Medicaid: It's Health Insurance! (Re-Release)

Episode Transcript
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SPEAKER_01 (00:00):
You're listening to New Hampshire Has Issues and I
never do this at the beginning.
I usually have like a cold openof sorts where my guests or
sometimes me, you know, we saysomething funny and then the
music cuts in and then there'sthe intro music and then future
list shows up.
And that's me this time, rightat the top.
I'm recording this on Monday,January 5th, 2026.

(00:22):
It is 9.45 at night.
But I thought I would have are-release of a really important
episode, especially now thatwe're in 2026.
Back in August, I had an episodewith Christine Stoddard about
Medicaid.
She does such an excellent jobof a tutorial of like what is
Medicaid?
It's health insurance.
What does it actually mean?
Who's covered?

(00:43):
Why does it matter?
Why do we need Medicaid?
And that's really important in2026 because between the state
budget in New Hampshire and thefederal budget, the changes are
coming to Medicaid.
Some of the changes are herealready.
And so going back to thatepisode, doing a little
re-release, especially for newlisteners who've joined since

(01:06):
then and may not have gone back.
Of course you should, go backand listen to all the episodes.
But the Medicaid one isextremely timely right now.
And I have some guests coming upin the next month or so that
talk about healthcare costs.
And so I think it's reallyimportant to go back to the
Medicaid episode as like arefresher.

(01:27):
Especially if you've alreadylistened to it back when it came
out.
Think about how many lifetimeswe've lived since August when it
was light out at 4 p.m.
Do you remember those days?
I barely do.
And a lot has changed sincethen.

(01:48):
Health care, uh everybody needsit.
And what does our state do tomake sure that everyone is able
to access the care that theyneed?
The one resource I'm gonna pointout right at the top as well is
the Medicaid Matters website,New Hampshire Needs Medicaid,
and the website isnhneedsmedicaid.com.

(02:08):
And I'll have the link in theshow notes.
They have on there the upcomingchanges to New Hampshire
Medicaid.
They talk about what is thecurrent law, what are the
expected changes, when are theyexpected to happen.
I feel like I can't emphasizeenough.
Even if you are not covered byMedicaid, and Christine does
such a great job of talkingabout this, we need to care

(02:29):
about what happens to those whoare covered and those who
perhaps are going to lose theircoverage.
So it's a great website to findout what's going on, and if you
want to get involved, that's theplace to go.
nhneedsmedicaid.com.
Uh nobody asked me to talk aboutthat at the top.
It's just an incredible resourcethat we should all know about

(02:49):
and be and be sharing around.
All right.
I'm gonna pass it back over tothe incomparable, Christine
Stoddard.
I'm gonna be honest with you,Christine.
I don't know a lot aboutMedicaid.
I know it, but I don't know it.

SPEAKER_02 (03:03):
It is very complicated, and there are so
many parts of it that areinfluenced by different
policies, whether at the statelevel or the federal level.

SPEAKER_01 (03:13):
Yeah.
It's like a spider web.

SPEAKER_02 (03:16):
It is a spider web.
Of course, speak in generalitieswithout uh missing some piece of
information.
But that's unless you want like10 hours of podcast, that's what
we're gonna have to do.

SPEAKER_01 (03:31):
Well, look, I'm happy to do a 10-part series
just on Medicaid.

SPEAKER_02 (03:38):
You might want another guess.

SPEAKER_01 (03:39):
And welcome to New Hampshire Has Issues, the
podcast that dares to ask, whydoes it appear that our

(04:00):
lawmakers really don't likelow-income people?
Christine, let me hear yourtagline.
Welcome to New Hampshire HasIssues.

SPEAKER_02 (04:08):
The podcast that dares to ask why everyone in New
Hampshire should care whether ornot their friends and neighbors
have health insurance.

SPEAKER_01 (04:18):
I cannot wait to get into this because I I'm just
gonna be honest that I don'tknow why it's controversial that
we should want everybody onhealth insurance.
It feels like.
I mean, Welcome to New Hampshirehas issues.
The podcast editors ask, whywould we want people to go
bankrupt from needing to go tothe doctor?
Why is that the position somepeople are taking?

(04:39):
It makes no sense to me.

SPEAKER_02 (04:41):
I've tried to explain it to my eight-year-old
who also doesn't understand.
Why do you have to pay to go tothe doctor when everyone should
have access to health care?

SPEAKER_01 (04:52):
I mean, your eight-year-old sounds like they
got it.
Like that's that's correct.
Why should you be paying to goto the doctor when you should
just be able to go to thedoctor?
Right.
Period.

SPEAKER_02 (05:02):
But America has this thing called health insurance
that you can have commercialhealth insurance.

SPEAKER_01 (05:08):
Should I cheer?
USA.
USA.
Is this the time where I do theis that the time to chant?
No.
Am I doing it right?
Definitely not on this one.
Okay.
All right.
Not this one.
I am your host, Liz Canada.
And joining me today isChristine Stoddard, who is a
health care policy ultra nerd.

(05:29):
And that is exactly who I needto help me understand Medicaid
because I hear about it a lot.
In my job, I hear about it.
But out in the news, especiallyright now, with, you know, I had
Phil Slutton on a few episodesago talking about the budget.
He alluded to changes toMedicaid, you know, the budget

(05:50):
that was passed by the Trumpadministration.
Like that has some impacts onMedicaid.
But I gotta be honest with you,what the heck is Medicaid?
So that is why, Christine, I'veasked you to come on because I
think there's somemisconceptions about it.
I think there are some like Ihear the word and then I have a
feeling, and I'm not sure howI'm supposed to feel about it.

(06:11):
And I'm hoping you can helpfolks understand what it
actually is and whether or notwe need it.
Do we need Medicaid?

SPEAKER_02 (06:19):
We do.

SPEAKER_01 (06:19):
We just okay.

SPEAKER_02 (06:21):
Episode over.

SPEAKER_01 (06:21):
Thank you.
Great.
I like to start every episodewith a simple question.
What the heck is Medicaid?
What is it?
And why is it even an issue inNew Hampshire?

SPEAKER_02 (06:32):
Medicaid is just health insurance.
That's all it is.
Medicaid is health insurance.
For some reason, differentgroups have turned it into this
bad thing that if you're onMedicaid, you're a bad person,
you don't work hard enough,you're not worthy of our support
or the government's aid.
We've turned it into theboogeyman, and it's not.

(06:55):
It was never meant to be that.
It is simply health insurance.
It's to help people accesshealthcare and particularly
low-income children, elderlypeople who live in nursing
homes, adults, low-incomeadults, and people in New
Hampshire with complicatedmedical needs.

(07:16):
They're not the boogeyman.
Those people all sound great.
Exactly.
You want to help them.
You want to help them behealthy.
There are friends, there areneighbors, they're our
constituents if we're electedofficials.

SPEAKER_03 (07:29):
Right.

SPEAKER_02 (07:30):
These are the people that you interact with when you
go get coffee in downtownConcord.
These are the people that answeryour questions when you go to
the library.
They're the people that hand youyour coffee through a drive-thru
window.
These are people.
They are granite staters andthey deserve our support and our

(07:53):
respect, not our animosity.

SPEAKER_01 (07:56):
Some folks have health insurance through their
jobs.
Yes.
I am married.
Bragging.
So I am married.
My wife, she has the policy forour health insurance.
So I am on her health insurance,even though I also have a job.

SPEAKER_02 (08:12):
Yes.

SPEAKER_01 (08:13):
There are some people who work jobs that do not
offer health insurance.

