August 26, 2025 • 58 mins
Don't be fooled: a Medicaid by any other name would smell as sweet - because it's health insurance!
In this episode, Liz and Kristine Stoddard (health care super nerd/wonk) cover what Medicaid really is (health insurance!) and what the impacts will be on *all* of Granite Staters...due to a majority of New Hampshire lawmakers' actions.
Liz uses many analogies in this episode (including A Christmas Carol) and Kristine asks Liz what a "wall ball" is.
New episodes on Tuesdays.
Become a supporter of the show
Have an idea for an upcoming episode? Email Liz: newhampshirehasissues@gmail.com
Links:
- Medicaid Matters: New Hampshire Needs Medicaid
- New Hampshire DHHS Medicaid website
- Health Insurance Marketplace
- One in Eight Granite Staters Enrolled in Medicaid in 2024, One in Thirteen Adults Enrolled in Medicaid Expansion (NH Fiscal Policy Institute)
- The Effects of Medicaid Expansion in New Hampshire (NH Fiscal Policy Institute)
- New report shows Medicaid coverage decreased slightly in New Hampshire in 2024 (NHPR)
- Opinion: We all benefit when families can access care: Why Medicaid premiums threaten more than just budgets (Concord Monitor)
- Access to NH Medicaid coverage is changing. Here's what you need to know. (NHPR)
- State leaders brace for ‘heavy lift’ from Medicaid, food stamp changes (Stateline)
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Liz Canada (00:00):
I'm going to be honest with you, K ristine.
I don't know a lot aboutMedicaid.
I know it, but I don't know it.
Kristine Stoddard (00:06):
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.
Liz Canada (00:17):
Yeah.
It's like a spider web.
Kristine Stoddard (00:19):
It is a spider web.
A boring policy.
And it's hard to speak ingeneralities without...
missing some piece ofinformation.
But unless you want like 10hours of podcast, that's what
we're going to have to do.
Liz Canada (00:34):
Well, look, I'm happy to do a 10-part series
just on Medicaid.
Kristine Stoddard (00:41):
You might want another guest.
Liz Canada (00:55):
Welcome to New Hampshire Has Issues, the
podcast that dares to ask, whydoes it appear that our
lawmakers really don't likelow-income people?
Kristine, let me hear yourtagline.
Welcome to New Hampshire HasIssues.
Kristine Stoddard (01:12):
The podcast that dares to ask why everyone
in New Hampshire should carewhether or not their friends and
neighbors have healthinsurance.
Liz Canada (01:21):
I cannot wait to get into this because I, I'm just
going to be honest that I don'tknow why it's controversial that
we should want everybody onhealth insurance.
It feels like, I mean, Welcometo New Hampshire has issues.
The podcast that dares to askwhy would we want people to go
bankrupt from needing to go tothe doctor?
Why is that the position somepeople are taking?
(01:42):
It makes no sense to me.
Kristine Stoddard (01:45):
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?
Liz Canada (01:56):
I mean, your eight-year-old sounds like they
got it.
Like, that's correct.
Why should you be paying to goto the doctor when you should
just be able to go to thedoctor?
Period.
Kristine Stoddard (02:05):
But America has this thing called health
insurance.
Yeah.
that you can have commercialhealth insurance.
Liz Canada (02:11):
Should I cheer?
USA, USA.
Is this the time where I dothis?
Is that the time to chant?
No.
Am I doing it
Kristine Stoddard (02:17):
right?
Definitely not on
Liz Canada (02:20):
this one.
Okay.
All right.
Not this one.
I am your host, Liz Canada.
And joining me today isKristine Stoddard, who is a
healthcare policy ultra nerd.
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.
(02:42):
But out in the news, especiallyright now with, you know, I had
Phil Sletton on a few episodesago talking about the budget.
He alluded to changes toMedicaid.
You know, the budget that waspassed by the Trump
administration, like that hassome impacts on Medicaid.
But I got to be honest withyou.
What the heck is Medicaid?
(03:02):
So that is why, Kristine, 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 how I'msupposed to feel about it.
And I'm hoping you can helpfolks understand.
understand what it actually is,and whether or not we need it.
Do we need Medicaid?
Kristine Stoddard (03:22):
We do.
Okay, episode over.
Liz Canada (03:25):
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?
