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Feltes for Governor Health Care Plan: “Live Free and Healthy”

Introduction: Health Care is a Right

Access to quality, affordable health care is on the ballot this November. From the White House to the State House, there are bold reforms we can move forward with, but only if there is an administration willing to do it. Access to health care is a basic human right, not a privilege. But for far too many Granite Staters the proper care is out of reach.

Under Governor Sununu, New Hampshire has the highest health care costs in the nation, even prior to COVID-19. COVID-19 has pushed our healthcare system to the edge, with health care workers losing their jobs, some providers going-out-of-business, and the remaining providers and workers struggling to provide care while risking their own health in the process. We must do more to support them.

At the State House, Senator Feltes has been a leader on health care policy. He served as a lead Democratic negotiator for the reauthorization of Medicaid Expansion in both 2016 and 2018 — protecting access to health care for over 50,000 Granite Staters. In 2016, Dan co-led a bipartisan effort to break down insurance company barriers to emergency in-patient opioid treatment. Also, as a result of legislation Dan filed in 2016, the first-ever commission to deal with mental health parity was established and the first-ever market conduct review of mental health parity was undertaken. In 2018, Dan passed landmark bipartisan legislation to combat childhood lead poisoning from both paint and water. Dan also led the bipartisan effort to get some of the toughest drinking water standards on PFAS in the country, and assist communities in cleaning up their water. And over several years, Dan has sponsored and gotten passed various measures helping senior citizens get better healthcare, including dementia and memory care standards and training.

In 2019, Dan introduced and passed legislation to protect individuals with pre-existing conditions by codifying provisions of the Affordable Care Act in New Hampshire law. Meanwhile, Governor Sununu supported the Trump-backed federal legislative effort to repeal the Affordable Care Act. In 2019, Dan was also the prime sponsor and passed the first-ever comprehensive children’s system of mental health care in New Hampshire, including a statewide mobile crisis and intervention team for children so any child in distress can receive treatment within an hour from a highly trained team. As Vice-Chair of the Senate Finance Committee, and one of the state’s budget writers, Dan fought for increased funding for the public health department, so critical now in light of COVID-19.

This election is about the future of New Hampshire. How do we get out of this crisis in a way that truly looks out for everyone? This plan lays out Dan’s vision for the future of health care in New Hampshire. It focuses on how we increase access to health care, how we address our co-occuring mental health and substance use disorder crises, only worsening in this pandemic, and how we support our caregivers, healthcare workforce, and Granite State families.

1. Access to Health Care:

All Granite Staters have a right to quality, affordable health care and in the middle of a global pandemic, the need has never been greater. Fundamentally, access to care comes down to costs and options. Health care must be affordable and a full range of services must be available. The unfortunate reality is that, right now, uninsured rates are on the rise again in New Hampshire with an estimated 11% of New Hampshire’s adult population uninsured. As Granite State families struggle with job loss or reduced hours the prohibitive costs of health care must be addressed.

Access to Affordable Health Care: The number one barrier to health care is cost. New Hampshire has the highest co-pays, highest premiums, and highest deductibles anywhere in the United States. As costs continue to rise faster than wages it becomes prohibitive for Granite Staters to access the care they need. Dan led the effort to require the application of a 1332 waiver to reduce costs in the individual market.

Lowering prescription drug costs is critical to lowering health care costs overall. In the Senate, Dan led the charge on bipartisan legislation to allow the importation of safe, low-cost prescription drugs from Canada. He also stood up for children, families, and seniors with diabetes, who all-too-often ration their life-sustaining Insulin, leading the effort to get the most progressive price cap on Insulin in the country, limiting the cost of Insulin to $30 per month. But we must do more.

Too often, Granite State seniors with Medicare fall through the cracks. We must support them by helping fully fill the coverage gap (“Donut” hole) and also assist with out-of-pocket costs. Dan led the effort to help assist lower-income senior citizens falling in the coverage gap, those hit hardest in this pandemic, unfortunately, Chris Sununu unilaterally cut it out of the budget. Like Trump, Sununu talks about prescription drug relief, but actually worked to increase costs on low-income seniors.