SPEAKER_02 (08:19):
Yes.
There are a lot of industries inNew Hampshire that do not offer
health insurance.
This could be the constructionindustry.
This could be big box stores,Home Depot, Walmart.
It could depend on how manyhours you work.
It could depend on whether ornot you work for a sole
proprietor.
If you have a 1099, if you're acarpenter like my husband is, he

(08:40):
doesn't have health insurancethrough his employer.
He's a 1099.
He contracts with othercarpenters to do work for them.
And he has health insurancethrough my job.
And a little secret I will sharewith you: my husband has an
autoimmune disease.
Not through anything that he didwrong.
He was born with an autoimmunedisease that can be hereditary.

(09:02):
We got legally married in ourkitchen in Concord, New
Hampshire, months before ourwedding, because my husband's
employer did not offer healthinsurance.
And because he has an autoimmunedisease, he has to take
biologics.
Biologics are very expensive.
Oh, yeah.
So we got married, didn't tellanyone so that he could get on

(09:23):
my health insurance.
And that's a reality that peopleface.
And no, it was not fraud.
We're still married.
We have two kids.
Um, I pay for his car, you know,whatever.

SPEAKER_01 (09:35):
Let's get into the details of your marriage,
Christine.
Tell me more about what'shappening, who's paying which
bills, and so forth.
This is what New Hampshire needsto know.
We need to know everyone'sactually that is what lawmakers
are trying to do is to get intoall of the details of everyone's
personal lives, but we will setthat one right aside.

SPEAKER_02 (09:56):
So he could not work without health insurance.
His he has psoriatic arthritisand which affects your joints.
And if you're a carpenter who'son a roof, you need your joints
to work properly so that youdon't drop an impact um gun or
something like that or a nailgun.
I don't know the names of tools.

SPEAKER_01 (10:18):
Let's get into the details of tools now.
We got into the marriage, andnow we're getting into the
tools.

SPEAKER_02 (10:24):
He literally could not work without this medicine
because his knuckles wereswelling, his joints and his
feet were swelling.
And my husband is like theepitome of health.
He exercises every day.
He's very, very healthy, withthis one exception.
And he could not work because hedid not have access to a

(10:45):
biologic.
But we got married months beforeour actual ceremony so that he
could access health insurance,access biologics, and continue
to work.
Otherwise, he would have beenunemployed.

SPEAKER_01 (10:59):
You've got the employer-sponsored health
insurance.
You have my spouse hasemployer-sponsored health
insurance, has the healthinsurance through their job.
And then you have individualswho aren't married to somebody
who has a job with healthinsurance.
And so what are their choices?

SPEAKER_02 (11:19):
So if they can afford it, if they're lucky
enough to afford it, they can goon the marketplace and buy their
health insurance.

SPEAKER_01 (11:26):
Not the Facebook marketplace.
There's no health insurance onthe field.

SPEAKER_02 (11:30):
You could try.

SPEAKER_01 (11:31):
You know what?
I haven't checked actually.
I don't know.
So what is this marketplace?

SPEAKER_02 (11:37):
So the Affordable Care Act created like a one-stop
shop for health insurance.
And on that health insurancewebsite, you can go and choose
what you need out of healthinsurance, how much you want to
pay.
And if you have certain incomes,then you get different benefits.
So you might get subsidizedhealth insurance or premium

(12:01):
subsidized health insurancethrough the marketplace.
It just depends on your income.
If you cannot afford thosemarketplace plans because you do
not make enough money, so sayyou work minimum wage in the
state of New Hampshire, minimumwage in the state of New
Hampshire is below the federalpoverty level.
So you would qualify for what iscalled Medicaid.

(12:26):
And if you are my age, say 40,almost 46, you would qualify for
Medicaid expansion, also knownas granite advantage.
New Hampshire, our minimum wageis$7.25.
We are one of the few states,right?

SPEAKER_01 (12:43):
$7.25.
A$5 bill, two$1 bills and aquarter.
Yes.
That is how much money we'retalking about for the minimum
wage in New Hampshire.

SPEAKER_02 (12:57):
So policymakers have said that it is okay to pay
granite staters$7.25, regardlessof your age, regardless of your
work experience.
It is acceptable to pay someonethat little.
And because of that, people cango without health insurance

(13:18):
prior to the Affordable CareAct.
They couldn't afford healthinsurance.
Prior to the Affordable CareAct, if you had a pre-existing
condition, insurance carriersdidn't have to insure you.
They could say no, or they couldsay, we'll insure you for these
services, but not this servicebecause you have a pre-existing

(13:38):
condition.
Like, say you have eczema orsomething random.
We'll do all of your otherdermatology appointments, but
we're not going to coveranything related to eczema.
That's why you need to go to thedoctor because you have this
condition that exists that youneed treatment for.
So the ACA comes into effect andsays insurance carries, you

(13:59):
can't kick people off anymorebecause you have pre-existing
conditions.
And so they made thismarketplace where people can go
and choose what they want fromfor health insurance.
But if they can't afford that,states had the option to do what
is called Medicaid expansion.
So adults who are between theages of 19 and 64 could access

(14:23):
Medicaid.
Again, it's just healthinsurance.

SPEAKER_01 (14:26):
It's another type of health insurance.

SPEAKER_02 (14:28):
Yes.
So they could access Medicaidand most of their expenses would
be paid for by a combination ofstate funding and the federal
government because they do nothave the money to pay for a$250
mammogram.
They don't have the money to payfor a$35 prescription because,

(14:51):
again, they make$7.25 an hour.
You can't afford an apartment inNew Hampshire.
So this Medicaid expansioncreated an option to increase
access to health insurancecoverage for people who can
otherwise not afford it.
All Medicaid is, is healthinsurance.
It's not a horrible thing.

(15:13):
It's not a horrible thing to beon Medicaid.

SPEAKER_01 (15:23):
And it's essentially for folks who, as you said
earlier, cannot afford any otherhealth insurance option.
Like does not have anything elseavailable to be able to have
health insurance coverage.

SPEAKER_02 (15:39):
Right.
You cannot afford, based on yourincome levels, to buy health
insurance or pay for thosehealthcare services.

SPEAKER_01 (15:47):
So when I hear, I'm not going to name names, despite
how badly I would like to namenames.
But there are some lawmakers whoseem not super into Medicaid.
What do they want people to doinstead?

SPEAKER_02 (16:04):
They want them to work for it and to prove that
they're working for it.
And in fact, most people onMedicaid are working.
Yeah.

SPEAKER_01 (16:12):
Again, let's just say$7.25 an hour.

SPEAKER_02 (16:17):
Working full time, you still do not make enough
money to pay for your healthinsurance.
So combine that with havingkids.
A single dad with two kids, onekid, you're making minimum wage
or$16 an hour at Home Depot.
You can't afford your healthinsurance.

(16:38):
So in that example, now, thankyou to Medicaid expansion.
The dad can access healthinsurance through, if he can't
get it through his employer, hecan access it through Medicaid,
through what we call the grantedadvantage.
And that his children can accessMedicaid also because of his low

(16:59):
income.
Pre-Medicaid expansion in NewHampshire, he would have gone
without health insurance.
The kids would have been able toget health insurance, but the
dad, who's responsible for thesechildren, who wants to work so
that he can put food on theirtable, who wants to go to their
band concerts at school, whoneeds to be healthy to work,

(17:22):
could not access healthinsurance.
And policymakers at the time, ittook many, many tries for us to
get Medicaid expansion passed inNew Hampshire.
You would think it would just bea slam dunk.
Here's a problem, here's asolution.
And by the way, the feds aregoing to cover 90% of the costs.
You'd think it would just be aslam dunk.