Kristine Stoddard (03:35):
Medicaid is just health insurance.
That's all it is.
It's health insurance.
(04:02):
healthcare and particularlylow-income children.
elderly people who live innursing homes, adults,
low-income adults, and people inNew Hampshire with complicated
medical needs.
They're not the boogeyman.
Those people all sound great.
(04:22):
Exactly.
You want to help them.
You want to help them behealthy.
They're our friends.
They're our neighbors.
They're our constituents ifwe're elected officials.
These are the people that youinteract with when you go get
coffee in downtown Concord.
These are the people thatanswer your questions when you
(04:43):
go to the library.
They're the people that handyou your coffee through a
drive-thru window.
These are people.
They are Granite Staters, andthey deserve our support and our
respect, not our animosity.
Liz Canada (05:00):
Some folks have health insurance through their
jobs.
Yes.
I am married.
Bragging.
So I'm married.
My wife, she has the...
Yes.
Yes.
health insurance?
Kristine Stoddard (05:22):
Yes, there are a lot of industries in New
Hampshire that do not offerhealth 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,
(05:43):
he 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 willshare with you.
My husband has an autoimmunedisease.
Not through anything that he didwrong.
He was born with an autoimmunedisease that can be hereditary.
(06:05):
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 anautoimmune disease, he has to
take biologics.
Biologics are very important.
Oh, yeah.
So we got married, didn't tellanyone so that he could get on
(06:27):
my health insurance.
And that's a reality thatpeople face.
And no, it was not fraud.
We're still married.
We have two kids.
I pay for his car, you know,whatever.
Liz Canada (06:39):
Let's get into the details of your marriage,
Kristine.
Tell me more about it.
What's happening?
Who's paying which bills and soforth?
This is what New Hampshireneeds to know.
We need to know everyone's...
Actually, that is whatlawmakers are trying to do is
get into all of the details ofeveryone's personal lives but we
will set that one right aside
Kristine Stoddard (06:59):
so he could not work without health
insurance his he has psoriaticarthritis and which affects your
joints and if you're acarpenter who's on a roof oh
yeah you need your joints towork properly so that you don't
drop an impact gun or somethinglike that or a nail gun and I
(07:19):
don't know the names of tools.
Liz Canada (07:22):
Let's get into the details of tools now.
We got into the marriage andnow we're getting into the
tools.
Kristine Stoddard (07:27):
He literally could not work without this
medicine because his knuckleswere swelling.
His joints in his feet wereswelling.
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 becausehe did not have access to a
(07:48):
biologic But we got marriedmonths before our actual
ceremony so that he could accesshealth insurance, access
biologics, and continue to work.
Otherwise, he would have beenunemployed.
Liz Canada (08:02):
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 whohas a job with health insurance
and so what are their choices
Kristine Stoddard (08:22):
so if they can afford it if they're lucky
enough to afford it they can goon the marketplace and buy their
health insurance
Liz Canada (08:30):
not the facebook marketplace there's
Kristine Stoddard (08:32):
no health insurance on the you could try
Liz Canada (08:35):
you know what i haven't checked actually i don't
know so what is thismarketplace
Kristine Stoddard (08:40):
so the affordable care act created like
a one-stop shop for healthinsurance and And on that health
insurance website, you can goand choose what you need out of
health insurance, how much youwant to pay.
And if you have certainincomes, then you get different
benefits.
So you might get subsidizedhealth insurance or premium
(09:04):
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.
Minimum wage in the state ofNew Hampshire is below the
federal poverty level.
So you would qualify for whatis called Medicaid.
(09:28):
And if you are my age, say 40,almost 46, you would qualify for
Medicaid expansion, also knownas granted advantage.
New Hampshire, our minimum wageis $7.25.
We are one of the few states,right?
$7.25.
A $5
Liz Canada (09:49):
bill, two $1 bills, and a quarter.
Yes.
That is how much money we'retalking about for the minimum
wage in New Hampshire.
Kristine Stoddard (10:01):
So policymakers have said that it
is okay to pay Granite Staters$7.25.
sense, regardless of your age,regardless of your work
experience, it is acceptable topay someone that little.
And because of that, people cango without health insurance
(10:21):
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 theycould say, we'll insure you for
these services, but not thisservice because you have a
(10:41):
pre-existing condition like sayyou have eczema or something
random we'll do all of yourother dermatology 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 and saysinsurance carriers you can't
(11:03):
kick people off anymore becauseyou 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
(11:26):
Medicaid.
