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Are State House Dems Plotting to Blow Up the Budget?

Guy Fawkes Day could be coming early to Concord as a contingent of House Democrats is reportedly scheming to blow up the proposed budget in a fight over Medicaid expansion.

Multiple sources tell NHJournal Democrats are toying with some radical plans, including the possibility of using a potential future majority in the evenly-split House to “vacate the speaker’s chair,” giving Speaker Sherman Packard (R-Londonderry) the boot.

Another idea: Strip Medicaid expansion from the House budget by voting on it as a standalone bill, then leave the House GOP to attempt to pass a budget — and fail — without Democratic votes. But since the Medicaid expansion bill has already been retained in committee, the Democrats would have to override the committee process and vote to bring it to the House floor.

The conspiracy talk comes at a time of heightened tension in the budget negotiations between legislators and Gov. Chris Sununu, with one source saying no one knows what is going to happen next.

“If they do any of this, it is total Armageddon,” one GOP House member told NHJournal.

Senate President Jeb Bradley (R-Wolfeboro) shares a similar view, calling the talk he has heard from the Democratic side of the aisle “Washington-style politics at its worst.”

As for a possible Democratic attempt to pull Medicaid expansion out of budget for its own vote, “I think it’s a very dangerous game,” Bradley said during a podcast interview with NHJournal. “It puts at risk the budget and Medicaid expansion at risk.”

Bradley took the lead in the Senate, spearheading SB 263, the Medicaid expansion bill, which extends the state’s Granite Advantage health insurance program. While low-income families qualify for traditional Medicaid, the Granite Advantage program makes Medicaid available to working families who earn too much for Medicaid but don’t have access to affordable health insurance through their employers. And 90 percent of the funding comes from federal dollars.

“My responsibility as I see it is to get the job done for the 50,000 to 60,000 people now depending on Medicaid expansion,” Bradley said. “To say nothing of the providers, the hospitals, the business community, all of the people that have gotten behind this coalition effort for the last nine years.

“Our responsibility, as adults, is to get the job done.”

The original proposal would have permanently expanded health coverage, while some House GOP members wanted to see just a two-year expansion. Bradley has agreed to a compromise plan that extends the benefit for seven years. That is complicated by the fact the budget, HB2, includes a two-year extension to Medicaid.

Packard is seen as a key opponent to the permanent expansion. Now, sources tell NHJournal some Democrats plan to yank Medicaid expansion away from the House Finance Committee and hold a floor vote on a permanent expansion. At the same time, those Democrats are also gearing up to push Packard out of the speaker’s chair.

House Clerk Paul Smith said motions to vacate the speaker’s chair are rare and typically unsuccessful. Any vote to remove Packard would require “50 percent plus one” of the entire body — not just those present. There are 196 Democrats in the House. With several vacancies, the current House membership is 396, meaning Democrats need 199 votes.

House Finance Committee member Rep. Peter Leishman (D-Peterborough) has heard the rumblings about Medicaid expansion, but he said the House conspirators are all talk. He noted that the Finance Committee voted Thursday to retain the bill, locking it into the committee.

“If the bill’s not reported out, they can’t take it away from the Finance Committee,” Leishman added.

But other House sources said an obscure and rarely-used move could allow Democrats to override the committee’s vote to retain. Smith said it would be a highly unusual move.

“Does it usually happen that the House withdraws a bill from committee? No, not usually,” Smith said.

House Majority Leader Jason Osborne (R-Auburn) conceded that, given the tight margins in the House and attendance issues, it’s very possible Democrats could again find themselves with a majority on the floor. If they do and choose to abandon the norms and traditions of the House, they could wreak havoc.

“But the real result would be total Republican unity,” Osborne added. “These things Democrats are talking about would completely unify my caucus.”

In fact, Deputy Speaker Steve Smith now says House leadership is on board with Bradley’s proposed Medicaid expansion deal.

“We’ve heard from the business community, the health care community, and people across New Hampshire about the importance of reauthorizing Medicaid expansion,” Smith said in a statement. “We all agree that the program needs to be reauthorized, and we’ve had a productive conversation about the appropriate length of time for a sunset provision.

“A seven-year extension of the Granite Advantage Healthcare Program makes logical and fiscal sense. New Hampshire gets the financial benefit of a full contract period, a continued drop in uncompensated care costs – which is a hidden tax, and it stabilizes the market allowing for more competition to help further drive down health care costs in our state. House Republican leadership fully supports the budget compromise of seven years. Let’s get it done,” Smith said.

Regardless of how the Medicaid vote goes, former House Speaker Rep. Steve Shurtleff (D-Penacook) said an attempt to force a vote, or worse, depose Packard, is a mistake.

“What we don’t need right now is this kind of gamesmanship,” Shurtleff said. “There’s no need for these kinds of fights.”

Too many people in the state rely on the budget passing, Shurtleff added, and delaying that makes those people the victims in an unnecessary political fight. “The budget is too important to too many people,” he said.

Then there is the question of motive. Given how relatively apolitical the current budget is — no anti-CRT legislation or late-term abortion bans — why would Democrats contemplate such high-risk actions against it? Particular a budget with hefty pay raises for state workers, who tend to be political allies of the Democratic Party?

Several House Republicans told NHJournal they believe the real target is Sununu. If the governor is tied in an ugly budget battle or trying to corral House chaos, it might stop — or at least slow — his presidential plans.

“Or maybe the Democrats are just [expletives],” one GOP House member said.

Blowing up the budget would hurt state employees, people who need affordable housing, families who need childcare, Granite State communities that need water infrastructure repairs, and every homeowner who needs property tax relief, Bradley said.

