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New Hampshire's GOP Governor Extends Medicaid Expansion But Adds Work Requirement

Gov. Chris Sununu used more than two dozen pens Friday to sign his name to sweeping legislation that preserves government-paid health insurance coverage for more than 50,000 low-income adults through 2023.

By Kevin Landrigan

Gov. Chris Sununu used more than two dozen pens Friday to sign his name to sweeping legislation that preserves government-paid health insurance coverage for more than 50,000 low-income adults through 2023.

The first-term Republican chief executive said he had many more than 24 influential players to thank for helping him broker a compromise on the state's expansion of Medicaid health insurance coverage, which without legislative action was to expire at the end of the year.

"This is probably the biggest single piece of landmark legislation I have been involved with as governor," Sununu said after the ceremony.

The governor has come full circle on the topic. He voted against the first Medicaid expansion contract as an executive councilor. At that time, he was critical of the program's complexity and the uncertainty of where future state matching money would come from.

This final package (SB 313) enabled the state to avoid any direct, state taxpayer dollars for this program by earmarking 5 percent of net profits from the sale of liquor, which had been going into the state's Alcohol and Drug Abuse Prevention and Treatment Fund.

"I knew this was going to be the most important challenge the state was going to face from day one," Sununu said during the ceremony at the Manchester Community Health Center, one of the clearinghouses that will help sign people up for coverage.

"There were a lot of cards dealt against us in this hand, and getting it right was going to be hard."

Manchester Community Health Center CEO Kris McCracken said the expansion has had an uncertain future since its beginning four years ago but this changes all that.

"To have a five-year planning window is just tremendous," McCracken said.

For the first time, the new law, effective on Jan. 1, will have a work requirement for all able-bodied people under Medicaid expansion to either seek work or be engaged in more schooling or job training.

State Rep. Frank Kotowski, R-Hooksett, chaired the House Health, Human Services and Elderly Affairs Committee that made some key changes to the bill. It underwent many revisions before the final form Sununu signed Friday.

"This time around I think we did a much better job," Kotowski said. "We put a work requirement on the thing that is acceptable to everyone. We wanted to make sure those who weren't able to work have a way to prove why they can't."

Health and Human Services Commissioner Jeff Meyers said the state will prepare waiver requests for the Trump administration to review that include details of the work requirements.

"This is a really good day, and I want to savor this moment. I really do. This is going to really help improve their lives and continue down the road," Meyers said. "This governor was engaged on this from day one and did so much hard work and really helped along the way to make it happen."

But a federal judge's decision Friday striking down a similar Medicaid work requirement for Kentucky underscores how Meyers was right in saying Friday that "there's still more work to do."

New Hampshire, Kentucky and three other states had received initial approval of work requirements and there are nine other states with work requirement plans pending before the Trump administration.

The judge in the Kentucky case faulted federal officials with failing to evaluate whether this requirement would enhance the objectives of the Medicaid program.

New Hampshire Legal Assistance does not think it does, and Policy Director Dawn McKinney wrote Meyers a 14-page memo urging the state not to submit the waiver.

McKinney notes that about 65 percent of the 52,000 people in the Medicaid expansion population are already working, and 77 percent come from working households.

"Extensive research reveals that work requirements do little or nothing to increase stable, long-term employment and do not decrease poverty," McKinney wrote. "In fact, work requirements have had the reverse effect, leading to an increase in extreme poverty in some areas of the country as individuals who do not secure employment also lose their eligibility for cash assistance."

But Senate Majority Leader Jeb Bradley, R-Wolfeboro -- the law's prime author -- said this final product will stand the test of time.

"One way or another we were going to pay for these services in the emergency room that is expensive or in the cost-effective community health care center as this will provide," Bradley said.

"I believe this institutionalizes a good New Hampshire plan. It is good for taxpayers, it is good for businesses, it is good for folks with substance abuse issues that get dedicated coverage."

Sununu stressed it showed how New Hampshire's smaller government approach works in ways Capitol Hill never can to the same degree.

"We don't say enough about the dysfunction of Washington. That is not New Hampshire and we don't allow that partisanship and infighting to get in our way," Sununu added.

(c)2018 The New Hampshire Union Leader (Manchester, N.H.)

Caroline Cournoyer is GOVERNING's senior web editor.
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