Again, it's just healthinsurance.
Liz Canada (11:29):
It's another type of health insurance.
Kristine Stoddard (11:32):
Yes.
So they could access Medicaidand most of their expenses would
be paid for Mm-hmm.
who can otherwise not affordit.
(12:11):
All Medicaid is is healthinsurance.
It's not a horrible thing.
It's not a horrible thing to beon Medicaid.
Medicaid covers kids.
It covers elderly people livingin nursing homes.
It covers adults.
And it's essentially for
Liz Canada (12:28):
folks who, as you said earlier, cannot afford any
other health insurance option,like does not have anything else
available to be able to havehealth insurance.
insurance coverage.
Kristine Stoddard (12:42):
Right.
You cannot afford, based onyour income levels, to buy
health insurance or pay forthose health care services.
So
Liz Canada (12:51):
when I hear, I'm not going to name names despite how
badly I would like to namenames, but there are some
lawmakers who seem not superinto Medicaid.
What do they want people to doinstead?
Kristine Stoddard (13:07):
They want them to work for it and to prove
that there working for it andin fact most people on medicaid
are working
Liz Canada (13:15):
yeah again let's just say seven dollars and 25
cents an hour
Kristine Stoddard (13:20):
working full-time yeah you still do not
make enough money to pay foryour health insurance so combine
that with having kids a singledad with two kids one kid you're
making minimum wage or sixteendollars an hour at home depot
you can't afford your healthinsurance and So in that
(13:42):
example, now, thank you toMedicaid expansion, the dad can
access health insurance through,if he can't get it through his
employer, he can access itthrough Medicaid, through what
we call the granted advantage,and that his children can access
Medicaid also because of hislow income.
(14:03):
Pre-Medicaid expansion in NewHampshire, he would have gone
without health insurance.
The kids would have been ableto get 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,
(14:25):
could not access healthinsurance.
And policymakers at the time,it took many, many tries for us
to get Medicaid expansion passedin New Hampshire.
You would think it would justbe a slam dunk.
Here's a problem.
Here's a solution.
And by the way, the feds aregoing to cover 90% of the cost,
you'd think it would just be aslam dunk.
(14:45):
But no, we had to argue aboutit like four times.
Liz Canada (14:49):
Okay, that's wild that it was even a debate.
Kristine Stoddard (14:52):
Multiple times.
Liz Canada (14:52):
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 because knowing thatit would cost a lot of money.
Kristine Stoddard (15:10):
So, I'm not a doctor, but say he gets sinus
infection or a respiratoryvirus, and he can't afford to
take time off because he makes$7.25 that he needs to pay for
his kids' food.
Liz Canada (15:24):
Yep.
Kristine Stoddard (15:25):
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 atraditional primary care doctor
because he can't afford thebill.
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 pneumoniaand it's so bad he can't
(15:46):
breathe.
So then he goes to theemergency room because at this
point it's serious and he'sunable to work.
The hospitals have to see him.
Yeah.
Yeah.
And seeing a primary careprovider is a hell of a lot
(16:20):
cheaper than going to anemergency room.
Liz Canada (16:23):
Yeah, absolutely.
Kristine Stoddard (16:24):
Even the copay for someone who has
insurance.
It's so expensive to go to anemergency room.
The minute you walk in thedoor, you're spending hundreds
of dollars regardless.
Why wouldn't we want to givethe dad, other Granite Staters,
the option to have healthinsurance, to stay healthy, to
be able to work, to be able tosupport the economy by working,
(16:45):
to be able to keep his employeron task on target why wouldn't
we want these things not only isit the right thing to do like
we want people to be healthybecause that's important that's
being kind that's being a goodhuman guess what it also saves
us all money
Liz Canada (17:04):
okay now you're talking the language of people
who like want to I don't knowtake things away hold them for
themselves whatever it might be
Kristine Stoddard (17:15):
this is saying the quiet part out loud I
Oh,
Liz Canada (17:18):
great.
It's a podcast, so we can turnthe volume up.
Yes, let's do it.
Kristine Stoddard (17:22):
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.
Liz Canada (17:32):
Yes.
Wait a minute.
