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Artificial sunsets
Why expanded Medicaid in N.H. fights for its existence every two years

03/31/16
By Ryan Lessard news@hippopress.com



 New Hampshire’s expanded Medicaid program, which the state has dubbed the New Hampshire Health Protection Plan, got a new lease on life when House lawmakers voted to renew it for two more years. But come Dec. 31, 2018, the program is again at risk of sunsetting unless the legislature goes through this process all over again. 

 
Short-term solution
“It’s a short-term solution for a long-term problem,” said Rep. Joseph Lachance, the Republican sponsor of the reauthorization bill.
Lachance, of Manchester, has taken a more moderate position on expanded Medicaid than some of his more conservative colleagues who would rather see the program discontinued.
“We’re compassionate people. I wanted nothing to do with throwing 48,000 people off the rolls and having the taxpayer pick up the uncompensated tab,” Lachance said.
Since the program was first implemented in 2014, health officials say 48,575 Granite Staters who had no health insurance before are now on the program as of March 18, so lawmakers on both sides of the aisle don’t hesitate to call it a success. 
The greatest figure that proponents point to as evidence of the program’s success is $142 million reduction in uncompensated care in 2015, according to the New Hampshire Hospital Association.
Some lawmakers, like Republican Sen. Andy Sanborn of Bedford, think the number is closer to $22 million.
Sanborn is part of a vocal contingent of Republicans who don’t want to see expanded Medicaid continue. And that divide in the party is one reason why any effort to reauthorize the program had to be written with an end date.
“I would not have authored a bill without an expiration date,” said Lachance. “On a two-year-young program, I think it’s only responsible to put that sunset on there and to take a look at where we stand two years from now.”
Lachance says he’s not against indefinite reauthorization himself. He drafted the bill as a compromise, knowing the sunset would make it easier to pass.
Still, he says, it’s probably smart to play it safe since the evidence he believes supports the narrative that this program is successful is only about two years’ worth of data. And Lachance raises the spectre of the federal government possibly drawing back its funding more than the 10 percent planned over the next four years.
 
Uncertainty
If Democrats had it their way, it would have been reauthorized indefinitely, according to House Minority Leader Stephen Shurtleff.
“I think they would just so we don’t keep going through this every two years,” Shurtleff said. “In the original bill, when we passed it, we said if the federal money ever stopped coming to New Hampshire, then that would be justification for stopping the program.”
But Shurtleff says doing it this way causes uncertainty in the healthcare industry and with patients on the program.
“It’s a problem. I’m sure to the insurance companies it’s a concern, to hospitals also and most importantly to those who are receiving the benefits to have to wonder every two years is this program going to stay in existence,” Shurtleff said. “I think there are a lot of people that are unfortunately negatively impacted by waiting for this every two years, for the reauthorization.”
Lachance, for his part, says the two-year renewal is not ideal, but at least it creates two years of certainty.
Lachance said he took what many might see as a risky position in a party that has placed the repeal of Obamacare in its platform because of the constituents who call him saying they have substance abuse treatment now they wouldn’t have otherwise — and because the Manchester welfare office saved nearly $1 million on prescription drugs now being paid for by Medicaid.
 
New Medicaid
Getting the program through the Statehouse in the first place was no small task. After years of wrangling between Republicans who wanted nothing to do with the Affordable Care Act and Democrats who wanted to push the program through, a compromise was crafted. New Hampshire is now one of a few states that offer expanded Medicaid coverage through private insurers with a model Arkansas piloted known as premium assistance. It helped get the Republican votes needed to pass the law because it is seen to encourage competition in the marketplace.
This year, the debate has been around how to fund the program after the federal government starts pulling back its funding gradually from 100 percent through the end of 2016 to 90 percent by 2020. 
The bill that passed the House would fund the difference with contributions from the hospitals and insurance companies who see it as a way to save money in the long run.
The Senate Finance Committee held its first hearing on the bill on March 22. The Senate is expected to pass reauthorization and Gov. Maggie Hassan has expressed her support.  





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