“I would just say that is the worst possible case scenario because everything could wind up in the tank,” Bradley said.

Even Democratic stalwart Sen. Lou D’Allesandro (D-Manchester), who voted against the budget last week, wants the spending plan to pass. D’Allesandro and Sen. Cindy Rosenwald (D-Nashua) voted against HB2 in the Senate Finance Committee, saying they want improvements to the final bill before they support it.

“There’s an opportunity to add a couple of things to the budget,” D’Allesandro said.

D’Allesandro wants to see more money for state employee pensions, more money for affordable housing, and no money for northern border security. He said that as long as the bill remains intact and the House remains sane, there will be another opportunity to vote on the budget after more negotiations. That includes negotiating more time for Medicaid expansion.

The specter of a messy fight over Packard’s speakership is a non-starter for D’Allesandro. Packard is doing a solid job leading a closely divided House, he said.

“Sherman Packard was my student when he was in high school. I think the world of Sherman; he’s a fine man.”

Likewise, Leishman does not think Packard should be pushed out.

“I think Sherm’s done a good job trying to hold things together,” Leishman said.

Senate Pushed Seven-Year Sunset for Medicaid Expansion

In an attempt to reach a compromise with reluctant House Republicans, the Senate Finance Committee Tuesday added a seven-year sunset clause to the proposed reauthorization of Medicaid Expansion.

“From where I sit, seven years is pretty darn good,” said Senate President Jeb Bradley (R-Wolfeboro).

The committee added the seven-year sunset as it moved SB263 to become part of the biennial budget and a major part of the GOP majority’s Family First platform.

“We have allocated resources to support key areas such as education, our economy, health care, infrastructure, and public safety, all while delivering more financial support to our communities. Further, the Senate Finance Committee accomplished all this while reducing spending by three-quarters of a billion dollars less than the budget was brought to us,” Bradley said.

The budget includes $169 million for education, $30 million for the Housing Champions program, an additional $10 million for local homelessness programs, and a $134 million increase to the Medicaid reimbursement rate. Senate Finance Chair Sen. James Gray (R-Rochester) said that was all being done without adding to the tax burden.

“Throughout the budget process, we have remained mindful of the diverse needs of our state, listening to the concerns of our constituents and working diligently to address them. This budget reflects our efforts to serve New Hampshire families without harming the financial stability of our Granite State,” Gray said.

Bradley is the main GOP driver behind SB263, the bill to continue New Hampshire’s Granite Advantage Medicaid program. It provides medical insurance for about 60,000 low-income residents and is scheduled to end next year without another reauthorization.

The bipartisan bill, already passed by the Senate, would have created a permanent Medicaid program as part of the Affordable Care Act. Though it is supported by New Hampshire’s medical and business communities, the bill ran into opposition from the slim GOP majority in the House.

House leadership under Speaker Sherman Packard (R-Londonderry) tried to limit the expansion to five or six years when SB263 went to the chamber earlier this month.

With the measure now heading to the House Finance Committee later this week, pressure was on to reach a compromise that could get to Gov. Chris Sununu’s desk. Sen. Cindy Rosenwald (D-Nashua) agreed to Bradley’s amendment limiting the expansion to seven years, saying it could always be changed next year.

“If the House retains the bill, we can override the seven-year sunset next year,” Rosenwald said.

Bradley said the seven-year extension allows the state to seek the best deal with managed care companies to administer the insurance. Any shorter time frame could add about 10 to 15 percent to the costs, he said. The bill also includes a clause to revive a commission that will investigate the future of the expanded Medicaid program.

“The seven-year sunset, I believe, is an acceptable compromise,” Bradley said.

Sen. Regina Birdsell (R-Hampstead) said the budget protects families while strengthening the state’s economy.

“By extending our innovative Granite Advantage Health Care Program for seven years and increasing Medicaid reimbursement rates by $134 million, this budget will not only safeguard the health and well-being of New Hampshire’s most vulnerable populations but also provide financial stability to our state’s health care sector,” Birdsell said.

Steve Ahnen, president of the New Hampshire Hospital Association, praised the compromise.

“We are pleased with the agreement on reauthorization of Medicaid expansion for the next seven years as part of the state budget for fiscal years 2024 and 2025 currently in Senate Finance,” Ahnen said. “This agreement will provide much-needed stability for the program that will serve our patients, providers, and the state well. The Granite Advantage Health Care Program has successfully helped to ensure our patients are able to receive the right care, at the right time, in the right place, and this compromise agreement will continue to help people access the care they need, when and where they need it. We appreciate the bipartisan leadership in both the Senate and House in reaching this important compromise.”

Under the Affordable Care Act, 90 percent of Granite Advantage is paid for by the federal government, with the remaining 10 percent getting funded by an insurance premium tax and other sources. In 2022, Granite Advantage cost a total of $558 million, but the federal government covered $502 million.

Expanding Medicaid to low-income residents has created savings for hospitals and led to more people being healthier and able to enter the workforce. It is also driving the costs of private insurance down by cutting the amount of money hospitals lose providing uncompensated care.

According to the New Hampshire Hospital Association, Granite Advantage has led to a 63 percent decrease in the number of uninsured people going to emergency rooms. There has also been a 57 percent drop in uninsured people being admitted to hospitals and another 41 percent reduction in the number of outpatient visits by uninsured people.

In 2014, hospitals reported $174 million in uncompensated care costs before Granite Advantage went into effect. In 2021, that figure dropped to $69 million, according to the NHHA.

Granite Advantage has also helped close to 30,000 people have been able to access mental health care. Another 9,000 have been able to seek treatment for substance use disorders.