You're telling me that ifpeople have coverage under
Medicaid, that saves me, LizCanada, who has insurance in
another form, that saves me andpeople like me money?
Kristine Stoddard (17:47):
Yes.
How?
Because the more people who areinsured in a market.
So in New Hampshire, our marketis just the state.
That's how health insuranceworks.
It's not a national market.
It's a state market.
So the more people who havehealth insurance, the more
adequate reimbursement is givento health care organizations,
(18:10):
the more the risk of an insurerhaving to pay an astronomical
amount of money out is spreadamong Thanks for having me.
(18:38):
If you have a heart attack, Godforbid, Liz.
Liz Canada (18:44):
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 very closely.
Yes, go on.
Kristine Stoddard (18:53):
If you have a heart attack, you have health
insurance through your wife.
Liz Canada (18:58):
Yes.
Kristine Stoddard (18:58):
Her employer-sponsored health
insurance covers you and yourkids.
Yes.
So if you go to the emergencyroom, and granted advantage, our
Medicaid expansion program isintact.
People who are eligible toaccess it can access it
everything's working as itshould the wait times will be
shorter because people won't begoing to the emergency rooms who
(19:21):
don't have emergencies so yourheart attack is treated earlier
which means the insurancecompany reimburses the hospital
for a less catastrophic event
Liz Canada (19:34):
okay
Kristine Stoddard (19:35):
because your heart attack could cause all
sorts of other things
Liz Canada (19:38):
I love that you're calling it my heart attack.
It's not just anyone's heartattack.
It's my heart attack.
I love it. Kristine, you'regoing to feel so badly if I have
a heart attack sometime betweennow and when-
Kristine Stoddard (19:49):
I am, actually.
I shouldn't say that.
Liz Canada (19:52):
I'm gonna laugh I may I need to make sure this
episode is published beforeit happens
I would feel so awful
But in this in this scenario Liz's heart attack is
trying to go to the ER and thatdad who didn't have insurance
who wasn't able to see someonefor a sinus infection who had to
wait to go get care who then isgetting sicker and sicker over
(20:15):
the course of time because it isuntreated then has the only
option essentially to go to theemergency room And now you've
got heart attack Liz and thisdad going for the same spot when
dad could have been treatedmonths ago.
Kristine Stoddard (20:28):
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 anemergency room in a town like
Berlin and Franklin that have ahigh number of Medicaid
enrollees.
Now, those Medicaid enrolleeslose their insurance.
(20:48):
So instead of having access toa primary care care provider,
Franklin residents or Berlinresidents are forced to go to
the emergency room to accesscare because they can't afford
it otherwise.
So the people that have heartattacks or diverticulitis or
appendicitis or gallbladderissues, a gallbladder attack,
(21:09):
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 costs,
right?
(21:29):
They have to cover their costof reimbursing all of these
health care 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 and employer
(21:51):
sponsored insurance.
Liz Canada (21:54):
So why is there an argument about the costs of
Kristine Stoddard (22:00):
Medicaid?
Medicaid insurance, by changingthe eligibility for Medicaid
(22:27):
insurance, you're pushing peopleoff of their health insurance.
So the state looks like it'ssaving money, right?
In those budget sheets thatPhil talked about, it looks like
the state is saving money.
But guess who's paying for it?
Everyone else.
You're paying for it.
My heart attack is paying forit.
Yeah, exactly.
Your heart's paying for it.
(22:48):
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 isthe costs get pushed down onto
other health insuranceconsumers.
It also gets pushed down ontoproperty taxpayers, everyone
(23:09):
else in New Hampshire, becausetowns in New Hampshire have
welfare offices.
When someone loses their healthinsurance, they can access
help, hopefully, if everything'sokay, I guess, they can access
help through the townwelfar office.
Liz Canada (23:24):
Right.
Kristine Stoddard (23:26):
So who pays for the town welfare
office, Liz?
Liz Canada (23:54):
The town. a lot in the last few years serving in
that subcommittee about thetypes of calls that they get and
the types of support that ourtown is thankfully able to
provide people who need
Kristine Stoddard (24:06):
Yes.
Liz Canada (24:06):
But it is not an unlimited amount of money in a
town to be able to do this.
That's pushed all these costsall the way down to just our
community, just our town aswell.
