshire’s expanded Medicaid program cleared the Senate on Thursday night, backed by both Republicans and Democrats who argued it has served the state well and is critical to addressing the state’s opioid crisis and mental health treatment challenges.
The program has put about 50,000 low-income people on private insurance, but it will expire at the end of the year if the Legislature doesn’t reauthorize it. The Senate voted 17-7 to continue the program for five years but change its structure to a managed care model to save money and encourage wellness.
The change would impose new work requirements on enrollees and use 5 percent of liquor revenues to cover the state’s cost as federal funding decreases. The program currently relies on voluntarily contributions from insurance companies and hospitals, a funding mechanism the federal government has rejected.
Seven Republicans joined all 10 Democrats in backing the bill, while seven Republicans opposed it. Republican Gov. Chris Sununu praised the bill, calling it a fiscally responsible New Hampshire plan. The bill now goes to the House.
All four Seacoast area state senators voted in favor of the bill. They are Democrats Martha Fuller Clark of Portsmouth and David Watters of Dover, and Republicans Dan Innis of New Castle and William Gannon of Sandown.
Sen. Lou D’Allesandro, a Democrat from Manchester, used an anecdote about having his tonsils removed in his family’s kitchen as a 7-year-old to describe how he feels lucky to have had people who cared about him and help him as he grew up. He said he feels this kind of obligation to the 7,000 people in his district who have benefited from the Medicaid program.
“The importance of this piece of legislation is so meaningful to every one of us, and the people we represent,” he said. “We have crafted a way to deliver this service. It’s innovative, it’s creative, and it’s going to make a difference.”
Republican Majority Leader Jeb Bradley, of Wolfeboro, said continuing the program will give the state a much better opportunity to deal with the twin problems of mental health and substance abuse by providing continuity of care and a predictable, known funding stream. He also said he was struck by how many people spoke at a public hearing about how the program has affected them, and he noted that of the 130,000 people who have been enrolled at some point since the expansion took effect in 2014, only 15,000 have been enrolled the entire time.
“To me, that’s success. As their lives have changed, as their lives have improved, exactly what we want to see has happened: They have transitioned off this helping hand onto other forms of insurance,” he said. “That’s success, and that’s why we should reauthorize it.”
Sen. Gary Daniels, R-Milford, opposed the bill saying Medicaid has expanded far beyond its original intent nationally, and in New Hampshire, and has failed both taxpayers and participants. He said lawmakers shouldn’t be building a new program atop a failed one.
“New Hampshire can and should do better,” he said.
He and other critics blamed the Medicaid program for putting the state’s individual health insurance market into a death spiral. This year, about three-quarters of those in the state’s individual market saw their premiums drop or remain flat because they’re part of the state’s expanded Medicaid program or get federal subsidies. But about 25,000 people who pay the full cost are facing increases averaging 52 percent.
Republican Sen. Andy Sanborn, of Bedford, said the program has effectively bankrupted the middle class and called it a “political solution” to help some residents at the expense of others. He argued that high enrollment figures don’t mean the program has been a success.
“Our job is to create trampolines, not hammocks,” he said.