Medicaid Expansion Bill Gains Steam in State House

As the bipartisan bill to reauthorize New Hampshire’s Medicaid expansion program, Granite Advantage, moves through the legislature, backers are making a conservative case for the expansion.

Senate President Jeb Bradley (R-Wolfeboro) is one of the bill’s prime sponsors. He says expanding Medicaid has lowered healthcare costs, improved healthcare for Granite Staters, and helped get more people into the workforce.

“The program has worked as intended,” Bradley said.

The Granite Advantage bill, SB 263, won unanimous support in the Senate last month. It’s scheduled for an executive session discussion on Wednesday before the House Health, Human Services and Elderly Affairs Committee. If approved, the bill will then head to the full House for a vote.

Granite Advantage was last reauthorized in 2018 and is set to expire at the end of the year without SB 263’s passage. Enrollment in the program was around 94,000 residents at the start of the year, though the national COVID-19 emergency inflated those numbers. Those figures are expected to return to around 60,000 residents in the coming months.

SB 263 would reauthorize the program and remove the requirement that the legislature pass legislation to reauthorize it every few years, instead relying on a study commission to send an annual report to the legislature reporting on the effectiveness of the program. Even if SB 263 were to pass, the legislature could sunset this program at any time by a vote of the legislature.

According to Bradley, providing coverage through Granite Advantage is taking a bite out of healthcare costs. The program is driving down the cost of uncompensated care hospitals are required to provide to people without insurance. That protects people with private insurance from being stuck picking up the tab when someone without insurance goes to an emergency room for treatment, he said.

“[Uncompensated care] is a hidden tax on any individual or any business with private insurance,” Bradley said.

According to the New Hampshire Hospital Association, Granite Advantage has led to a 63 percent decrease in the number of uninsured people going to emergency rooms. There has also been a 57 percent drop in uninsured people being admitted to hospitals and another 41 percent reduction in the number of outpatient visits by the uninsured.

In 2014, hospitals reported $174 million in uncompensated care costs before Granite Advantage went into effect. In 2021, that figure dropped to $69 million, according to the NHHA.

Sen. Lou D’Allesandro (D-Manchester) said permanently expanding Granite Advantage makes sense beyond the numbers.

“I just feel it’s the right thing to do,” D’Allesandro said. “We take care of a lot of people.

And, he pointed out, the bill does not use any money from the state’s General Fund.

The bill’s costs are 90 percent covered by the federal government. In 2022, Granite Advantage cost $558 million, but the federal government covered $502 million. According to Bradley, the remaining $56 million was paid through healthcare taxes and fees, with money from the state liquor fund also available to cover costs.

New Hampshire Business and Industry Association (BIA) President and CEO Michael Skelton said abandoning Medicaid expansion would hurt both the state’s economy and the people who make New Hampshire’s growing economy possible.

“We benefit from an overall healthier population,” Skelton said. “Hospitals and other caregivers avoid catastrophic loss of revenue, and employers and employees across the state will benefit from individuals being healthy enough to work.”

In addition to the BIA, numerous other NH-based business organizations including the NH Retail Association and several chambers of commerce have advocated for the reauthorization of Medicaid expansion.

House, Senate Finalize State Budget in Conference Committee. Full Votes to Come Next Week.

After four days of back-to-back negotiations between the New Hampshire House and Senate, lawmakers on the state budget conference committee finally decided Wednesday on an $11.7 billion two-year spending plan. Although its widely expected to pass the Senate, there is still a chance that it could fail in the volatile House.

“This is a budget the legislature and the people of New Hampshire can be proud of,” said House Speaker Shawn Jasper after the committee approved the final version of the budget. “This budget provides resources to address the opioid crisis, mental illness, and domestic violence, includes several reforms to state government, and keeps spending in check. We’ve achieved a balance that ensures our citizens will have access to services they need while reducing the tax burden.”

Whether it will garner enough Democratic or conservative votes remains to be seen. Democrats claim Republicans are not spending all of the revenue available to the state and criticize that a workforce training proposal, known as Granite Workforce, was cut from the budget. It would have provided training and wage subsidies for certain types of workers since the state is dealing with a worker shortage.

“Democrats have made it very clear: we will not support a budget that asks working people to dig further into their wallets while the elite get more handouts,” said Senate Minority Leader Jeff Woodburn. “Unfortunately, our efforts to stand up for everyday people have been rejected at every turn. The reality is that this Trump-like, Republican budget agreement caves to the wealthy elite and ignores those who are most in need.”

Also, Democrats still don’t like that language was added to the budget that prohibits the state from giving money to health care facilities to provide abortions, which indicates that House Democrats are most likely not going to vote in favor of the budget in the full session next week.

State Reps. Al Baldasaro, R-Nashua, and Debra Altschiller, D-Stratham, brought up that issue on Twitter.

Little has changed from the Senate version of the budget passed last month, with a few notable exceptions. The new budget includes an amendment mandating new work requirements for people enrolled in the state’s expanded Medicaid program. Low-income adults would have to work, attend job training, or go to school for at least 20 hours per week to qualify for the New Hampshire Health Protection Program. If the federal government rejects the work requirement, as it did last year, expanded Medicaid would end by 2018.

Some advocacy groups, like New Futures — which focuses on mental health, substance abuse, and children issues — were critical that an amendment in the budget would allow the governor to divert money away from the state’s Alcohol Fund, which is used for substance abuse treatment, prevention, and education programs. The governor would be allowed to reach into the fund to help pay for operations at the state’s juvenile detention center in case of emergencies after approval from the fiscal committee.