Kristine Stoddard (24:17):
But guess who people blame when their
property taxes go up?
They blame town officialsbecause that's all they see.
They see their property billand they think, why are my
property taxes going up?
Well, it's because policymakersat the state level are making
policy choices that cost youmoney and you're going to pay
(24:39):
for it through your propertytaxes and with your health.
And
Liz Canada (24:44):
the issue as well is that when they make these
decisions, they don't follow therule of math class.
They don't show their work tosay, they don't use their
calculator, but they don't showtheir work and say, okay, so
we're going to make this change.
And because we've made thischange at the state level, the
towns are going to have to paybecause we've done that.
(25:08):
They don't show that work, butthat's what's happening
regardless.
Kristine Stoddard (25:35):
I'm trying to think
Liz Canada (25:51):
of an analogy.
I love analogies.
But it would kind of be like inour household, you know, if
you've got Molly and me.
Then you got the two boys.
And if we make the analogy oflike we're the state and the
boys are the local level, it'slike saying like, well, we
balance the budget.
We didn't need to spend anymoney on school lunches this
year.
Great news for us, huh?
And then the boys are like,wait, no, we still have to have
(26:13):
school lunch.
It's like, well, it's not inthe budget.
Yeah.
And then they're just gonnahave to figure it out on their
own.
Like there's still that needsto happen, even if we're just
like, no, cut that line and I'msaved.
Saved our expenses.
pretty great
Kristine Stoddard (26:26):
good for us kids in New Hampshire aren't
hungry they don't need to eatthey just want more things they
always want things
Liz Canada (26:32):
they always want money, K ristine I literally
dropped the boys off at theirfriend's house and I fed them
so many things so I'm like donot walk into their house and
say what's for dinner as soon asyou walk in because one that is
rude they're just hungry allthe time yeah and my younger one
was like this you know I'mgonna do it anyway I'm like I
know you are but please don'tjust walk into someone's house
and be like is there any foodhere.
In this little silly analogy,if Molly and I are like, no, we
(26:55):
did our budget and schoollunches didn't make the cut, the
boys are still going to need toeat.
Are they just going to have toscrounge for food?
What are they going to have todo?
Similarly to the state.
The state can say, actually, wecut that line at them.
But the local level has to pickup the tab.
Kristine Stoddard (27:11):
They have to figure it out.
Liz Canada (27:12):
Yeah.
Kristine Stoddard (27:13):
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 timeof year and they are what they
(27:34):
are.
So if the policymakers inConcord or D.C.
change Medicaid eligibilitytoday, there's nothing your town
can do about it.
But if today we changedeligibility 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
(27:55):
town welfare office more peopleend up coming to the town
welfare office the town welfareoffice has a discrete amount of
money they can only pay for somuch food for people you can't
just go raise taxes willy-nillyand decide to Bye.
Bye.
Bye.
and has just gobs of money, itdoesn't make any sense to me or
(28:26):
my moral compass to not wantpeople to have health insurance
because it's better foreveryone.
Liz Canada (28:33):
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.
(28:54):
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
(29:18):
property taxes.
It does.
Kristine Stoddard (29:19):
Right.
Towns and cities can only raiserevenue from a very limited
number of sources, especially inNew 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.
The state has more options andmore choices.
Liz Canada (29:39):
Kristine, I learned a lot from Phil.
Kristine Stoddard (29:42):
Don't you always?
Liz Canada (29:43):
I always do.
But that interest and dividendstax moment, I'm still thinking
about it.
I am still thinking about Yes.
It's wild.
Kristine Stoddard (30:03):
Policymakers chose to reduce the revenue
coming into the state of NewHampshire by eliminating the
interest and dividends tax,which, like you said, the bulk
of it was paid for by very, verywealthy people.
People who are not justsurviving on their pension.
It's people who have millionsand millions of dollars in
(30:23):
assets.
People who earn hundreds ofthousands of dollars on their
interest and dividends.
Liz Canada (30:28):
Money that was just generating in an account that
they've essentially donenothing.
Right.
Generating
Kristine Stoddard (30:36):
passive income.
roads, like schools, likehealth care?
(31:06):
Why would you just say, oops,never mind, we don't need that
revenue?
You're creating a problem,which is exactly why we're in
the 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
(31:27):
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,
policymakers made.
Liz Canada (31:37):
A majority of policymakers made.
