Hanan Babikir Bedri, MS, MA, is executive director of New Hampshire Public Health Association. Marie Ramas, MD, is a New Hampshire Medical Society council member and president of New Hampshire Academy of Family Physicians.
Earlier this month, the Senate unanimously passed SB 263, relative to extending the New Hampshire Granite Advantage healthcare program. Now the bill is in the House of Representatives, and a hearing is scheduled for April 4.
If enacted, SB 263 will make Granite Advantage permanent, and reestablish the commission to evaluate its effectiveness. This sixteen-member body, established in 2018, is called the Commission to Evaluate the Effectiveness and Future of the New Hampshire Granite Advantage Health Care Program. It reviews the program’s finances and offerings and its impact on insurance premiums. The bill further removes the transfer of funds from the Alcohol Abuse Prevention and Treatment fund to the Granite Advantage healthcare trust fund.
Since it was enacted, Granite Advantage has helped to provide health service access to more than 219,000 people in our state. Nearly 30,000 Granite Staters accessed mental health medication treatments in a single fiscal year. At least 8,600 accessed some form of substance use disorder care services. As many as 792 people received maternity care, and more than 25,600 were treated for problems related to COVID-19. Granite Advantage provides access to routine preventive medical care services for children, adults, and disabled people. These services include medical check-ups, vision care, prescription drugs, and many more.
In the five years after Medicaid Expansion became a reality, the number of people in our state without access to health coverage declined by 58,000, a reduction of more than 40 percent. The state’s increased capacity for substance use and mental health treatment has saved and/or improved thousands of lives, and the program stands to do even more unless it is ended.
The federal government contributes 90 percent of the money that keeps Granite Advantage running. Revenues from state taxes make up only 10 percent of Medicaid Expansion funding, and for the last four years, those contributions have come from: revenue transferred from the Alcohol Abuse Prevention and Treatment Fund; Insurance Premium Tax revenues generated in association with Medicaid Expansion; an assessment on health insurance providers previously associated with a high-risk pool of enrollees; voluntary contributions made to the New Hampshire Granite Advantage Health Care Trust Fund; savings generated by state-contracted managed care organizations that keep program costs below established minimum medical loss ratios; funds drawn from the Liquor Commission Fund, which cover any remaining shortfall after contributions from all other sources; and a portion of Medicaid Enhancement Tax revenues associated with uncompensated care cost calculations at hospitals in the state, and other payments made to those hospitals.
In short, Medicaid Expansion has virtually no impact on the individual taxpayer in New Hampshire. The funds that keep it running come from other sources.
Medicaid Expansion saves money, furthermore, and the money saved helps to pay for Medicaid Expansion. These savings are the result of offsetting other state costs, including payments for care provided to the uninsured at hospitals, Medicaid expenses with less favorable federal matching fund rates, and medical expenses for the incarcerated.
This legislation has plain economic benefits for the whole of New Hampshire, in part because it cuts the rate of uninsured people here. Those who don’t have insurance still need medical attention, and the only way many can get it is to visit an emergency room, where they are required by law to be treated. This places additional strain on our emergency rooms, and it costs money. According to the president of the NH Hospital Association, the cost to hospitals of uncompensated care dropped between 2014 and 2021 from $173 million to $69 million, thanks to Granite Advantage.
Perhaps most importantly, when people are healthy, they can go to work. New Hampshire’s economy cannot thrive without labor power. Granite Advantage helps to ensure that people can perform their labor and that they can keep our state humming with activity.
If recent years have taught us nothing else, they have shown us that money spent on healthcare is money well-spent. It keeps our friends and neighbors healthy, and in effect, it keeps us healthy. We stand to gain nothing from letting the people around us go without healthcare, whereas ensuring they can access it will benefit everyone. There is no doubt that if we let this essential program fall by the wayside, we will feel the effects in deeply unfortunate ways. It is imperative that our legislators vote ‘Ought to Pass’ on this bill.