“Weakening the addiction treatment system in the midst of New Hampshire’s devastating opioid crisis will place the lives of people struggling with addiction at risk,” said Linda Saunders Paquette, CEO and president of New Futures. “This irresponsible decision by the committee cannot be overstated, and will be felt for years to come, as our public health crisis will only intensify without long-term sustainable investments.”

The budget includes cuts to the state’s businesses profits tax and business enterprise tax, but lawmakers also eliminated the electricity consumption tax, which generates about $5.5 million for the state each year.

“This budget also eliminates the Electric Consumption Tax, helping our state move in the right direction to reduce the burdensome electric rates paid for by homeowners and businesses,” said Senate Finance Chair Gary Daniels, R-Milford. “By making changes that will result in lower monthly bills, we put money back in our employer’s pockets and create an improved, lower cost state to run a business.”

With these tax cuts, House GOP leadership is hopeful that enough members of the conservative House Freedom Caucus join in supporting the budget. The caucus still has concerns that the state spending levels are too high, indicating that some of its members will probably vote against it.

The House needs a majority to pass the budget and they need conservative support in order to do that. Jasper said he is optimistic the budget will get passed in the House next week. Behind the scenes, top GOP officials are starting to whip votes in order to make sure that it happens.

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What Factors Led New Hampshire to Be Ground Zero for the Opioid Crisis?

It’s a well-known figure that New Hampshire has the second-highest per capita drug overdose deaths in the United States, right behind West Virginia. The state also has the highest rate of fentanyl-related overdose deaths per capita, leading researchers, health care providers, first responders, and lawmakers to wonder what about the Granite State makes it one of the most ravaged by the drug epidemic.

That was the subject of a forum at Dartmouth College last month, which included Dr. Nora Volkow, director of the National Institute on Drug Abuse (NIDA) at the National Institutes of Health; Lisa Marsch, director of the Dartmouth Center for Technology and Behavioral Health (CTBH); and U.S. Rep. Annie Kuster, D-N.H.

“Not only did we want to bring together a broad group of stakeholders about the crisis in our communities, but we also wanted to have a discussion about the response to the crisis,” Marsch told NH Journal. “Why New Hampshire? What’s going on in New Hampshire that’s distinct and giving rise to it?”

To find out why the rate of opioid overdoses increased by nearly 1,600 percent from 2010 to 2015, the New Hampshire Fentanyl “HotSpot” Study was funded by the NIDA. The rapid epidemiological study focuses on the increase of overdoses from fentanyl, a drug that is 50 to 100 times more potent than heroin and often is mixed with heroin. In Phase I of the study, researchers spoke with medical responders, law enforcement officers, state authorities, and policymakers.

The study was conducted by the CTBH, in collaboration with the National Drug Early Warning System, and funded by the NIDA.

Marsch said they quickly realized that they needed to speak with opioid users to better understand the trajectory of fentanyl use, the tracking of the drug, and fentanyl-seeking behavior in order to effectively inform policy and community response.

Phase II was then commissioned to do just that. March’s team interviewed 76 opioid users, 18 first responders, and 18 emergency department clinical staff from six counties in New Hampshire during October 2016 to March 2017. The results of the study are not publicly available yet, but Marsch presented key findings at the forum.

The report found that the recent increase in the availability of fentanyl is because it is less expensive and quicker to take effect than heroin. However, the high doesn’t last as long and requires users to use more often, increasing the risk of overdose.

About 90 percent of the drug users interviewed for the study indicated they actively sought out drugs that would cause overdoses.

“We want whatever is strongest and the cheapest. It’s sick,” one respondent said. “I now me using, when I hear of an overdose, I want it because I don’t want to buy bad stuff. I want the good stuff that’s going to almost kill me.”

Marsch said the study allowed researchers to analyze “a whole array of factors that set up the perfect storm” for New Hampshire to be one of the hardest hit states by the opioid crisis. She said the Granite State consistently rates in the top 10 states with the highest drug use rates and opioid prescribing by doctors exceeds national averages.

 

New Hampshire is also in close proximity to a supply chain for the fentanyl drug in Massachusetts.

According to the U.S. Drug Enforcement Administration’s 2014 National Drug Threat Assessment Summary, most heroin supplies in the New England region are brought in from New York along the vast interstate highway system, naming I-95 and I-93 as the major routes for New Hampshire’s heroin traffickin. The report also named Lawrence, Mass. as a main distribution center for northern New England states.

The New Hampshire “HotSpot” Study pointed to these other factors contributing to the heroin and fentanyl crisis in the Granite State:

  • Treatment admission rates per capita are lower than both the national average and all other New England states
  • N.H. has the lowest per capita spending on treatment in all of New England and it’s the 2nd lowest in the nation
  • The state has the lowest rate of Suboxone, a medication used to treat opioid addiction, providers per capita in all of New England
  • Public health funding per resident is lower than the national average and surrounding states
  • N.H. is the only state in the Northeast with no needle exchange program (The legislature recently passed a bill legalizing the programs and Gov. Chris Sununu said he would sign it.)
  • The state’s rural setting keeps people in tightly knit social networks and has limited access of “things to do.”

“The economic factors, the rural nature, the politics, lack of resources, and the close proximity to the source of these drugs has created a really bad scenario for the state,” Marsch said.

In order to curb the alarming trend of opioid overdose deaths in the Granite State, the researchers suggested the state increase public health resources for substance use prevention and treatment, expand prevention programs in elementary and middle schools, assist physicians with understanding opioid prescribing, and collaborate with Massachusetts on addressing the manufacturing and trafficking of fentanyl and other opioids.

