During This Public Health Crisis, We Must Protect Uninsured Granite Staters

For about a decade, right out of law school and up until serving in the State Senate, I served as a legal aid attorney with New Hampshire Legal Assistance helping low-income families, seniors, and veterans. While there, I represented hundreds of people during the last economic crisis — the Great Recession — helping protect against foreclosure, representing workers crushed by job loss get unemployment insurance and helping families and seniors get access to health care.

Now, due to COVID-19, we are facing record-high unemployment claims, tens of thousands of workers laid off from their jobs and it’s going to get worse before it gets better. Record-high unemployment also means that many of these workers will also lose their employer-sponsored health insurance.

Prior to this crisis, New Hampshire already had the highest health care costs in the nation. New Hampshire has the highest premiums, the highest co-pays, and the highest deductibles. With fewer people insured due to the loss of employment, health care costs will be driven up for everyone even more.

We have a way to prevent this. During previous emergencies, Republican and Democratic presidential administrations alike have empowered states to loosen Medicaid rules in order to meet growing coverage and treatment needs. Whether it was in the aftermath of the September 11th terrorist attacks, after Hurricane Katrina or during the H1N1 epidemic, states requested and were granted the ability to use Medicaid in their responses to cover the uninsured.

Last week, New Hampshire’s 1135 waiver was approved by the Center for Medicaid and Medicare Services (CMS), allowing New Hampshire to waive certain rules and regulations regarding access to Medicaid. CMS expanded on their approval, writing “For those waiver or modification requests…through a section 1115 demonstration, my staff will continue to work with your team to review and make determinations regarding approval as quickly as possible.” The 1115 waiver presents the opportunity for New Hampshire to ensure that all uninsured residents are protected and provided health care. Unfortunately, Governor Sununu has not applied for an 1115 waiver.

At one of his recent press conferences, Governor Sununu was asked about requesting an 1115 waiver, Governor Sununu said that would take “too long”. But CMS made it clear that they would work quickly to approve it. Three weeks ago, I respectfully encouraged Governor Sununu to make the 1115 waiver application. Now, I again urge Governor Sununu to request an 1115 waiver as soon as possible to ensure everyone has access to health care, to protect the public health at this critical time, to protect our hospitals from uncompensated care, and to protect New Hampshire taxpayers.

This is particularly important given the increased unemployment insurance benefits folks will receive as a result of the federal stimulus. Our federal delegation worked hard to make sure the federal stimulus helped ordinary folks impacted by this crisis, including securing an additional $600 per week in unemployment on top of the funds those receiving weekly unemployment insurance benefits are already getting. The unintended result is many persons who were eligible for Medicaid within the income guidelines for Medicaid expansion (138% of Federal Poverty Guidelines) will now exceed those income guidelines and no longer be eligible for Medicaid expansion or risk losing their coverage. The good news is that there are ways the state can prevent this. The additional unemployment benefits from the federal stimulus could be not included for the purposes of calculating eligibility and/or there could be the flexibility to maintain coverage for these folks so they can receive the additional funds from the stimulus without fear of losing health care coverage or being ineligible for Medicaid expansion. Governor Sununu should include this as part of an 1115 waiver application and/or emergency order, helping make sure unemployed persons don’t get kicked off of their health insurance simply for getting some help from the federal stimulus.

We’re going to face many challenges in the next few weeks. Our economy is reeling, testing is still a challenge even though Dartmouth Hitchcock has stepped up to the plate to help, and, just as the surge is about to hit New Hampshire, we are likely short thousands of critically needed ventilators. Health insurance shouldn’t be one of the challenges we face. It doesn’t have to be. Governor Sununu could address this immediately.

Please Note: For folks for who lost their job and health insurance, or otherwise need health insurance, you could be eligible for Medicaid expansion and help getting an insurance plan on the health insurance exchange. You can find additional guidance from the New Hampshire Department of Insurance here. The Insurance Department is here to help, you can contact them with any questions at (603) 271‐2261, or by email at consumerservices@ins.nh.gov.

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Dan served as a legal aid lawyer helping low-income NH families, seniors and veterans for almost a decade. Now serves as the majority leader in the NH Senate.

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