(17:42):
But no, we had to argue about itlike four times.

SPEAKER_01 (17:45):
Okay, that's wild that it was even a debate.

SPEAKER_02 (17:48):
Multiple times.

SPEAKER_01 (17:49):
Prior to the Affordable Care Act, prior to
Medicaid expansion, that dadwould have had no health
insurance and would have goneeither to the doctor and had
exorbitant costs associated forbeing able to go there.
Or not gone at all becauseknowing that it would cost a lot
of money.

SPEAKER_02 (18:07):
So say he gets, I'm not a doctor, but say he gets
sinus infection or a respiratoryvirus.
Yep.
And he can't afford to take timeoff because he makes$7.25 that
he needs to pay for his kids'food.

SPEAKER_01 (18:21):
Yep.

SPEAKER_02 (18:22):
So he keeps going to work.
He's sick.
He tries to put aside the factthat he's sick.
And he can't go to a traditionalprimary care doctor because he
can't afford the bill.
He's forced to wait to see ahealth care provider because he
doesn't have health insuranceand he can't afford it.
So he ends up with pneumonia andit's so bad he can't breathe.

(18:44):
So then he goes to the emergencyroom because at this point it's
serious and he's unable to work.
The hospitals have to see him.
They have to treat his pneumoniabecause of federal laws that
require that.
But had he had health insurance,he could have gone to his
primary care provider.
He could have accessedprescription drugs because he

(19:05):
had health insurance.
So he could have accessed theantibiotics necessary to treat
an infection and it would havenever turned into pneumonia.
And seeing a primary careprovider is a hell of a lot
cheaper than going to anemergency room.

SPEAKER_01 (19:19):
Yeah, absolutely.

SPEAKER_02 (19:21):
Even the copay for someone who has insurance, it's
so expensive to go to anemergency room.
The minute you walk in the door,you're spending hundreds of
dollars, regardless.
Why wouldn't we want to give thedad, other granite staters, the
option to have health insurance,to stay healthy, to be able to
work, to be able to support theeconomy by working, to be able

(19:42):
to keep his employer on task, ontarget?
Why wouldn't we want thesethings?
Not only is it the right thingto do, like we want people to be
healthy because that'simportant.
That's being kind.
That's being a good human.
Right.
Guess what?
It Also saves us all money.

SPEAKER_01 (20:02):
Okay.
Now you're talking the languageof people who like want to, I
don't know, take things away,hold them for themselves,
whatever it might be.

SPEAKER_02 (20:12):
This is saying the quiet part out loud, I guess.

SPEAKER_01 (20:14):
Oh, great.
It's a podcast, so we can turnthe volume up.
Yes.
Let's do it.

SPEAKER_02 (20:19):
It saves money for people to be on Medicaid.
So not only does it save thestate money, it saves people who
have insurance through theiremployer money.
Wait a minute.

SPEAKER_01 (20:29):
Yes.
Wait a minute.
You're telling me that if peoplehave coverage under Medicaid,
that saves me, Liz Canada, whohas insurance in another form.
That saves me and people like memoney.

SPEAKER_02 (20:44):
Yes.
How?
Because the the more people whoare insured in a market.
So in New Hampshire, our marketis just the state.
That's how health insuranceworks.
It's not a national market, it'sa state market.
So the more people who havehealth insurance, the more
adequate reimbursement is givento healthcare organizations, the

(21:07):
more the risk of an insurerhaving to pay an astronomical
amount of money out is spreadamongst more people.
The more people who have healthinsurance, the better access
they have to health care.
It doesn't necessarily equalthey get access to health care,
but it improves the likelihoodthat they will be able to access

(21:28):
health care.
So if you have access to healthcare because you have health
insurance, it means that therewill be less wait times.
So if you have a heart attack,God forbid, Liz.

SPEAKER_01 (21:41):
Look, there are plenty of reasons for me to have
a heart attack.
I don't need to get into them,but yes.
I'm following this scenario veryclosely.
Yes, go on.

SPEAKER_02 (21:50):
If you have a heart attack, you have health
insurance through your wife.

SPEAKER_01 (21:54):
Yes.

SPEAKER_02 (21:54):
Her employer-sponsored health
insurance covers you and yourkids.

SPEAKER_03 (21:59):
Yes.

SPEAKER_02 (21:59):
So if you go to the emergency room and granted
Advantage, our Medicaidexpansion program is intact.
People who are eligible toaccess it can access it.
Everything's working as itshould.
The wait times will be shorterbecause people won't be going to
the emergency rooms who don'thave emergencies.

(22:20):
Ah so your heart attack istreated earlier, which means the
insurance company reimburses thehospital for a less catastrophic
event.

SPEAKER_01 (22:30):
Okay.

SPEAKER_02 (22:31):
Because your heart attack could cause all sorts of
other things.

SPEAKER_01 (22:35):
I love that you're calling it my heart attack.
Like it's it's not just anyone'sheart attack, it's my heart
attack.
I love it.
Christine, you're gonna feel sobadly if I have a heart attack
sometime between now and youshouldn't say that.
I I'm gonna laugh.
I make I need to make sure thisepisode is published before it
happens.

SPEAKER_02 (22:54):
I would feel so awful.

SPEAKER_01 (22:55):
But in this in this scenario, Liz's heart attack is
trying to go to the ER.
And that dad, who didn't haveinsurance, who wasn't able to
see someone for a sinusinfection, who had to wait to go
get care, who then is gettingsicker and sicker over the
course of time because it isuntreated, then has the only
option essentially to go to theemergency room.

(23:18):
And now you've got heart attackLiz and this dad going for the
same spot when dad could havebeen treated months ago.

SPEAKER_02 (23:24):
Right.
And dad and all of his friends,right?
If you look at Berlin, NewHampshire, Berlin has a high
number of Medicaid enrollees.
So imagine going to an emergencyroom in a town like Berlin and
Franklin that have a high numberof Medicaid enrollees now.
Those Medicaid enrollees losetheir insurance.

(23:45):
So instead of having access to aprimary care provider, Franklin
residents or Berlin residentsare forced to go to the
emergency room to access carebecause they can't afford it
otherwise.
So the people that have heartattacks or diverticulitis or
appendicitis or gallbladderissues, a gallbladder attack,

(24:05):
those people get pushed down theline, right?
Because there's so many peoplein front of them.
So what ends up happening isyour insurance company has to
pay more money eventually.
It drives insurance rates up.
If they're paying more, theyhave to charge their
beneficiaries more because theyhave to cover their cost, right?

(24:26):
They have to cover their cost ofreimbursing all of these
healthcare providers.
So they have to spread theburden amongst their consumers.
And now there's fewer consumersto spread it amongst because
there's fewer insured people.
So the more people that havehealth insurance, the lower our
costs are as people who haveaccess through

(24:47):
employer-sponsored insurance.

SPEAKER_01 (24:51):
So why is there an argument about the costs of
Medicaid?

SPEAKER_02 (24:58):
Honestly, Liz, I don't know.
I honestly do not understand whyanyone would want to take
someone's health insurance awayfrom them.
I understand that policymakershave all of these big decisions
that they have to make, all ofthese considerations that they
have to make, but the math justdoesn't work.

(25:18):
By reducing access to Medicaidinsurance, by changing the
eligibility for Medicaidinsurance, you're pushing people
off of their health insurance.
Um, so the state looks like it'ssaving money, right?
In those budget sheets that Philtalked about.
It looks like the state issaving money, but guess who's
paying for it?
Everyone else.