Not
Kristine Stoddard (31:40):
every single one who's there.
That's a very good point.
Liz Canada (31:43):
Enough.
A majority of the folks did.
Kristine Stoddard (31:46):
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.
That's just the way insuranceworks.
Liz Canada (32:07):
Let's talk about the folks who are covered by
Medicaid, because I know that alot of them are kids, are
younger people, right?
And there's also a lot of folkswho are maybe 65 and older, and
they're older folks who needhealth coverage as well.
Kristine Stoddard (32:27):
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.
Liz Canada (32:40):
And does that mean that they all are in families
that have lower incomes?
Kristine Stoddard (32:57):
thing is less expensive.
For another, it's better foreveryone.
So there are children who havespecial needs that also access
Medicaid.
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.
(33:18):
They are the highest spend inour Medicaid program because
nursing home care is expensive.
I don't know how old you Buthealth care for geriatric
patients is very, veryexpensive.
And in-home care is veryexpensive.
So if you have a child whoneeds a feeding tube or has an
(33:42):
immune disorder that doesn'tallow them to go to school, they
can access health care servicesin their home with Medicaid.
And it's literally life ordeath for some people.
Without health care services,people who are medically complex
die.
And Medicaid is their lifeline.
And that's not hyperbole.
(34:02):
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 amount ofincome.
Their parents, again, couldhave health insurance through
their employer, and they couldsave a little bit of money by
having the kids on insurancethrough Medicaid.
(34:24):
But Again, they're stillconsidered low income.
So they need access to healthinsurance that they can't
afford.
They need access to health careservices that they can't afford
without Medicaid coverage.
Liz Canada (34:39):
So what changes are expected to happen because of
the state budget or because ofthe federal budget or both?
What happened with Medicaidthis summer, essentially?
Because it all happened in Juneand July across the state and
the country.
Kristine Stoddard (34:55):
Yes.
And what happened in the stateis different than what happened
at the federal level inCongress.
So they're not in alignmentbecause those bill drafting
processes are different.
So in New Hampshire, our statebudget passed.
This is a budget year.
And in this budget, because wehad less revenue, because again,
(35:19):
legislators chose...
To reduce sources of revenue.
Liz Canada (35:24):
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.
They're like, you know what weneed is money.
And so here we are.
Kristine Stoddard (35:34):
So the legislature reduced the revenue
coming into the state over thepast six years.
And that means that when thelegislature decided to craft its
budget, they had less money towork with, which means...
they are paying for lessservices.
So the choices that they madeto the Medicaid program include
(35:55):
charging low-income parents whohave children on Medicaid
premiums so that their childrenhave health insurance.
Liz Canada (36:04):
Kristine, I love words like this because premium
is like, oh, it sounds so fancy.
What does premium actuallymean?
What does that word mean?
Yeah.
Kristine Stoddard (36:12):
So healthcare is so full of jargon.
I apologize.
Liz Canada (36:15):
No, I love it.
But what does lower incomefamilies have to pay a premium?
What does that mean?
Kristine Stoddard (36:21):
So that is the monthly amount of money that
they have to pay.
The amount of money they payeach month for their kids to be
insured.
And so...
In New Hampshire, this policychange means if you have a
family of three and you havekids on CHIP, which is kids
Medicaid, you have to earn justunder $68,000.
(36:45):
That's not a lot of money.
So that captures a lot ofgranite staters, right?
So that family of three isgoing to have to pay $230 a
month so that their child canaccess health insurance.
Hold on.
Wait.
Liz Canada (37:01):
I'm going to get my calculator, a.k.a.
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 going to do,
$7.25.
So they would need to work 31hours to pay that premium on a
(37:21):
$7.25 an hour job.
Kristine Stoddard (37:24):
And that doesn't
Liz Canada (37:26):
include...
Kristine Stoddard (37:27):
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.
Liz Canada (37:35):
For a cool 31 hours of work...
And just that you can pay forthe health insurance you already
have.
Yes.
True?
Kristine Stoddard (37:45):
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 islike $1,300.
You have to pay $1,300 and youhave to pay your health
(38:09):
insurance And if you do acomparison, I mean, it truly
depends on your employer andwhat kind of plan they offer.
But families in somecircumstances who have
employer-sponsored insurancewould be paying less than this
parent trying to provideMedicaid coverage.