In addition, transparency is critical to accountability and reducing costs. As more and more care in New Hampshire, and across the country, comes under the umbrella of large hospital or hospital-affiliated systems we must ensure there is transparency in pricing. As Governor, Dan would sign legislation requiring hospitals and health care systems to provide certain financial information to the Department of Health and Human Services to ensure Granite Staters are getting the best, and most affordable, care possible. We must also move forward with working with all stakeholders in creating an actual statewide healthcare plan, which builds off the network adequacy reviews and requirements.

Access to Reproductive Health Care: As Vice-Chair of the Senate Finance Committee, Dan fought to include additional resources for reproductive health care centers in the state budget and backfill the lost funding from the Trump administration’s unjust Title X Gag rule. Just like Trump, Sununu worked to cut off funding for Planned Parenthood, vetoed insurance coverage for women’s reproductive health care, nominated anti-choice New Hampshire Supreme Court Justices, supported both Brett Kavanaugh and Neil Gorsuch’s nominations to the U.S. Supreme Court, and directed CARES Act funds to an anti-choice crisis pregnancy center. Access to reproductive health care is on the ballot this November.

However, it is not enough to just stop Chris Sununu’s anti-choice attacks. We must move forward and expand access to reproductive health centers. We should increase funding for STD and reproductive health care centers in the state budget. In an economic crisis, our health care centers take on an even greater responsibility and we must support them. As Governor, Dan would use available CARES Act funding to support our reproductive health care centers. Increasing funding for reproductive health care centers is about investing in preventative care, which saves individuals, families, and taxpayers down the line.

As Governor, unlike Sununu and Trump, Dan would support legislation that requires insurance providers that cover maternity care to also cover abortion health care services and block any efforts to restrict access to the abortion health care services.

Finally, protecting reproductive health care must include judicial nominations. Dan has pledged that as Governor he will only appoint pro-choice judges to positions within New Hampshire’s judicial system.

Racial Justice in Health Care: Due to racism, sexism, and other systemic barriers that have contributed to income inequality, women of color are typically paid significantly less than their male counterparts. These lost wages mean women of color and their families have less money to support themselves and their families and may have to choose between essential resources like housing, child care, food, and health care. The vast majority of working people in the United States do not have paid family leave through their employers, and the consequences are especially impactful for people of color, and women of color suffer most. A lack of access to economic support from your employer makes it more difficult for families of color to financially recover from a serious family or medical need like COVID.

It is well known that people of color tend to receive lower-quality health care and services and experience worse health outcomes than white people, highlighting the need for paid family and medical leave, which Chris Sununu opposes.

Additionally, long-standing systemic health and social inequities have Black and other people of color at an increased risk of contracting COVID-19. We must increase access and increase funding for reproductive health care centers across New Hampshire, reduce income inequality, and establish paid family and medical leave to guarantee people’s health care needs are addressed and increase positive medical outcomes for people of color.

Black women in the United States experience unacceptably poor maternal health outcomes and are three to four times more likely to experience a pregnancy-related death than white women. Both societal and health system factors contribute to high rates of poor health outcomes and maternal mortality for Black women. Women of color are more likely to experience barriers to obtaining quality health care and often face racial discrimination in health care throughout their lives. Investing in reproductive health care centers will save lives. Black women are less likely to have health insurance and are more likely to experience gaps in coverage throughout their lives. To improve Black women’s health outcomes and health outcomes for all people of color, we must expand and maintain access to care and coverage.

As Governor, Dan will create an Office of Racial Equity, which will take a comprehensive look at our health care system and outcomes and provide recommendations to reduce the disparity in care right here in New Hampshire.

2. Mental Health Care and Substance Use Disorder:

Far too many Granite Staters struggling with mental health care and substance use disorder cannot get the care they need because of stigma and a system that does not have the proper support from the state. When you break a leg or have a heart attack you get treatment right away — mental health care and substance use disorder should be the exact same. Mental health care is health care. Substance use disorder health care is health care. Period.