At the forum, Kuster, who co-chairs the House Bipartisan Task Force to Combat the Heroin Epidemic, said she was confident that Granite Staters’ “certain blend of tenacity and creativity” will help find solutions to this epidemic. Officials point to the Safe Station program, which allows anyone who is struggling with drug addiction to go to fire stations in the state to connect with recovery resources, as a New Hampshire solution to the drug epidemic.

Yet, Kuster was worried that it would be difficult to get more funding and resources under President Donald Trump’s leadership.

“We cannot get this job done without Medicaid expansion. I’m concerned about cuts for mental health and behavioral health services,” she said. “If they’re [Republicans] going to walk the walk, as they have talked about opioid addiction, they’ve got to fund the programs that will bring the services to our communities.”

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Price, Conway Visit New Hampshire to Reaffirm Trump’s Commitment to Ending Opioid Crisis

The latest stop in Tom Price’s opioid crisis listening tour brought the health and human services secretary to the New Hampshire State House on Wednesday. He wasn’t alone, though. Always near him was Kellyanne Conway, counselor to President Donald Trump. They were joined by Gov. Chris Sununu, state Health and Human Services Commissioner Jeffrey Meyers, and Democratic U.S. Rep. Annie Kuster of New Hampshire, among other treatment providers, law enforcement, first responders, and families who have been impacted by the substance abuse crisis.

The meeting in Concord only lasted about an hour and members of the press were not allowed to be in the Executive Council chambers where the listening session took place. Afterwards, Price and Conway went to Manchester Fire Department to learn about the city’s Safe Station program. Press were also kicked out at first, but were then invited back in.

At a press conference after the listening session, Price said solving the opioid crisis is a priority for the Trump administration and his visit was a chance to see how states are dealing with it at the ground level.

“The Department is all in, the President is all in,” he said. “He has such passion for this issue, because he knows the misery and the suffering that has occurred across this land, and wants to help, help solve it.”

Price points to the recent $3.1 million in funds — with more money on the way — being sent to New Hampshire as evidence of the administration’s commitment to getting more resources out into the field.

Yet, more funds are needed for the Granite State, which has the second-highest overdose deaths per capita in the country. Nearly 500 people have overdosed on drugs in 2016. New Futures, a nonprofit focused on the opioid crisis, released a report Monday that found substance misuse costs the state’s economy about $2.36 billion each year.

Sununu praised the White House for its “tremendous” effort in reaching out to the states to see what they think of certain policies and solutions to combat opioid misuse.

“This administration has provided a great philosophy in that they want to set a foundation and a platform for good policy out of Washington but they look to the states to implement it,” he said. “Unlike the previous administration where Washington was going to implement and control everything, they want the states to be the implementers.”

However, Democrats are blasting the U.S. House of Representatives’ passage of the American Health Care Act, which would make major changes to Medicaid expansion. Democrats argue that the bill would weaken funding for federal programs to battle the drug epidemic.

Just before Price and Conway’s arrival, protesters staged a “die-in,” laying on the floor in the hallways of the State House, holding up signs that said, “Trump lied, I died” and “I died for a billionaire’s caviar.”

Democrats held their own press conference while Price and Conway met with New Hampshire leaders, criticizing Sununu for holding a closed-door meeting.

“New Hampshire won’t stand for a plan where premiums skyrocket, benefits shrink, and thousands are booted off [health care] coverage,” said Senate Minority Leader Jeff Woodburn.

Price said Trump is committed “to make certain that every individual has access to the kind of coverage that they want for themselves and for their family.”

“I think it’s important to step back and say is the Medicaid program the most appropriate program for every individual in that economic setting,” he added. “Is there a better way to provide coverage? Is there a better way to provide services? Whatever the answer to that is the president is committed and we’re committed to making certain every single American has a seamless transition.”

He vowed “that nobody falls through the cracks. That no rug is pulled out from anybody and that we make certain that the coverage and the care is available to every single American.”

Sununu said he had “some severe reservations” about the House’s health care bill, but he appreciates “the progress the House made.”

“We have to move that ball forward,” he said. I do have reservations in some areas when you look at the details. But people have to understand this is simply one part of the process. The Senate is going to go through their process. It shows that Congress isn’t stalled, not stagnated. They’re not going to do nothing. I think we’ve had eight years of a lot of do nothing. They’re doing something and they’re standing up for the American people.”

Conway said the opioid epidemic should be a bipartisan issue that Democrats and Republicans solve together.

“We look at this as a non-partisan issue in need of a bipartisan solution,” she said. “And we are working with people on both sides of the aisle in Washington and within each of the states to do exactly that.”

However, there are instances of disagreement between Republicans, especially on the American Health Care Act. It also appears that New Hampshire leaders and the White House aren’t always on the same page.

Several media outlets reported that the Trump administration was contemplating a 95 percent cut for the White House Office of National Drug Control Policy (ONDCP), which houses the agency’s high-intensity drug trafficking program and drug-free communities support program. Officials dismissed the claims and reaffirmed Trump’s support for ending the opioid crisis. Sununu called the reports “very disconcerting.”

Price and Conway did not mention the national drug czar’s office during their visit. While New Hampshire is one of the hardest hit states of the drug epidemic, it appears an official from the state has not been invited to sit on the President’s Commission on Combatting Drug Addiction and the Opioid Crisis, leaving many to question how committed Trump is to fulfilling his campaign promise.

New Jersey Gov. Chris Christie is chairing the commission, and it was announced Wednesday that Democratic Gov. Roy Cooper of North Carolina, Republican Gov. Charlie Baker of Massachusetts, and former Democratic Rep. Patrick Kennedy of Rhode Island will also serve on the commission. Bertha Madras, a former deputy director of the Office of National Drug Control Policy, will also work on the commission, but no one from the Granite State.

