Healthcare

As a new work requirement for beneficiaries of New Hampshire’s expanded Medicaid program takes effect this month, some in the healthcare industry say early signs are pointing to a bumpy road ahead.

New Hampshire has joined a handful of states that mandate some Medicaid recipients to engage in certain activities: for example, a job, school, or community services. But recent federal changes tightening certain aspects of the program, as well as proposed legislation, have renewed debate over the Granite State's approach. 

In the midst of the opioid epidemic, the U.S. Department of Health and Human Services is addressing the need for alternative pain management. The department recently released a draft federal report on best practices — and opened a public comment period. Pain specialists recommend an interdisciplinary approach, combining physical treatments, pharmacology and mental health therapy. Many Granite Staters encounter hurdles with insurance coverage, access to health care providers, and stigma in treating their pain holistically.

We talk to physicians about the best approaches to acute and chronic pain. We also hear how health insurance companies are adjusting coverage to meet changing trends in pain management.

Chris Pappas, Democratic candidate in the 1st Congressional District, says we bipartisan legislation is needed to bring down insurance costs, and that patient protections will rein in profit-driven insurance companies.

All Things Considered host Peter Biello spoke with Pappas on health care policy in our final interview for this series. In the past two weeks, All Things Considered spoke with all of New Hampshire's gubernatorial and Congressional candidates.

[This transcript has been lightly edited for clarity.]

The Republican candidate in New Hampshire's 1st Congressional District Eddie Edwards says he supports the repeal of the Affordable Care Act. For people who currently rely on expanded Medicaid, he says, increasing access to insurers across the country would bring down costs.

All Things Considered Host Peter Biello spoke with Edwards about healthcare policy. All Things Considered is speaking with all congressional candidates this week.

(This transcript has been edited lightly for clarity.)

Democratic Congresswoman Annie Kuster says if she is re-elected, her proposals for healthcare in New Hampshire, including a plan for Medicare expansion, will increase access and stabilize health insurance markets.

All Things Considered Host Peter Biello spoke with Kuster, incumbent in the 2nd Congressional District, on healthcare policy. All Things Considered is speaking with all Congressional candidates this week.

(This transcript has been edited lightly for clarity.)

The Republican candidate in New Hampshire's 2nd Congressional District Steve Negron says he does not think the government should be in the business of healthcare, although he supports federal funding for Medicaid to help needy populations. 

NHPR's Peter Biello spoke with Negron about healthcare policy. All Things Considered is speaking will all congressional candidates in the New Hampshire this week.

(This transcript has been edited lightly for clarity.)

If you are elected to Congress how would you tackle the state's opioid crisis?

Gov. Chris Sununu says he has a model for paid family and medical leave that's voluntary, citing his opposition to the mandatory proposal that passed the House during the last legislative session.

Dr. Anna Konopka, a physician in New London, surrendered her medical license in October to settle allegations from the New Hampshire Board of Medicine. Months later, she’s still fighting to reopen her doors.

As her battle plays out in the courts, many of her patients are struggling to find a new primary care doctor. Many of them are low income and reliant on pain medication day-to-day.

With uncertainty over the Affordable Care Act's future, and Congressional inaction on an alternative, some lawmakers in D.C. and New Hampshire are re-branding an old idea: government-financed universal healthcare.  We look at the pros and cons from a medical and budgetary perspective.

GUESTS:

In the past few months, the Manchester VA Medical Center met with scandal, disaster, and a full helping of public outcry. Today on Word of Mouth, NHPR's Peter Biello looks back on the summer's news and tells the story of one woman's effort to improve hospital facilities for survivors of military sexual trauma. 

Dr. Anna Konopka’s medical office sits just across the driveway from her house, tucked along the shore of Pleasant Lake in New London. There’s no cell service, no wifi. Her phone rings off the hook.

At 85, she’s set to close her practice Friday, but the move is not voluntary. She says she’s being forced to shut down by a system that no longer values the type of patient-centered medicine that she practices.  

The New Hampshire Board of Medicine has a different take. They’re challenging her medical decision-making and other fundamental aspects of her work.

After the Graham-Cassidy Bill proposed by Republicans -- their latest Repeal and Replace effort -- failed to garner enough votes recently, patients, healthcare providers, and insurers still face plenty of uncertainty before open enrollment begins November 1. Meanwhile, Senator Bernie Sanders's single-payer proposal continues to gain fans. We'll get the latest on how national politics is shaping the health care debate across the country.  

GUEST:

• Julie Rovner - Chief Washington Correspondent for Kaiser Health News. She has written extensively about the politics surrounding health insurance for KHN's Repeal & Replace Watch. Rovner also hosts the What the Health? podcast. 

The Boston Globe published revelations on Saturday of dangerous delays in care and unsanitary conditions at the Manchester VA Medical Center.

Recently, VA Secretary David Shulkin told a Senate Committee that an important program designed to help veterans get care at private hospitals was running out of money sooner than expected. He was talking about the Veterans Choice program.

Meanwhile, here in New Hampshire, the program has slowly required more and more administrative help from employees at the Manchester VA. Assistant Director of the medical center, Kevin Forest, recently said as much to the State Veterans Advisory Committee.

Governor Sununu and other New Hampshire lawmakers announced their opposition to the proposed healthcare bill from the U.S. Senate.  "Keno-garten" comes to the Granite State, but critics worry the new funding from the electronic gambling game Keno won't be enough for widespread full-day kindergarten programs. And Mayor Ted Gatsas of Manchester announces his re-election campaign, amongst some controversy. 

An assessment of the quality of care provided to military veterans at the VA hospital in White River Junction, Vermont, has found that management and staff failed on numerous occasions to follow best practices to keep patients safe.

  New Hampshire Congresswoman Annie Kuster is calling on Republican House leaders to withdraw their health care reform bill.

The nonpartisan Congressional Budget Office estimates the bill would increase the number of people without insurance by 14 million in the first year, and 24 million by 2026.

Speaking to NHPR's Morning Edition, Kuster said she's not surprised White House officials are disputing the figures released Monday.