Calls of caution, defiance over ACA repeal

CONCORD - The costs of a difficult pregnancy in 2013 forced Katryna Wade to file for medical bankruptcy in Arkansas.

She "fell off the map" without insurance and stayed relatively healthy for the next few years.

Then she learned last month she was diagnosed with a cancerous tumor and lost her job two weeks ago.

The current Manchester resident urged New Hampshire's two Democratic senators to do all they can to stop a pending Senate health care reform measure from passing this week.

"Please do not let this go forward. Our lives are depending on it," Wade said Friday, blinking back tears as she spoke during an "emergency field hearing" at the University of New Hampshire School of Law.

For families like hers with severely ill members, the Senate proposal has many things not to like - yet last week's announcement of another health insurer exiting the Obamacare exchange market points to the rising costs many middle class families face getting coverage under that Affordable Care Act.

Minuteman Health executives say they hope to re-emerge next year as a private, for-profit health insurer, but their exit will leave only two insurers that provide coverage to families on the exchange - Anthem and Harvard Pilgrim; a third insurer, Ambetter, only offers coverage to low-income adults who qualify for coverage under the expansion of Medicaid.

Gov. Chris Sununu said "Obamacare has failed" and the health care system demands reform.

"It further underscores why Washington must act now to reform our health care system and take actions to stabilize our individual health insurance market. This environment of instability was created by Obamacare's costly regulations and taxes that are causing premiums to skyrocket," Sununu said.

"Washington must work together to end the partisan gridlock and move reform forward otherwise more Granite Staters are likely to be negatively impacted. New Hampshire deserves better and the time for reform is now. Failure is not an option."

The health care debate like no other has exposed the partisan divide on Capitol Hill with Democrats maintaining President Donald Trump's goal is to be heartless toward the poor and sick in order to deliver massive breaks for insurers, drug companies and the wealthy now paying higher taxes under Obamacare.

"Make no mistake. This bill will be a disaster for the people of New Hampshire and for millions of Americans across this country," said Sen. Maggie Hassan, D-N.H.

Sen. Jeanne Shaheen, D-N.H., said Trump himself has called the House-passed health care measure "mean," and she insists this one is worse because it could place limits on how much families could get insurers to cover. 

"In many ways, it is more dangerous than the House bill," Shaheen said. "We know why the Republicans wanted to keep this bill a secret." 

Never satisfied

Meanwhile, Trump said at a re-election rally in Cedar Rapids, Iowa, last week that he could devise the most humane and generous health care reform bill and all Democrats would still vote against it.

"The Senate Democrats are fond of saying they realize Obamacare is imperfect, but where has their legislation been over these many years to fix it?" asked Greg Moore, executive director of the state chapter of the fiscally conservative Americans for Prosperity during a recent interview.

The family members, doctors, nurses and nonprofit providers at the Friday hearing came intent not to simply lob partisan shots but instead to try to defend what they've grown to depend on from the ACA.

The two provisions of the pending Senate bill most objectionable to them are:

. Ending Medicaid expansion: The Senate bill starting in 2021 would phase out over three years the bonus grants states have gotten to offer coverage to low-income adults who previously made too much income to qualify.

In that first year, the change would cost the New Hampshire state budget $79 million more to maintain this coverage, according to the Center for Budget and Policy Priorities in Washington, D.C.

The House-passed bill gets rid of Medicaid expansion in 2020.

Hassan signed Medicaid expansion in 2015 that won bipartisan support because private insurance companies - and not government - offers this coverage.

Ashley Hurteau of Farmington said without Medicaid coverage, she would likely not be alive.

Hurteau, 32, started using drugs in high school. She and her husband became addicted to heroin and they stole to support their habit.

In 2014, she lost custody of her son and several months later woke up next to her husband who was dead from a drug overdose.

She kept using and only stopped after getting thrown in jail, getting placed in the Strafford County drug court and then enrolling into Medicaid where she got substance abuse coverage.

She's now out of prison and has a job working to help recovering addicts like herself.

"I got back custody of my son two weeks ago and I've been sober 17 months," she declared.

"Medicaid expansion is really about opportunity, the opportunity to get sober, to move on and to live a clean life."

On Friday, a fifth Republican senator, Nevada's Dean Heller, announced he can't support the bill because it does away with Medicaid expansion. Presidential candidate Hillary Clinton won Nevada, and Heller faces reelection next year. Senate Republicans cannot pass their measure with more than two defections from their ranks since no Senate Democrats are expected to support it.

The other four GOP no votes are conservatives who don't believe this reform does enough to undo Obamacare.

A return to caps on coverage

. State waivers: This would allow states to get federal permission to change the essential health benefits all insurance plans have to cover. Those waivers could include letting insurance companies vary the cost of coverage based on health risks and to bring back annual or lifetime caps on how much insurers have to pay out for someone's care.

Lisabritt Solsky is executive director of Well Sense, one of the two companies providing managed care for Medicaid clients. A former state human services executive, Solsky also has a 15-year-old with "chronic health care issues" who would likely suffer under an annual or lifetime cap.

"One of his drugs costs retail $5,000 a month," Solsky said.

"I also worry about Medicaid block and per capita grants. I think it's a race to the bottom."

Jane McDermott of Stoddard said her husband was diagnosed with Stage 3 lung disease and they too would exceed any lifetime or annual cap.

"He takes three prescriptions that cost $900 a month out of pocket," McDermott said. "We are just one blip on the map, but this is going to affect every household in this country in one way or another."

Sununu, who opposed Medicaid expansion as an executive councilor, urged the Senate in a letter Friday to go slow on changing it. But over time, Sununu urged senators to allow states to introduce more forces from the competitive market.

"For 2019 and beyond, the state would welcome the opportunity to further refine this program free of Medicaid-specific constraints (for example, the requirement of added layers of appeal and the prohibition on cost-sharing for emergency room use) that have hampered the state's ability to address costs efficiently through market forces," wrote Sununu in his letter, co-signed by state Senate President Chuck Morse, R-Salem, and House Speaker Shawn Jasper, R-Hudson.

For her part, Hassan said she appreciated part of Sununu's message. "I am pleased he did support keeping Medicaid expansion in that letter," Hassan said.

"I am concerned he did not speak to any of the other issues with this bill."