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What Does the GOP Health Care Bill Mean for N.H. Residents in the North Country?

With the American Health Care Act moving to the U.S. Senate, some New Hampshire Republicans are cheering as the bill makes its way through the legislative process. Yet, for some Trump supporters in the Granite State, especially in the North Country, they might not be too happy with its current version.

Despite still having some concerns about the AHCA, Gov. Chris Sununu said on Thursday that he was glad the bill passed the Republican-led U.S. House of Representatives.

“Failure to reform our health care system is not an option,” he said. “It is critical that we keep this conversation moving forward. My concerns with the AHCA remain firm and I expect that the United States Senate will take those concerns into consideration as they work to improve our nation’s health care system.”

Before the House passed the bill on Thursday afternoon, Sununu and 15 other governors sent a letter to House Speaker Paul Ryan reiterating their support for the Obamacare replacement and asked for states to have more flexibility when it comes to Medicaid.

It’s a similar letter Sununu signed on to earlier this year when the U.S. House tried to repeal and replace the Affordable Care Act the first time. In a Friday interview with the Concord Monitor, he applauded the passage of AHCA, but said he still had issues with the current version.

“I love the idea that Congress is taking action, the president is taking action,” he said. “They’re listening to the American people and they’re moving the ball forward. In it’s current form, I still have a lot of concerns, there’s no doubt. But we are moving it forward, and more important than anything is the need to reform the health care system right now that has failed the American people.”

It’s a different tone than he had in March, when he said the first version of the bill didn’t give states flexibility and would hurt New Hampshire’s expanded Medicaid program, which had bipartisan support.

“The bill that’s been proposed in Congress gives us concerns on a lot of different levels, to be very blunt about it,” Sununu said at a March press conference. “What I’m seeing in Washington gives me a lot of pause for concern to be sure, not just on the Medicaid expansion front, because that would drastically affect New Hampshire, but just on the mandates that are coming out of it.”

As expected, all of New Hampshire’s Democratic congressional delegation is opposed to the GOP-led plan. U.S. Reps. Carol Shea-Porter and Annie Kuster voted against the bill. Critics slammed the bill for potentially making millions lose health care and making it harder for people with some pre-existing conditions to find affordable insurance.

Some Granite State health care providers say more than 100,000 low-income New Hampshire residents could be at risk of losing health coverage under the AHCA plan. New Hampshire Hospital Association President Steve Ahnen said his organization was “deeply disappointed” that the U.S. House passed the health care bill.

“This bill is a significant step backwards on the commitment to ensure coverage and we cannot support it,” he said. “We will continue to work with Congress as this bill moves over to the Senate to ensure that any final legislation to repeal and replace the Affordable Care Act improves our health care system in a thoughtful and responsible way, rather than dismantling coverage for our most vulnerable residents.”

President Donald Trump campaigned aggressively on repealing Obamacare and lowering premiums. However, according to recent analysis, it appears premiums would significantly increase for older Granite Staters.

The Henry J. Kaiser Family Foundation, a nonprofit focused on health care, compared premium costs under the ACA and AHCA. For New Hampshire residents aged 60 or older who make $30,000, they could see their premium costs increase by 173 percent under AHCA. However, the same analysis also says younger residents in New Hampshire would pay less under the AHCA plan.

Many critics point out that the Trump-approved health care bill would negatively impact the people who voted for him. This holds up when using Coos County as an example.

Coos County overwhelmingly voted for Trump over Democrat Hillary Clinton by 52 to 43 percent, respectively. There is a large number of residents who are aged 65 and older in the North Country and the average household income is about $42,000, according to U.S. Census Bureau data. Those residents could fare worse under the AHCA plan than under the ACA.

In a Granite State Poll released Monday by the University of New Hampshire Survey Center, Trump’s approval rating in the state has remained steady at 43 percent. It’s the same rating he had in February. Republicans also still overwhelming approve of the president at 83 percent. Survey results from the North Country showed a statistically insignificant change.

It will be interesting to see over the next few months if residents in the North Country, especially those who voted for Trump, change their support. Nationally, it seems his base is sticking with him so far. Now, the U.S. Senate will now take over the AHCA bill and reports suggest the chamber will overhaul the legislation, making it different from the House version. The health care debate in Washington is far from over, leaving how it will ultimately impact New Hampshire a mystery for now.

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With AHCA’s Defeat, Obamacare Remains. What Does That Mean for New Hampshire?

The American Health Care Act (AHCA) was pulled Friday minutes before a vote was to take place on the bill in the U.S. House of Representatives, which essentially means Obamacare is here to stay.

House Republicans were shy of the votes needed to get the legislation passed, and defections from the conservative House Freedom Caucus, whose members didn’t think the “repeal and replace” bill went far enough, put it out of reach for President Donald Trump and House Speaker Paul Ryan.

After pulling the vote, Trump said that the “best thing we can do, politically speaking, is let Obamacare explode. It’s exploding right now. Almost all states have big problems.”

With no new health care plan in the foreseeable future, there are a couple of bills that New Hampshire lawmakers are expected to revisit that would make changes to Granite Staters’ health care.

Under AHCA, the Congressional Budget Office estimated that 14 million fewer people would be insured in the first year if it passed. Although it was unknown how many New Hampshire residents could have lost coverage under the plan, about 91,000 people had individual plans on the health exchanges as of February, according to state estimates. Also, 52,000 low-income people in New Hampshire who have insurance through Medicaid expansion were at risk.