(25:39):
You're paying for my heartattack is paying for it.

SPEAKER_01 (25:42):
Yeah.

SPEAKER_02 (25:43):
Exactly.
Your heart's paying for it.
Your wife is paying for it.
Everyone else now has to bearthe burden because policymakers
are kicking people off of healthinsurance.
So what ends up happening is thecosts get pushed down onto other
health insurance consumers.
It also gets pushed down ontoproperty taxpayers, everyone

(26:05):
else in New Hampshire, becausetowns in New Hampshire have
welfare offices.
When someone loses their healthinsurance, they can access help,
hopefully, if everything's okay,I guess, they can access help
through the town welfare office.
Right.
So who pays for the town welfareoffice, Liz?

SPEAKER_01 (26:25):
The town.

SPEAKER_02 (26:26):
Yes.
Who gives the town money?

SPEAKER_01 (26:28):
Liz's heart attack again is giving.
Yes.
Just Liz in that scenario.
Yes.

SPEAKER_02 (26:32):
You and your wife pay property taxes.

SPEAKER_01 (26:35):
Which I will say, and I talked with folks from
Families in Transition abouthomelessness and how I brought
up the welfare office actually,because I serve on our town's
budget recommendationscommittee.
And one of my subcommittees isthe welfare office.
So I have learned a lot in thelast few years serving in that
subcommittee about the types ofcalls that they get and the
types of you know support thatour town is thankfully able to

(27:00):
provide people who need it.

SPEAKER_02 (27:02):
Yes.

SPEAKER_01 (27:03):
But it is not an unlimited amount of money in a
town to be able to do this.
Like that's that's pushed allthese costs all the way down to
just our community, just ourtown as well.

SPEAKER_02 (27:14):
But guess who people blame when their property taxes
go up?
They blame town officialsbecause that's all they see.
They see their property bill andthey think, why are my property
taxes going up?

SPEAKER_03 (27:27):
Right.

SPEAKER_02 (27:27):
Well, it's because policymakers at the state level
are making policy choices thatcost you money and you're going
to pay for it through yourproperty taxes and with your
health.

SPEAKER_01 (27:41):
And the issue as well is that when they make
these decisions, they don'tfollow the rule of math class.
They don't show their work tosay They don't use their
calculus.
They don't use their calculus,but they don't show their work
and say, okay, so we're gonnamake this change.
And because we've made thischange at the state level, the
towns are going to have to pickup that cost because we've done

(28:04):
that.
They don't show that work, butthat's what's happening,
regardless.
Exactly.

SPEAKER_02 (28:09):
Because they only have to balance the state
budget, they don't have to worryabout their the town budgets in
their districts.
They their responsibility is tobalance the state budget.
It's not their responsibility todecide what residents in
Franklin are paying for and forhow much.
So all you see when you go to astate budget hearing is the

(28:31):
savings that the state'sgenerating and the funding that
they're providing for programs.
You don't see what else ishappening.
They do not have to show ontheir budget reconciliation
documents what the consequencesare.

SPEAKER_01 (28:47):
I'm trying to think of an analogy.
I love analogies.
But it's it would kind of belike in our household, you know,
if you got Molly and me, thenyou got the two boys.
And if we make the analogy oflike we are the state and the
boys are the local level, it'slike saying, like, well, we
balance the budget.
Uh, we didn't need to spend anymoney on school lunches this
year.
Great news for us, huh?

(29:08):
And then the boys are like,wait, no, we still have to have
school lunch.
It's like, well, uh, it's not inthe budget.

SPEAKER_03 (29:12):
Yeah.

SPEAKER_01 (29:13):
And then they're just gonna have to figure it out
on their own.
Like, there's still that needsto happen, even if we're just
like, nope, cut that line atthem saved, saved our expenses.
Pretty great.
Liz.
Good for us.

SPEAKER_02 (29:23):
Kids in New Hampshire aren't hungry.
They don't need to eat.
They just want more things.
They always want things.

SPEAKER_01 (29:29):
They always want money.
Christine, I literally droppedthe boys off at their friend's
house and I fed them so manythings.
So I'm like, do not walk intotheir house and say, what's for
dinner?
as soon as you walk in.
Because one that is rude,they're just hungry all the
time.
Yes.
And my younger one was like,Liz, you know I'm gonna do it
anyway.
I'm like, I know you are, butplease don't just walk into
someone's house and be like, isthere any food here?
In this little silly analogy, ifMolly and I are like, no, we we

(29:52):
did our budget and uh schoollunches didn't make the cut, the
boys are still gonna need toeat.
Like, are they just gonna haveto scrounge for food?
Like, what are they gonna haveto do?
Similarly to the state.
Like the state can say,actually, we uh cut that line
item, but the local level has topick up the tab.

SPEAKER_02 (30:08):
They have to figure it out.

SPEAKER_01 (30:09):
Yeah.

SPEAKER_02 (30:09):
And they figure it out by raising your property
taxes.
Or if they don't, if they can'traise property taxes, people go
without.
So, like you said, your welfareoffice has a very limited amount
of money right now, right?
Right.
Because taxes can't go up anddown by the day.
Right.
They're set at a certain time ofyear and they are what they are.

(30:31):
So if the policymakers inConcord or DC change Medicaid
eligibility today, there'snothing your town can do about
it.
But if today we change theeligibility so that people lose
their Medicaid health insuranceand they then can't go to work,
which means they can't affordtheir food.
So they go to the town welfareoffice.

(30:54):
More people end up coming to thetown welfare office.
The town welfare office has adiscrete amount of money.
They can only pay for so muchfood for people.
You can't just go raise taxeswilly-nilly and decide to buy
more food.
It doesn't work that way.
So they go without.
Families go without.
And in a state that is sowealthy and has just gobs of

(31:19):
money, it doesn't make any senseto me or my moral compass to not
want people to have healthinsurance because it's better
for everyone.

SPEAKER_01 (31:30):
I want to also be clear that town welfare offices
are doing critical, suchimportant work because I know
that there are stories ofindividuals who are about to
lose their homes or who havebeen staying in their car for
weeks and months, and then itgets so cold and they're finally
going into the welfare office.

(31:51):
That is really, reallyimportant.
And your point is so true thatwe can't just say, well, you
know, we need to bring in moremoney to the welfare office to
do this because there's only somuch a local community can do.
There's a lot more that a statecan do, and a lot more that the
country can do.
And when they choose not to, itgets pushed down to us and our

(32:14):
property taxes.
It does.

SPEAKER_02 (32:16):
Right.
And towns and cities can onlyraise revenue from a very
limited number of sources,especially in New Hampshire.
They can't just go create a taxor create a source of revenue.
We're very limited as to howtowns and cities can generate
revenue.
Right.
The state has more options andmore choices.

SPEAKER_01 (32:36):
Christine.
Yes.
I learned a lot from Phil.

SPEAKER_02 (32:39):
Don't you always think about it?

SPEAKER_01 (32:41):
I really always do.
But that interest and dividendstax moment.
I'm still thinking about it.
I am still thinking about howpeople had millions and millions
of dollars and it generatedhundreds of thousands of
dollars, and they were taxed tenthousand dollars, and that tax
was cut for those people.

SPEAKER_02 (32:57):
Yes.
Policymakers chose to reduce therevenue coming into the state of
New Hampshire by eliminating theinterest in dividends tax,
which, like you said, the bulkof it was paid for by very, very
wealthy people.
People who are not justsurviving on their pension.
It's people who have millionsand millions of dollars in

(33:19):
assets, people who earn hundredsof thousands of dollars on their
interest and dividends.

