Universal health care is not on the immediate horizon. In New Hampshire, with our current patchwork of employment based and government health plans, up to 90,000 of our neighbors lack health insurance. As a result, the uncovered lack access to health care, the insured pay onerous premiums, and providers are burdened by unreimbursed care.
The vast majority of Americans, Republicans and Democrats, providers and patients, covered and uncovered are dissatisfied with our health care system. Yet the problem is generally considered intractable with no solution in sight.
Nevertheless, I would argue that progress is possible. In fact, with the creation of the Affordable Care Act in 2009 and adoption of Expanded Medicaid in 2015, New Hampshire’s percentage of uninsured residents was cut in half. When the pandemic hit, the governor immediately expanded telehealth services and the Legislature pivoted quickly to make that expansion permanent. There are many more such changes that we can and should enact to make health care more accessible to New Hampshire citizens. Here are just a few possibilities.
When expanded Medicaid was renewed in 2017, a well-intended compromise led to a significant work requirement in order for recipients to retain their coverage. Since that time, however, much has changed. After an initial delay due to the state’s inability to register participants, federal courts ruled that the program, along with similar ones in Arkansas and Kentucky, was unlawful. Recently the U.S. Supreme Court agreed to hear the case on appeal.
During the upcoming legislative session I will introduce a bill to repeal the work requirement, guaranteeing that those with financial need continue to have access to health care. This is especially important during the pandemic.
Adult recipients of N.H. Medicaid receive no dental benefits. Should they have a toothache they will likely end up in a hospital emergency department once the pain becomes unbearable. Here, their only options are antibiotics, pain medications and/or extraction, none of which address the root cause. Not only are emergency room visits expensive, but many pain medications lead to or exacerbate substance use disorders. In addition, poor oral health is associated with heart disease, diabetic complications, and poor mental health.
In 2019 a bill was signed by Gov. Sununu to create a dental benefit. Unfortunately, he vetoed a 2020 bill setting specific timelines for implementation, citing COVID-related budget concerns. Nevertheless, the governor has clearly stated that he supports a Medicaid dental benefit and that Democrats and Republicans should work together to make it a reality.
There is a working group, within Health and Human Services, making plans for such a program. Once again, I will introduce legislation to guarantee implementation. With the governor and Legislature committed to making this happen, we can ensure that our fellow citizens will no longer endure the indignity, pain, and associated medical conditions associated with poor oral health.
Currently many immigrants must wait five years to qualify for various federal benefits, including Medicaid and the Children’s Health Insurance Program. In 2009, the federal government created an option for states to eliminate the five-year wait for children and pregnant women who are legally residing in the U.S., but not yet permanent residents. New Hampshire is the only state in the Northeast that has not opted to do so.
Access to prenatal care and regular health care for children is an important investment in public health and will save money through timely diagnosis. While there will be a cost to the state, the federal government will pick up much of it. Eliminating the five-year wait for immigrant children and pregnant women will send a clear message that we welcome and value newcomers to our state who both enrich our communities and add to our workforce as employees and entrepreneurs.
These are just a few of the ways that we can increase access to health care for New Hampshire residents. There are many more. They may seem incremental and limited in scope. They may fall short for those of us who think health care should be a human right.
Nevertheless, to an adult unable to secure employment because they lack most of their teeth or to a pregnant woman who must carry her child without prenatal care, they are life-altering advances.