It didn’t take long for the Granite State’s all-Democratic congressional delegation to praise the withdrawal of the AHCA, citing how much harm it would do to the state’s residents.

“It’s time for them to admit that while the Affordable Care Act is not perfect, it has made New Hampshire and the country healthier and is worth improving, rather than repealing,” U.S. Sen. Jeanne Shaheen said to WMUR.

U.S. Sen. Maggie Hassan also applauded the defeat of the bill.

“The failure of Trumpcare is good news for people across New Hampshire and America who would have faced higher costs for less care,” she said.

They also all said that Republicans and Democrats should work together to make improvements to former President Barack Obama’s Affordable Care Act (ACA).

“It’s time to have a serious discussion about improvements that can help our health care system work better for everyone,” U.S. Rep. Carol Shea-Porter said. “There’s so much more work to do if we can put partisanship aside and work for the good of our constituents. Let’s get to work.”

Since it appears Congress isn’t going to change health care, it’s now up to the states to make changes within the scope of the ACA, and that’s what the New Hampshire Legislature will do. Leaders of each state party also seem ready to tackle Medicaid expansion with bipartisanship, yet there appears to be some disagreement over when it should get done.

Gov. Chris Sununu said he had issues with the AHCA and he wanted flexibility under the law to allow states the power to implement the policy in ways that made sense to each state. He previously supported a block grant system for Medicaid, which would have capped the federal share, letting the states decide how to spend the dollars on care.

“The bill that’s been proposed in Congress gives us concerns on a lot of different levels,” Sununu said last week. “Expanded Medicaid is part of that discussion. There’s no doubt expanded Medicaid has provided [drug] recovery, treatment options for a lot of folks that otherwise may not have had that option available.”

New Hampshire was one of 31 states that expanded Medicaid under Obamacare. Former Democratic Gov. Maggie Hassan signed the plan into law in 2014 after working with Republican legislators to approve it in two-year increments. She signed the latest expansion bill in 2016. New Hampshire has more than 187,000 individuals enrolled in either traditional or expanded Medicaid, according to state health officials.

Now that block grants aren’t on the table anymore, New Hampshire lawmakers will figure out if they want to extend the program past 2018. The Senate tabled a bill last week, without debate, that would make Medicaid expansion permanent. Senate leadership said they wanted to see what happened with the AHCA before they debated Medicaid expansion in the state.

Senate Minority Leader Jeff Woodburn told NH1 News that “what we designed in a bipartisan fashion clearly has worked. Democrats are ready to move immediately.”

Senate Majority Leader Jeb Bradley said lawmakers shouldn’t rush into anything, especially since the New Hampshire Protection Health Program doesn’t expire until the end of next year.

“Even though the legislation in Washington was pulled and there’s no changes right now to federal guidelines for Medicaid Expansion, I think before we think about reauthorizing the current program, we need to make sure that’s exactly what’s going to happen in Washington that three or four or five months from now, they’re not coming back with a new health care bill,” Bradley told NH1 News. “If December comes and there are no changes to the ACA, that will guide us in what we’re going to do in terms of Medicaid Expansion next year. To me that’s the prudent way to do it. It’s what we did in 2016. We waited for the implementation to go forward in [2015]…So I continue to think doing it now is premature.”

Sununu has also previously indicated that he doesn’t want to continue kicking the can down the road with Medicaid expansion by renewing it every two years. He said he wants to find a long-term solution.

The right-leaning public policy group, Federalism in Action, released a 2016 study discussing the issue of long term care in New Hampshire and the challenges it will face in the future.

“New Hampshire is an apt harbinger of the country’s long-term care challenges. The state’s age 85 plus population will nearly quadruple in the next three and a half decades,” the report stated. “If its Medicaid long-term care expenditures for the elderly keep pace they’ll increase from $282 million per year to $1,047 million, more than one billion dollars every year. Sustainability at that level is highly dubious.”

It’s not immediately clear if New Hampshire lawmakers plan on taking the Medicaid expansion bill off the table in 2017 or will debate in 2018.

The N.H. Senate also tabled Senate Bill 149 last week that would allow out-of-state health insurance companies to operate in the Granite State without providing the benefits required under state law. It was tabled most likely to see what the federal government was going to do.

Significant questions still remain over what Obamacare would have in store for people with health insurance on the exchanges. Health experts are also curious about how the insurance industry will react in 2018. Will they stay or leave? What will rates be like? Minuteman Health in New Hampshire said it plans to be on the exchange in 2018, but no other health insurer has yet to say it would remain in the state.

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Sununu’s Shifting Tone on Medicaid Expansion Highlights Tough Position for Republican Governor

When it comes to Medicaid expansion in New Hampshire, Gov. Chris Sununu is in a tight spot. It’s not just him, actually. A lot of Republican governors across the country are having a difficult time figuring out how to balance the “repeal and replace” rhetoric on Obamacare within their party, while also seeking to protect certain provisions of the health care law, like Medicaid, that help the residents of their states.

It’s a balancing act that Sununu, the first GOP governor in the Granite State in 12 years, waded into last week. He said in its current form, he’s not “signing on” to the House Republicans’ American Health Care Act due to his concerns over Medicaid funding and coverage.

“The bill that’s been proposed in Congress gives us concerns on a lot of different levels,” Sununu said on Tuesday. “Expanded Medicaid is part of that discussion. There’s no doubt expanded Medicaid has provided [drug] recovery, treatment options for a lot of folks that otherwise may not have had that option available.”