SPEAKER_01 (33:25):
Money that was just generating in an account that
they've essentially donenothing.
It's just generating passiveincome.

SPEAKER_02 (33:31):
Right.
And I'm not judging them.
I mean, good for you for havingthat.
But there are other people whohave nothing.
And honestly, like the state hasan obligation to pay for basic
services.
And the interest in dividendstax and the business tax, that

(33:51):
is how the state of NewHampshire raises revenue.
And so if these are the ways youcan raise revenue to pay for
basic services like roads, likeschools, like healthcare, why
would you just say, oops, nevermind, we don't need that
revenue.
You're creating a problem, whichis exactly why we're in the

(34:11):
situation that we are in.
Over the last six years,policymakers have reduced,
purposely reduced state revenue.
And now it's like, well, now wecan't fund Medicaid because we
don't have any revenue.
Look at us, there's no money.
Well, of course there's nomoney.
It's because you cut it.
And that was a choice that thestate of New Hampshire made,

(34:32):
policymakers made.

SPEAKER_01 (34:34):
A majority of policymakers made.

SPEAKER_02 (34:37):
Not every single one who's there, but that's a very
good point.

SPEAKER_01 (34:40):
Enough.
A majority of the folks did.
Yeah.

SPEAKER_02 (34:43):
Right.
And their towns are going to beimpacted.
Their constituents are going tobe impacted.
You're going to be impacted,even if you don't live near
them, because your insurer isgoing to have to pay more money.
So you're going to have to paymore to have that insurance
through Molly's employer.
Right.
That's just the way insuranceworks.

SPEAKER_01 (35:04):
Let's talk about the folks who are covered by
Medicaid.
Because I know that a lot ofthem are kids, are younger
people, right?
And there's also a lot of folkswho are maybe 65 and older, or
you know, in their they'rethey're older folks who need uh
health coverage as well.

SPEAKER_02 (35:24):
Yeah.
So the biggest group of peoplewho have Medicaid in the state
of New Hampshire are actuallykids.
There's about 90,000 childrenwho are covered by Medicaid in
the state of New Hampshire.

SPEAKER_01 (35:37):
And does that mean that they all are in families
that have lower incomes?
No.

SPEAKER_02 (35:43):
Some of these kids have severe disabilities.
Some need in-home care.
And we want people to stay intheir home, right?
That's we want people to be ableto access care in their home.
For one thing, it's lessexpensive.
For another, it's better foreveryone.
Right.
So there are children who havespecial needs that also access
Medicaid.
Yep.

(36:03):
But children cost the leastamount of money in the Medicaid
program.
We have elderly people andadults with disabilities who
account for about 24,000 people.
They are the highest spend inour Medicaid program because
nursing home care is expensive.
I don't know how old yourparents are, but health care for

(36:26):
geriatric patients is very, veryexpensive.
And in-home care is veryexpensive.
So if you have a child who needsa feeding tube or has an immune
disorder that doesn't allow themto go to school, they can access
healthcare services in theirhome with Medicaid.
And it's literally life or deathfor some people.

(36:50):
Without healthcare services,people who are medically complex
die.
And Medicaid is their lifeline.
And that's not hyperbole.
It's true.
You also have kids whoseparents, like you said, are what
we consider low income, whichmeans you live at a certain
level, you make a certain amountof income.

(37:10):
Their parents, again, could havehealth insurance through their
employer, and they could save alittle bit of money by having
the kids on insurance throughMedicaid.
But again, they're stillconsidered low income.
So they need access to healthinsurance that they can't
afford.
They need access to healthcareservices that they can't afford

(37:33):
without Medicaid coverage.

SPEAKER_01 (37:35):
So what changes are expected to happen because of
the state budget or because ofthe federal budget?
Or both?
What happened with Medicaid thissummer, essentially?
Because it all happened in Juneand July across the state and
the country.

SPEAKER_02 (37:52):
Yes.
And what happened in the stateis different than what happened
at the federal level inCongress.
Right.
So they're not in alignmentbecause the great super duper
terrorism.
Those bill drafting processesare different.
So in New Hampshire, our statebudget passed.
This is a budget year.
And in this budget, because wehad less revenue, because again,

(38:15):
legislators chose to reducesources of revenue.

SPEAKER_01 (38:21):
They were like, you know what we don't need is
money.
So let's get rid of thatrevenue.
And then they did the budget,and they're like, you know what
we need is money.
And so here we are.

SPEAKER_02 (38:30):
So the legislature reduced the revenue coming into
the state over the past sixyears.
And that means that when thelegislature decided to craft its
budget, they had less money towork with, which means they are
paying for less services.
So the choices that they made tothe Medicaid program include

(38:52):
charging low-income parents whohave children on Medicaid
premiums so that their childrenhave health insurance.

SPEAKER_01 (39:01):
Christine, I love words like this because premium
is like, ooh, it sounds sofancy.
What does premium actually mean?
What does that word really mean?

SPEAKER_02 (39:08):
So healthcare is so full of jargon.
I apologize.

SPEAKER_01 (39:11):
No, I love it.
But what does lower incomefamilies have to pay a premium?
What does that mean?

SPEAKER_02 (39:18):
So that is the monthly amount of money that
they have to pay, the amount ofmoney they pay each month for
their kids to be insured.
And so in New Hampshire, thispolicy change means if you have
a family of three and you havekids on chip, which is um kids
Medicaid, you have to earn justunder$68,000.

(39:43):
That's not a lot of money.
So that that captures a lot ofgranite staters, right?
So that family of three is goingto have to pay$230 a month so
that their child can accesshealth insurance.

SPEAKER_01 (39:57):
Wait, I'm gonna get my calculator, aka my.
Smartphone.
Let's just do a math thingreally fast.
How much did you say?
$230 a month.
$230 a month divided by, youknow what I'm gonna do?
$7.25.
So they would need to work 31hours to pay that premium on a

(40:18):
$7.25 an hour job.

SPEAKER_02 (40:21):
And that doesn't include 31 hours.
Yeah.
That doesn't include SocialSecurity.
That doesn't include the foodthat they have to buy.
That doesn't include the rentthat they have to pay.

SPEAKER_01 (40:32):
For a cool 31 hours of work and just that you can
pay for the health insurance youalready have.
Yes.
True?

SPEAKER_02 (40:42):
No one can pay that amount of money if you make$7.25
an hour.
This isn't in a vacuum, right?
There's so many other thingshappening in the state of New
Hampshire.
We don't have enough access tohousing.
So rent is very, very expensivehere.
The average for a studio is like$1,300.
You have to pay$1,300 and youhave to pay your health

(41:05):
insurance premium.
And if you do a comparison, Imean it truly depends on your
employer and what kind of planthey offer.
But families in somecircumstances who have
employer-sponsored insurancewould be paying less than this
parent trying to provideMedicaid coverage.

(41:25):
And I make quite a bit more than$7.25 an hour.
That's less of a burden on methan someone who makes minimum
wage.

SPEAKER_01 (41:43):
Where they talked about how they they wanted to do
the premium the way that itpassed it, because they didn't
want it to be called an incometax.
They're like, we don't want itto be called an income tax, so
we're gonna do with this otherthing instead.
It's like, no, it's still you'reit's still a a fee, a premium on
the income.
Yes.
You can call it a banana, butit's still the same thing at the

(42:05):
end of the day.

SPEAKER_02 (42:06):
What is that phrase if it walks like a duck?

unknown (42:08):
Yeah.

SPEAKER_01 (42:08):
And talks like a duck.
It's an income tax, is what itis.

unknown (42:12):
Yes.

