By Rep. Erica Layon
Medicaid expansion is an important program which fills a hole in the healthcare system for people who don’t qualify for traditional Medicaid and who are priced out of commercial insurance, and I believe that an extension that lasts less than eight years is the right answer. Not two, not eight, not forever. I offered a six year extension on the House floor, which I believe is a good choice.
Extending the Granite Advantage Program – our Medicaid expansion – for six years allows the state to get the best price on monthly enrollment costs for everyone in the program, gives time for the 30,000 people in the program who were kept on Medicaid expansion during Covid to move back to the private market, allows our hospitals and providers to recover from the shock of Covid, and allows lawmakers to look closer into the details of the program and how to get the best care and best value for your dollar when negotiations come up again.
Five Year Program, Take Two
Five year contracts provide a lot more stability than annual contracts, which is important because the insurance companies we pay to run the program have a monthly per-person price to provide all the care people on the program require. And usually, a five year horizon doesn’t have too many unexpected events.
Unfortunately the five year term for the Granite Advantage Plan only had one year of normal operation because it began in January 2019 and by March 2020 the world as we knew it changed. Once the public health emergency hit, you could get on Medicaid expansion and stay on through the end of the emergency even if you were making six figures. And the states have a yearlong grace period to make sure everyone on the program qualifies after the May 11 end of the public health emergency. That makes one normal year out of five, not a great test run.
A six year sunset on Medicaid expansion is our chance to give the program the five year test intended by the 2018 legislature, and should maximize value for those on the program and those paying for it.
A Good Program, But It Could Be Better
While the Granite Advantage Program is providing a valuable service to 88,000 Granite Staters today, the program could use improvement. The work requirement needs work and there is no drug testing requirement, which means that people with dangerous opioid addictions may not be receiving the treatment they could while on the program. And unlike in commercial programs, there are no copays.
Fiscal conservatives tried in committee debates and on the floor of the House to discuss the problems with the program but we were countered by silence in committee, robotic and repetitious talking points on the floor and finally a motion to silence debate from Democrat leadership. The people of New Hampshire deserve better!
By limiting debate, legislators were unaware that the amendment for the drug testing requirement was shaped to protect legal use and those in treatment. Medicaid expansion provides comprehensive care for people with substance use disorder, and failing to offer these services to people in the Granite Advantage Program who can’t provide a clean drug test twice a year is a serious failure.
Obamacare Has Taken Away Doctors’ Independence
The healthcare market has suffered since the Affordable Care Act passed under President Obama, and the damage will take work and time to reverse. The heavy regulations have forced most doctors to become part of a hospital system to survive. Healthcare delivery has become more complicated and expensive in the last 13 years, and it has become more attractive for big medicine to focus on the big population management solutions and move away from the more
individualized care many of us used to know. The European system limits care, and we must reject similar government-run healthcare schemes.
Free market advocates have ways to help people get quality care by increasing access to affordable quality care by removing anti-competitive laws and providing pathways for associations to purchase healthcare that fits the needs of Granite Staters. This will take time, but it is necessary to keep our system functioning.
If you miss having a relationship with an independent family doctor, you should join with me to support a six or seven year sunset on Medicaid expansion. Without a sunset on the program, individualized healthcare will ride off into the sunset never to be seen again.
Erica Layon is the Vice Chairman of the House Health Huma Services and Elderly Affairs Committee. After earning an economics degree from MIT, she worked on Wall Street for nearly two decades beginning her career on the options trading floor and culminating as a medical device analyst helping investors find and profit from lifesaving and life-improving technologies.