Mental Health Care for All: We need to be honest about the fact that we do not have an accessible, affordable, or sufficiently robust mental health system in New Hampshire and have the courage to take ownership. Until we do we will only make changes at the margin.

Addressing our mental health crisis starts with the 10-Year Mental Health Plan. The 10-Year Plan is the result of hundreds of hours of work and provides a great framework for how New Hampshire must address our mental health crisis; however, the plan is only as “real” as the funding dedicated to supporting it. As Governor, Dan will dedicate the resources necessary to make the plan a reality. We cannot cut corners.

New Hampshire continues to have a significant emergency room boarding crisis of high-risk mental health cases in our community hospitals that are not equipped to provide effective care. We wouldn’t tolerate substandard care and boarding if people were being warehoused with acute heart or cancer issues. And it should not be tolerated now.

We must invest in transitional beds so that we can move patients through the continuum of care and relieve stress on our emergency rooms. We must also immediately stand-up the children’s mobile crisis unit established in Dan’s bill, SB 14, so that our children in moments of distress can get the care they need in their own community. The resources are available in the state budget. There is simply no excuse for Chris Sununu’s delay of over a year in implementing the statewide children’s mobile crisis unit, and, as a consequence of his delay, children are in emergency rooms waiting for needed care. The children’s mobile crisis unit will also help reduce our emergency room boarding crisis by providing treatment outside of a hospital setting. We need to take a multi-pronged approach of providing additional community treatment on the front end and providing additional housing on the back end.

We also need greater emphasis on creating integrated delivery networks with primary care doctors and social workers/counselors/psychiatrists working in deliberate ways to address physical and emotional well-being. By integrating care we can reduce complex barriers to entry and provide additional preventative care outside of emergency rooms.

Finally, we must support our kids with additional resources at our school. The national suicide rate for people ages 10–24 rose 56% from 2007–2017. Right here in New Hampshire, in our public schools, on average, 25% or more of the kids report being depressed, 18–20% are giving “ serious consideration” to suicide, and 12–14% have actually made plans in the last 12 months to take their own lives. We should provide the resources to ensure our schools have the necessary levels of counselors in our schools. Integrated care must include mental health care being available at our school and in coordination with the children’s system of care in Dan’s bill (SB 14), which Chris Sununu has refused to implement.

Recently, Chris Sununu proposed going back to 2019 spending levels in the state budget. That would decimate all services, including mental health services, ever more needed now during this pandemic.

Addressing the Substance Use Disorder Crisis: Unfortunately, under Governor Sununu, we still have one of the worst opioid public health problems in the nation, with one of the worst treatment capacities to deal with it. Overdoses are going up around the state.

That has driven up health care costs for everyone. Despite good people on the ground trying their best, Governor Sununu’s so-called “Doorways” program has not worked. It is largely an intake and referral program without treatment capacity on the backend. In other words, it is Doorway to nowhere. We need to replace Chris Sununu’s “Doorways” program with a “Doorway to Recovery” that truly has capacity.

As Vice-Chair of the Senate Finance Committee, Dan also helped secure the first state investment in the Safe Station program that has helped thousands of Granite Staters, and Dan fought for provider rate increases for behavioral health care.

As Governor, Dan will develop a true statewide opioid response plan that includes real metrics for how we deal with this crisis. We cannot settle for press conferences and photo-ops that don’t deliver real results. We must listen to those on the ground, those who know these issues best.

Most recovery and treatment centers operate with very thin margins, putting them consistently at risk of shutting down. In the last state budget, we increased Medicaid Reimbursement Rates for the first time in years, even as Chris Sununu fought us every step of the way, including recently unilaterally cutting those rates out of the budget. But even those increases were not enough. We need real reimbursement rates so providers are treated with respect, maintain, and even expand capacity, and they also need a governor who will ensure Medicaid expansion is made permanent (ad hoc reauthorizations every couple of years does not provide the certainty to providers on the ground that is necessary).