SPEAKER_01 (42:13):
I don't know.

SPEAKER_02 (42:13):
Or a fee that I know they wanted us to be.

SPEAKER_01 (42:17):
What's the difference between a tax, a fee,
a premium?
Semantics.
So$230 a month for a family ofthree, making around like$65,000
a year.

SPEAKER_02 (42:30):
Yeah.
So that's one of the greatpolicy changes that was put in
place in this budget.
The other one was And this wasat the state level.

SPEAKER_01 (42:39):
The state law making.
This is at the state level.

SPEAKER_02 (42:41):
Yeah.
So in addition to that, peoplewho are on Medicaid expansion or
what is called Granite Advantagewill have to Why do we have all
these secret code names?

SPEAKER_01 (42:52):
Why are we calling it these?
It's like, it's not Medicaid,it's Granite Advantage wink.
It's not Medicaid, it's ChipWink.
It's not an income tax, it's apremium wink.
Like that's how I feel thatwe're why are we doing this?
It's not Medicaid, it's KatieBeckett.

SPEAKER_02 (43:07):
It's Katie What?
What is Katie Beckett?
Katie Beckett is a Medicaidprogram in the state of New
Hampshire.
Because that's a person's name.
Right.
It's also a Medicaid program.

SPEAKER_01 (43:17):
It's like Jeremy Barramy in a good place.
Like it's the concept of time.
It's Jeremy Barrame.

SPEAKER_02 (43:23):
What?
So states get to craft whattheir Medicaid programs look
like.
They get to decide whichpopulations and which needs they
cover.
And so they name them afterpeople.
Katie Beckett is a real person.
A and B is also a Medicaidprogram.

SPEAKER_01 (43:43):
A and B.
A and B.
ANB.

SPEAKER_02 (43:47):
And is in Nancy.
Aid to the Needy Blind.

SPEAKER_01 (43:50):
Okay.
Yep.

SPEAKER_02 (43:52):
APTD, aid to the permanently disabled, Medicaid
for Employed Adults withDisabilities.
In and Out Medicaid, home andcommunity-based waivers.
So here's a a category that alsohas four names that are

included (44:11):
in-home supports, DD, also known as developmental
disabilities, acquired braindisorders, choices for
independence.

SPEAKER_01 (44:20):
Are these all names of programs that's actually just
Medicaid?

SPEAKER_02 (44:24):
Yes.
They're all Medicaid.

SPEAKER_01 (44:27):
That is so interesting.

SPEAKER_02 (44:30):
It is, but you know what happens?
Normal people who don't live inour policy world, who go about
their days thinking.
I wish I could turn that off inmy brain.
People don't know, andrightfully so, right?
Like who would say Katie Beckettand think Medicaid?
It's just a name.

SPEAKER_01 (44:51):
I remember seeing polling that shows that people
support the concepts ofMedicaid, support things like
chip.
Yeah.
Right?
Like they support those things.
And then if you say, What do youthink about Medicaid?
They're like, oh, I don't likethat.
It's like, no, you just said youliked it, but a different name
of it.

SPEAKER_02 (45:06):
It's because we've created this monster Medicaid.
Stigma.
Yeah.
We've created a stigma wherethere shouldn't be one.

SPEAKER_01 (45:14):
It's just health insurance, folks.

SPEAKER_02 (45:16):
It's just health insurance.
The only difference is whodesigns the program and how it's
paid for.
And you know, Liz, throughMolly's health insurance, you're
not paying the cost of all ofthat health insurance.
No.
It costs her employer a lot ofmoney to insure your family.
You're paying a fraction of thehealth.

SPEAKER_01 (45:35):
Which is a good thing because I'm going to have
a heart attack.
But yes, right.
Tomorrow.
It's going to be the ultimatehilarious joke.
It'll all be worth it.
It'll all be worth it.
We are as serious as a heartattack here on the podcast.
We are not paying the full costof the health insurance.

SPEAKER_02 (45:55):
No.
But now we're making people whohave very, very little income
pay for what they get.
We're making another policychoice.
We're making them demonstratethat they've worked for a
hundred hours a month, or elsewe're going to take their health
insurance away.

SPEAKER_01 (46:10):
Okay, tell me about that.
This is a new requirement, workrequirements?

SPEAKER_02 (46:15):
Yes.
So Medicaid was created toprovide better access to
healthcare services.
It is for the millionth timejust health insurance.
That is what it was designed tobe.
And in 2018, I believe, thestate of New Hampshire asked
Centers for Medicaid andMedicare to allow the state of

(46:37):
New Hampshire to make peoplework in order to access their
Medicaid.
So, which is great, I mean,because people are already
working, right?
But now you have to go throughthis rigmal role to prove that
you're working.

SPEAKER_01 (46:51):
Yes.
How does one prove that they areworking?
Do they have to take a video ofthemselves?
Do they have to go to theDepartment of Health and Human
Services and fill out what youthink?

SPEAKER_02 (47:03):
So imagine all of the paperwork that has to be
done and all of the steps thathave to be taken for a human to
verify that they're employed.
They have to get something fromtheir employer.
They have to find paperwork thatdemonstrates they're employed.
They have to drive to the DHHSdistrict office or mail it or

(47:24):
upload it on internet.
What if they don't have theinternet?
There are exceptions that werebuilt into that program.
So if you have substance usedisorder and you're actively
engaged in treatment, you havean exemption.
But guess what?
You can't just say, I havesubstance use disorder.
The state can't just go look atall of the claims for your

(47:44):
substance disorder treatment intheir system because our system
doesn't work that way.
So they have to take this personbattling substance use disorder
with all of these other thingsgoing on, has to make an
appointment with their healthcare provider that's weeks out,
has to get the healthcareprovider to sign a form.
The healthcare provider has tomake a determination.

(48:06):
The other phrase that we usedwas medically frail.
That's not a medical term.
So we have to, as a healthcareprovider, decide whether or not
our patient is medically frail.

SPEAKER_01 (48:17):
Medically frail?

SPEAKER_02 (48:18):
Yeah, I don't even know what that means.

SPEAKER_01 (48:20):
Like Tiny Tim from a Christmas carol?

SPEAKER_02 (48:22):
I don't know.

SPEAKER_01 (48:23):
I meant to read a passage from a Christmas carol
because this is all of thedebates against Medicaid and
against supporting folks withlower incomes is just the
opening scenes of a Christmascarol of Ebenezer Scrooge being
like, then let them die.
We really do like analogies.
That's another good one.
I'm sorry.

(48:43):
Yes.
That's a good one.
It's the English teacher brainof like trying to find them.
But that's how it feels.
He's like, yes.
Aren't there poor houses?
Aren't there places workplacesto go?

SPEAKER_02 (48:54):
That's how this feels.
Right.
So we're creating more barriersfor people who are eligible for
Medicaid.
We're creating more barriers forthem to access health insurance
that they are legally eligibleto access to save money.
New Hampshire has tried a workrequirement before and it didn't
work.

(49:14):
We had to stop it because it wascosting the state so much money,
and we weren't able to contactenough people who would be
subject to the work requirementto get them to comply with the
work requirement.
So we paused it.
It's stopped.
It's actually current law andit's not in effect because it

(49:35):
doesn't work.

SPEAKER_01 (49:36):
The work requirement doesn't work, but they put it
back in this time.

SPEAKER_02 (49:40):
Yes.

SPEAKER_01 (49:41):
So that we could talk about it, so that we can
say, you know what didn't workthe first time was the work
requirements.
And yet here we are again.

SPEAKER_02 (49:47):
Right.
It's like that Taylor Swiftsong.

