Medicaid Expansion Extension Gets First Public Hearing — and Support from DHHS

Jan 28, 2016

DHHS Commissioner Jeff Meyers speaks at a hearing on Medicaid expansion.
Credit Casey McDermott, NHPR

Newly confirmed New Hampshire Health and Human Services Commissioner Jeffrey Meyers spent part of his first official day on the job lending his support to a plan to extend the state’s Medicaid expansion another two years.

In his previous role as the health department's intergovernmental affairs director, Meyers had a main part in implementing New Hampshire's Medicaid expansion over the last two years. The Executive Council confirmed Meyers as commissioner Wednesday.

“We know that the program is working,” Meyers said at a public hearing on the proposal to extend the program through 2018. “In terms of the provision of services to the members, in terms of revenue to our healthcare providers — which, as has been discussed today, has helped reduce uncompensated care in New Hampshire — and in terms of costs avoided by the department and by the state.”

Meyers said he supports both the extension of the program as a whole, and the specific proposal brought forward by a group of mostly Republican lawmakers this week.

New Hampshire’s Medicaid expansion program began in 2014, but only temporarily. It’s set to expire at the end of this year. That's when the federal government will start asking the state to cover a portion of the program costs.

The proposal on the table Thursday would ask hospitals and insurers to help cover the state’s share of costs needed to continue coverage for another two years. It would also add some work requirements as a condition of coverage and would charge a fee for unnecessary emergency room use.

Another bill to extend the program indefinitely has also been filed, but a hearing hasn’t yet been scheduled. (For more on the proposals and the program so far, check out this primer.)

At Thursday’s hearing, Meyers joined officials from the Business and Industry Association, the New Hampshire Medical Society and the New Hampshire Public Health Association, among others, in support of extending the program.

Several people enrolled in the Medicaid expansion also shared their stories.

One woman said she was finally able to stop using drugs thanks to treatment she accessed through the program. Another man, Peter Berwin from Antrim, said he’s self-employed and turned to the program as a “stopgap measure” after a downturn.

“My effort is to, as soon as possible, to be off the program,” he said. “But I would like to know — not only for my family but for other families in New Hampshire — that that program exists for when people like me fall into that crack.”

While the proposal in question is backed by a group of mostly Republican lawmakers, some of their colleagues said they’d like to see the program go away.

Rep. Frank Edeblut, who is running for governor, described the plan as “a classic example of politicians kicking the can down the road.”

“I believe, and I think we all here believe, in the concept of a safety net for those who are less fortunate, those who are disadvantaged in our state and in our society,” Edelblut said. “But what we do not support is a security fence that has the effect of locking New Hampshire citizens into a stasis of poverty. In effect, that is what this legislation does.”

Others who spoke up against extending Medicaid expansion also cited financial concerns, questioning whether the hospitals and insurers — which have agreed to help fund the program — would end up passing along costs to consumers.

“This bill is a complete abandonment of New Hampshire ideals,” said Rep. Leon Rideout, of Lancaster. “We are throwing away New Hampshire’s small government, our low spending-equals-low taxes history.”

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Credit Office of the Legislative Budget Assistant

According to estimates from the Office of the Legislative Budget Assistant, New Hampshire will need to come up with about $10 million to keep the program running in 2017 (on top of money already set aside from the insurance premium tax), $25 million in 2018 and $15 million in 2019.

Under the expansion proposal discussed Thursday, those costs would be covered by a combination of revenue from the insurance premium tax and contributions from health providers.

Insurers and hospitals would split the costs evenly, according to the proposal. Together, they would be responsible for an estimated $10.4 million in 2017, $16 million in 2017 and $10.4 million in 2018, according to the LBA.

Senate President Chuck Morse, a proponent of the plan, was one of several Republicans who tried to make the case that the price of not covering people through Medicaid expansion ends up being expensive for the state in other ways.

“We developed a bucket outside of government that gets a deposit from the federal government, and that basically pays for insurance plans for these people who are using the services,” Morse said, describing the current structure of the Medicaid expansion. “How was it done in the past? They got to use the services anyways, and you picked up the tab to the extent of $429 million in uncompensated care in New Hampshire.”