The Congressional Budget Office estimates that $880 million less in federal money would be spent on Medicaid over the next decade. The Republican plan phases out the program by 2020 with states receiving funding for existing expansion recipients as long as they maintain continuous Medicaid coverage.

The Medicaid provisions in the Republican’s bill are reigniting a longstanding debate between conservatives and moderates of the party. Conservatives are critical of the program’s cost and performance, while moderates are worried that cuts to the program will result in a loss of funds in their state’s budget, leaving patients without help.

Sununu falls into the latter category. He has previously indicated his support for Medicaid expansion, yet doesn’t want to make the program permanent. He’s waiting to see how the Medicaid battle plays out in Congress before taking any action in the state.

New Hampshire was one of 31 states that expanded Medicaid under former President Barack Obama’s Affordable Care Act. Former Democratic Gov. Maggie Hassan, now a U.S. senator for the state, signed the plan into law in 2014 after working with Republican legislators to approve it in two-year increments. She signed the latest expansion bill in 2016, with the program scheduled to expire at the end of 2018. New Hampshire has more than 187,000 individuals enrolled in either traditional or expanded Medicaid, according to state health officials.

During Sununu’s 2016 gubernatorial bid, he said extending the state’s Medicaid program until 2018 was “probably a good step forward,” but lawmakers shouldn’t keep doing it every two years.

“I like the idea that we’re moving forward without any tax payer burden, any tax burden on the taxpayers back,” he told NH1 News in February 2016. “We have essentially a public-private partnership helping to fund it as we move forward, and those are very positive steps. What I would like to see is a long term strategy for this state, not simply taking it in two- or four- year chunks.”

Democrats attempted to paint him as opposing Medicaid expansion because of his 2014 Executive Council vote against a $292 million state contract to implement Medicaid expansion. However, the item was added to the agenda at the last minute and he tried unsuccessfully for a two-week delay to fully understand the contract. He said the council shouldn’t vote on something that hasn’t been read thoroughly.

Yet, throughout the campaign, he was ambiguous about his plans for the future of Medicaid in New Hampshire. He didn’t indicate if he was supportive of extending past 2018 or would support an outright repeal of the program.

Those in New Hampshire who were concerned about Medicaid’s future were also not consoled by a letter Sununu sent to Congressional GOP leadership in January. With Republican President Donald Trump in the White House and GOP majorities in the U.S. House and Senate, it appeared that the repeal of Obamacare was imminent.

As a result, Sununu sent a letter to U.S. House Majority Leader Kevin McCarthy, urging Congress to give states as much flexibility as possible to design their own health care systems.

“We urge Congress to untie the hands of the States,” he wrote in the letter. “Let us have the flexibility to design a New Hampshire system for New Hampshire citizens.”

However, his letter left out any mention or comment on Medicaid expansion.

It wasn’t until February that Sununu became more clear on what he thinks about the program. He said “there’s no doubt that it’s [Medicaid expansion] been helpful.”

“It was a price tag of somewhere between $400 and $500 million,” he told NHPR. “We’ve been able to do it to date without a single New Hampshire taxpayer dollar. No state taxes go into it.”

Later that month, he expanded on what he wanted to see from Medicaid in the GOP’s health care plan.

“When we hear the term block grants coming out of Washington, especially with healthcare, the opportunities are tremendous for us,” he said at a meeting of the Concord Chamber of Commerce. “We spend tens of millions of dollars on the state level on things we simply don’t need. So give us a block grant.”

When Republicans initially rolled out their health care plan, block grants weren’t included. The House plan focused on paying states a fixed per-capita amount to cover their population based on their average expenses, but a Republican amendment to the bill allowed the option for states to choose a Medicaid block grant in lieu of the capped reimbursement model.

Under current health care laws, when an eligible person enrolls in Medicaid there are matching federal funds to ensure that they get care. The block grant proposal caps that federal share, letting states decide how to spend the dollars on care. However, many health care professionals say capping Medicaid funding in block grants could hurt access to quality health care for the poor, children, and elderly by cutting the amount of federal dollars available.

It’s not immediately clear if Sununu approves of the most recent, updated version of the American Health Care Act, but Sununu said he would work with Trump to to ensure that the bill gives states the opportunity to create “flexible” and “nimble” health care program.

Democrats in the state, including Hassan, believe block grants would fail to sustain the expanded Medicaid program. It’s a position that’s shared with many advocacy groups, including AARP, which released a “fact sheet” last week about how changing Medicaid to a block grant or per capita cap could hurt New Hampshire residents.

“The House bill will impact health care seriously, but what it would do to Medicaid expansion … it would in fact repeal it,” Hassan said at a press conference last week. “That [block grants] 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.”

New Hampshire has one of the highest drug overdose death rates in the country. Nearly 500 people died from drug overdoses in 2016 and approximately 6,000 Medicaid expansion recipients have accessed treatment, state health officials said.

Sununu, and other state Republican leaders, believe block grants will allow them to allocate the money to places that need it most, such as towns hardest hit by the opioid crisis. Yet, some policy experts argue that block grants will severely strain state budgets and leave states vulnerable when they have to deal with unexpected issues, like drug outbreaks that raise the average cost of treating individual patients.

Sununu said he has spoken with Trump and Vice President Mike Pence about the importance of Medicaid with treatment and recovery for the opioid crisis, and how that requirement should continue under the GOP plan.

The N.H. Senate tabled a bill Thursday, without debate, that would make Medicaid expansion permanent. The senators said they wanted to wait to see what will happen at the national level before they tackle it in the state.

As conservatives and moderates battle it out on Medicaid provisions in the GOP health care bill, it appears New Hampshire, and Sununu, will wait for the dust to settle.

 

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