SPEAKER_01 (49:50):
Oh, which one?

SPEAKER_02 (49:54):
I love that song.
It doesn't work, New Hampshire.
You're going to waste money.
We shouldn't be doing it.

SPEAKER_01 (50:01):
We shouldn't be doing it.
And people will lose theirhealth care if they don't do it.

SPEAKER_02 (50:05):
They will.

SPEAKER_01 (50:06):
How soon after?
If they don't prove that theyhave worked for a hundred hours,
what happens?

SPEAKER_02 (50:11):
We don't know yet what it's going to look like
because now federal law saysstates, if you want Medicaid
dollars, you have to have a workrequirement.
So we don't know yet what willhappen if you don't prove that
you're working.
But we do know that people aregoing to lose their health
insurance.
Clinicians are going to losereimbursement for the services

(50:34):
that they provide.
And people are going to gowithout care.
Your insurance costs are goingto go up if you're commercially
insured.
We know all of these things, andwe're still doing it.

SPEAKER_01 (50:45):
Holding health insurance hostage.
Yes.
Fantastic.
Really glad that's what we'respending our time on.

SPEAKER_02 (50:52):
Such a good use of money.

SPEAKER_01 (50:54):
Such a good use of money and time and resources.

SPEAKER_02 (50:57):
Such a good use of our very limited revenue because
people chose to eliminategigantic sources of revenue.

SPEAKER_01 (51:04):
Oh well, well.
To save money really means thatyou're betting on people not
doing it and therefore losingtheir health insurance.
Like you're making a bet againstpeople.

SPEAKER_02 (51:17):
We are betting that granite staters don't want to
work.
We are choosing to see the worstin our friends and neighbors.
We're choosing to see people asanything but human beings.
And at the end of the day, itactually doesn't save anyone

(51:37):
money.
It doesn't save the state money.
It doesn't save you money as ahealthcare consumer.
It doesn't save the healthcareprovider money.
It actually costs a ton of moneyfor the state of New Hampshire
to implement a work requirement.
Like millions and millions ofdollars.
So we're actually spending moneyto do something that doesn't

(52:00):
help anyone, that doesn't saveany money for what?
To prove a point?

SPEAKER_01 (52:05):
I don't know.
I mean, I I joke and not jokeabout Ebenezer Scrooge, but
like, are they just hoping thosepeople will die and not have to
cover them?
What are they trying to do?

SPEAKER_02 (52:18):
Love to believe that they think they're trying to
help people who are unemployedaccess work.
But we know that's not the case.
Most people on Medicaid areworking.
I always tell my kids not toassume the worst in people.
Assume the best.
But despite hours and hours oftestimony from healthcare

(52:40):
consumers, from healthcareproviders, from their own
Department of Health and HumanServices telling them,
policymakers, that they werethat most people are working,
that the people who aren'tworking, there's a legitimate
reason.
And that legitimate reason isalready an exception that we
built into the law in 2018.

SPEAKER_03 (53:02):
Right.

SPEAKER_02 (53:02):
So why are we going through these extra steps just
to prove a point?
In the first year ofimplementing a work requirement,
it is going to cost the state ofNew Hampshire.
So just the state, nothealthcare providers, which we
should also talk about, becausethe burden is going to be borne
by them as well.
Right.
It's going to cost the statealone almost$4 million in the

(53:26):
first year, almost um$3.8million in the second year,$3.8
million in the third year.
So we are wasting money to provea point that we research already
shows is not real.

SPEAKER_01 (53:41):
We're spending money to justify cutting money.

SPEAKER_02 (53:46):
So how can anyone assume that this is done to
benefit people, people whoaren't working to get them
working when the only savings isgenerated by them losing their
health insurance?

SPEAKER_03 (53:58):
Yeah.

SPEAKER_02 (53:59):
Hopefully my kids don't listen to this because
this is me assuming the worst,but I don't see any other way
the math works on this.
It doesn't work.
You're spending more money thanyou're saving, and so much harm
is going to be done to actualpeople.

SPEAKER_01 (54:16):
Let's talk about the healthcare providers.
Because when I've been indoctors' offices, some have
signs that say we do not acceptMedicaid here.
Medicaid is not accepted.
And then there are otherproviders who do accept
Medicaid.
With these changes and what'shappening at the state or
federal level, like what's goingto happen to the providers who
do accept patients who haveMedicaid coverage?

SPEAKER_02 (54:38):
There are providers who are legally required to
accept Medicaid.
Those include hospitals.
Hospitals have to acceptMedicaid.
It includes what are calledfederally qualified health
centers, also known as communityhealth centers.
And those provider types existacross the country just like
hospitals do.

SPEAKER_01 (54:59):
Yep.

SPEAKER_02 (54:59):
And they cannot turn away Medicaid patients.
Community health centers cannotturn away a patient for their
inability to pay.
And so the way they make theirmath work, they do have to make
their math work also becausecommunity health centers are
small businesses.
They have boards of directorswho are members of their

(55:22):
community who decide what typesof services they provide, what
the needs in their communitiesare, how they can meet those
needs.
So it's a very community-basedorganization.

SPEAKER_03 (55:34):
Right.

SPEAKER_02 (55:34):
Community health centers have to use different
sources of revenue, just likethe state, just like you and
Molly, to make their ends meet.
And so they have grants, theyhave federal grants, they have
private grants, they acceptcommercial insurance, they
accept Medicare, they acceptMedicaid.

SPEAKER_01 (55:54):
Medicaid reimbursement rates vary by
state.
So Vermont's reimbursement ratesfor their Medicaid programs are
different than Maine's, which isdifferent than New Hampshire's,
because their lawmakers get todecide.
Is that correct?

SPEAKER_02 (56:10):
Policymakers get to decide traditionally, yes, how
much Medicaid reimbursementrates are to a certain extent.
So what they don't decideusually, they don't decide the
dollar amount.
They decide the the amount ofthe in the bucket.
They decide how much money is inthe Medicaid bucket.

SPEAKER_03 (56:29):
Yep.

SPEAKER_02 (56:29):
And then DHHS or whatever their health agency is
called decides what the ratesare.
So if the state doesn't givethem a lot of money, then they
have to make the rates low inorder to make the lines work.

SPEAKER_01 (56:43):
There's a pool of money to be able to reimburse
providers with.
Right.
Who accept Medicaid patients.
Right.
And so if our state lawmakersput less money in that pot of
money for Medicaid, thenproviders will therefore have
lower reimbursement ratesbecause there is less money
theoretically.

(57:04):
Unless, of course, a whole bunchof health centers close and then
there are just fewer providersin general.
Is that what they're trying todo?

SPEAKER_02 (57:12):
So this is again them not showing their work.
This isn't in the budgetreconciliation documents, but
this is what happens.
When you reduce the number ofinsured patients in a state, you
reduce the revenue thathealthcare providers earn by
providing those services.
And the provider earns lessmoney, they have to cut services

(57:35):
to make ends meet, they have toclose sites to make ends meet,
and wait times increase.
So even if you're insured, yourwait times are going to be
longer at your primary careprovider because they have less
revenue, because there are lessinsured granite staters.
So if you look at a communityhealth center or a hospital, for

(57:57):
example, they have to acceptMedicaid.
They have to treat communityhealth centers have to treat you
regardless of your ability topay or insurance status.
If their patient loses theirhealth insurance, they can't
turn them away.
They still have to provide the$300 in primary care to their
patient.
They just have no source ofrevenue now for that patient.