While Chris Sununu created more bureaucracy with his glorified referral program, Dan will empower those on the frontlines of this crisis by streaming communication, removing bureaucracy, and actually invest in inpatient, intensive outpatient capacity, respite care, and real recovery housing so there is actually a place for persons to get referred to. Too often there is a revolving door because we have not built out the full continuum of care in New Hampshire. That ends when Dan Feltes is governor.

3. Supporting Our Caregivers and Families:

We must ensure our caregivers are supported and families can find the care they need when they need it. New Hampshire has continued to struggle with a caregiving crisis leaving health care providers struggling to hire and retain caregivers. We also must support Granite State families as they struggle to balance caring for a loved one and work.

Caregivers: Our caregivers are the backbone of our health care system in New Hampshire and we must do everything we can to attract and retain them. This starts with good wages and benefits. New Hampshire is on an island in New England as the only state in the region without a state minimum wage so we default to the unacceptable federal minimum wage of $7.25 per hour. If we are going to attract and retain caregivers we must raise the minimum wage to $15 per hour over the next few years.

Next, we must build on the progress made in the last legislative session and increase our investments in student loan forgiveness programs for caregivers. Graduating Granite Staters have among the highest student debt levels in the country for both four-year and two-year programs. We need to do more as a state to get our higher education costs under control, and a critical first step is targeted student debt relief in high need fields such as caregiving.

As mentioned above, New Hampshire needs to continue to raise Medicaid reimbursement rates so that our providers can afford to provide competitive wages and benefits. Our community health centers, especially our rural centers, operate on very thin margins. Prior to this last budget, it had been over a decade since an across the board Medicaid rate increase leaving New Hampshire, again, trailing surrounding states.

Further, this COVID-19 crisis has put our caregivers on the frontlines. New Hampshire has suffered from one of the worst long-term care crises in the country putting additional pressure on our already overworked and underpaid caregivers. We must reinstate our $300 per week COVID stipend so that the caregivers and all healthcare workers on the frontlines get the pay increase they deserve. Dan first proposed the idea of a Frontline Worker Fund back in April.

Additionally, we need to streamline and cut red tape for retired healthcare workers to re-enter professions on a part-time or even volunteer basis.

Finally, we must also expand the eligibility and support for the State Loan Repayment Program, which was recently unilaterally cut by Chris Sununu. Doing so is central to attracting and retaining the healthcare workforce necessary to do the job.

Supporting Preventative Care, Families, and Caretakers: Chris Sununu opposes paid family and medical leave insurance and has three times blocked bipartisan legislation to finally establish paid family and medical leave insurance, including vetoing Dan’s bill, the Granite Caregiving Act of 2019 (Senate Bill 1), then actually auctioned off a copy of his veto of Dan’s bill, along with flags flown over the State House the day he vetoed Dan’s bill. Chris Sununu has called paid family leave a “vacation”. One of the most cited reasons for leaving the workforce is to care for an ailing loved one. We value work and we value family, we should value the proposition that we should not have to choose between the two if at all possible. This is especially important for families in this pandemic.

This is a moral issue, but it is also a cost issue. One of the main reasons New Hampshire has the highest health care costs in the nation is the lack of preventative care. Having access to paid family and medical leave insurance helps workers get access to the care they need, when they need it, helping to prevent costly treatment down the road.

More than 200,000 New Hampshire workers do not have access to paid sick days, which is almost 40% of all workers in New Hampshire. Similar to paid family and medical leave insurance, paid sick days allow Granite Staters to take the time they need to care for themselves and their families. Preventative care will save families, and taxpayers costs down the road.

Preventative care also means finally moving forward with a Medicaid dental benefit, which Chris Sununu opposes and also vetoed. This will save costs down the road by avoiding costly dental surgeries, which are frequently a result of untreated minor dental issues.

Additionally, Dan has sponsored legislation to establish a “Working Families Property Tax Credit” which provides a property tax credit for families who are caregiving for a parent or dependent.

Finally, we need to recognize that we have a very geographically diverse state and the health care needs of rural Granite Staters are very different than those living in the Southern Tier. All Granite Staters, regardless of zip code, should have access to the care they need in their communities. As Governor, I will reinstate the committee to study access to rural health care so we can continue to address these critical challenges.

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