(58:20):
So they lose the$300.
They still have to take care oftheir patients.
They just don't get any revenuefrom that, those services.
And so what ends up happening isthey have to treat the patient.
The patient can't afford to pay.
So the health center has todecide where the income's coming
and where it's not.

(58:41):
And they cut the services thatthey earn less revenue on, for
instance, substance use disordertreatment.

SPEAKER_01 (58:49):
Let's be exceedingly clear here.
All of these patients deservehealth care.
They are not doing anythingwrong in this process.
They deserve to be able to makean appointment, go to a health
center, get treatment, do getthe get the things that they
need to get healthy in whateverhealthy way needs to happen.

(59:12):
And that should be the extent oftheir participation in this
conversation.
They should just be able to getthe health care that they need.
Yes.
You shouldn't have to deserveit, you shouldn't have to like
earn it.
Prove it.
Prove you need that health care.

SPEAKER_02 (59:26):
Prove you have skin in the game.
You're worthy of an insurancecard to put in your pocket.

SPEAKER_01 (59:32):
Right.
And the providers who areproviding this health care need
to have the revenue coming in tobe able to provide that health
care for these people who needit.

SPEAKER_02 (59:42):
Right.
Because guess what, Liz?
Your high cholesterol stillneeds to be.

SPEAKER_01 (59:48):
Shout out to my high cholesterol.
Your high cholesterol stillneeds to be.
We are getting into why theheart attack is happening.

SPEAKER_02 (59:57):
Can you tell I just had my blood tested?

SPEAKER_01 (01:00:01):
That's good.
You should you should be able toget the health care that you
need and the blood tests thatyou need when you need them.
Right.
Yes.

SPEAKER_02 (01:00:08):
Right.
And I have health insurance.
So I can access those servicesand not be out$800 that blood
work costs.
So then when they the providerslose revenue because their
patients lose insurance, theyhave to let people go, which
means they're fired.

SPEAKER_01 (01:00:28):
Fewer providers.

SPEAKER_02 (01:00:29):
Which means they have fewer providers, which
means that provider just losttheir job, lost their health
insurance, lost their incomethat supports their family.
And you have to wait longer toget your cholesterol levels
checked because they have fewerproviders.
Right.
Because policymakers chose toimplement policies that are

(01:00:52):
guaranteed to kick people off ofMedicaid.
So everyone, Liz, should care ifgranite staters retain their
Medicaid because it willinevitably impact every single
person in our state.

SPEAKER_03 (01:01:07):
Yeah.

SPEAKER_02 (01:01:08):
And that doesn't even get into what's happening
at the federal level.
Because that's fun.

SPEAKER_01 (01:01:13):
You have an interesting definition of the
word fun, is what I'm hearing.
Mm-hmm.
Let's hold on the federal piece.
Yeah, it's a lot.
No, this is incredible.
So my last question for you isif folks are listening to this
podcast and they're like, wow, Idid not know all this stuff
about Medicaid, and say they'repretty frustrated to find out

(01:01:36):
that our lawmakers and ourpolicymakers in New Hampshire
have made the consciousdecisions to negatively impact
people who are covered byMedicaid or who could be and so
forth.
What should they do, Christine?
What does one do with all therage?

SPEAKER_02 (01:01:53):
Scream very, very loud into the void.

SPEAKER_01 (01:01:58):
Yes.
Scream into the void.
Check.
I do that every day.
It's a good part of my morningroutine.
Scream into the void.

SPEAKER_02 (01:02:04):
Mountain bike before work.
That helps me.
I crossfit.

SPEAKER_01 (01:02:08):
Yeah, I crossfit.
Oh, yeah.
It's one hour of my day that Iknow I cannot think about work
because I am too busy doing toomany wall balls.

SPEAKER_02 (01:02:17):
Right.
No time.
If I think about work, I crashand I get bruises.

SPEAKER_01 (01:02:22):
You mountain bike.
I do mountain bike.
I crossfit.
So scream into the void, dosomething to maybe avoid anxiety
attacks.

SPEAKER_02 (01:02:31):
Yes, right.
Panic attacks.
So you gotta do that.
And then talking to your friendsand neighbors, because I bet
you, Liz, you throw a rock, ormaybe I don't know, a tennis
ball is a better choice.
Right.
No, rocks are great.
You throw a tennis ball fromyour front door and you hit
someone, they probably haveMedicaid.
Because guess what?

(01:02:53):
Almost 200,000 people in ourstate are covered by Medicaid.
If you go to the MerrimackCounty nursing home, those
residents are thankfully insuredby Medicaid.
So it will affect every aspectof your life, of your friends
and neighbors' lives.
So you have to learn, right?

(01:03:14):
And then vote.
Also vote.

SPEAKER_01 (01:03:17):
Vote.

SPEAKER_02 (01:03:19):
The other thing we need to do is write letters,
make phone calls to yourlegislators.
We have the most accessiblelawmakers.

SPEAKER_01 (01:03:28):
We really do.

SPEAKER_02 (01:03:29):
There's 400 in the house.
Yeah.
One of your neighbors isprobably a legislator.

SPEAKER_01 (01:03:34):
They're everywhere.

SPEAKER_02 (01:03:35):
So call them and talk to them about why you're
concerned and how you don't wantyour health insurance rates to
go up and what they can do toprevent that.
Because guess what?
There's already reports outthere that say health insurance
rates are going to go up.

SPEAKER_03 (01:03:52):
Yeah.

SPEAKER_02 (01:03:52):
Not just because of what happened at the federal
level, it's also these choicesthat our state policymakers have
made to reduce state revenue andto push the burden and the cost
down onto residents.

SPEAKER_01 (01:04:04):
Letting them know that health insurance costs and
health insurance coveragematters a heck of a lot to you.
That is a tangible next stepthat you can take after you
scream into the void, after youmountain bike or do your reverse
lunges like we've been doing atthe gym.
I don't know what that is.
They're hard to.
You're gonna vote, of course,but also you're gonna contact

(01:04:27):
your lawmakers.
You don't have to wait untilelection day.
You can talk to them now.

SPEAKER_02 (01:04:31):
Right.
And it's actually better to talkto them now because they're less
busy because they're not in thelegislative session.
And they're also drafting billsright now.

SPEAKER_00 (01:04:40):
Yeah.

SPEAKER_02 (01:04:41):
So if there's something they can do to help
you or mitigate the consequencesthat are going to come because
of this legislation, they can doit now.

SPEAKER_01 (01:04:49):
You can talk to them now.
You don't have to wait.
Christine, thank you so much foryour time.
Thank you for coming on here andtalking to me about Medicaid,
which is health insurance.

SPEAKER_02 (01:05:00):
That's all it is.
That's all it is.
Health insurance.

SPEAKER_01 (01:05:02):
Medicaid, not scary.
Not a scary thing.
Just health insurance.

SPEAKER_02 (01:05:06):
It's great.

SPEAKER_01 (01:05:24):
What is a wall ball?
You take a weighted ball and yousquat and then you throw it up
as you get up and it hits thewall and it comes back down and
you keep doing those.
It's, as you might say, fun.

SPEAKER_02 (01:05:35):
What happens if it hits you on the head?
Like, is that a punk?
And then I gotta catch it.

SPEAKER_01 (01:05:39):
You'll catch it.
You you don't want to get hit.

SPEAKER_02 (01:05:41):
I wear bifocals, Liz.
You're asking a lot.

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.css-14f5ked{margin:0;word-break:break-word;display:-webkit-box;-webkit-box-orient:vertical;box-orient:vertical;-webkit-line-clamp:2;overflow:hidden;}Medicaid: It's Health Insurance! (Re-Release)

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