And I make quite a bit morethan $7.25 an hour.
(38:34):
That's less of a burden on methan someone who makes minimum.
wage right
Liz Canada (38:40):
i believe there was a debate in the room where it
happened...
Hamilton, but in a bad way,where they talked about how they
they wanted to do the premiumthe way that it passed x they
didn't want it to be called anincome tax they're like we don't
want it to be called an incometax so we're gonna do this other
thing instead it's like no it'sstill you're it's still a fee a
(39:01):
premium on the income that yesyou can call it a banana but
it's still the same thing at theend of the day
Kristine Stoddard (39:09):
What is that phrase if it walks like a duck?
Liz Canada (39:12):
Yeah, and talks like a duck.
It's an income tax is what itis.
I don't know.
Kristine Stoddard (39:17):
Or a fee.
I know.
Liz Canada (39:21):
What's the difference between a tax, a fee,
a premium tax?
Semantics.
So $230 a month for a family ofthree making around like
$65,000 a year.
Yeah.
Kristine Stoddard (39:34):
So that's one of the great policy changes
that was put in place in thisbudget.
The other one was...
Liz Canada (39:41):
And this was at the state level, the state
lawmakers.
Kristine Stoddard (39:43):
Yes, this was at the state level.
Yeah.
So in addition to that, peoplewho are on Medicaid expansion or
what is called grantedadvantage
Liz Canada (39:52):
have to.
Why do we have all these secretcode names?
I have no idea.
Why are we calling it these?
It's like, it's not Medicaid.
It's granted advantage.
Wink.
It's not Medicaid.
It's chip.
Wink.
It's not an income tax.
It's a premium.
Wink.
Like, that's how I feel thatwe're.
Why are we doing this?
It's
Kristine Stoddard (40:09):
not Medicaid.
It's Katie Beckett.
It's Katie.
What?
What is Katie?
Katie Beckett is a Medicaid.
program in the state of NewHampshire.
Because that's a person's name.
Right.
It's also a Medicaid program.
Liz Canada (40:21):
It's like Jeremy Bearamy in The Good Place.
Like it's a concept of time.
It's Jeremy Bearamy.
Kristine Stoddard (40:27):
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.
Liz Canada (40:46):
A and B?
Kristine Stoddard (40:48):
A and B.
A-N-B.
N as in Nancy.
Aid to the needy blind.
Liz Canada (40:54):
Okay, yep.
Kristine Stoddard (40:55):
A-P-T-D.
Aid to the permanentlydisabled.
Medicaid for employed adultswith disabilities.
Medicaid for employed olderadults with disabilities.
In-and-out Medicaid.
Home and community-basedwaivers.
So here's a...
a category that also has fournames that are included.
In-home supports, DD, alsoknown as developmental
(41:19):
disabilities, acquired braindisorders, choices for
independence.
Liz Canada (41:23):
Are these all names of programs that's actually just
Medicaid?
Kristine Stoddard (41:27):
Yes.
They're all Medicaid.
Liz Canada (41:30):
That is so...
Interesting.
Kristine Stoddard (41:33):
It is, but you know what happens?
Normal people who don't live inour policy world, who go about
their days without thinking.
Who are those people?
And rightfully so, right?
Like, who would say KatieBeckett and think Medicaid?
It's just a
Liz Canada (41:54):
I remember seeing polling that shows that people
support the concepts ofMedicaid, support things like
CHIP, right?
Like, they support thosethings.
And then if you say, what doyou think about Medicaid?
They're like, oh, I don't likethat.
It's like, no, you just saidyou liked it, but
Kristine Stoddard (42:08):
a
Liz Canada (42:08):
different name
Kristine Stoddard (42:09):
of it.
It's because we've created thismonster.
A stigma, yeah.
We've created a stigma wherethere shouldn't be one.
Liz Canada (42:17):
Ugh.
It's just health insurance,folks.
Kristine Stoddard (42:20):
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.
Which is a good
Liz Canada (42:39):
thing because I'm going to have a heart attack.
But yes, right.
Tomorrow.
It's going to be the ultimate.
hilarious 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.
No.
Kristine Stoddard (42:59):
But now we're making people who have very,
very little income pay for whatthey get.
We're making another policychoice.
We're making them demonstratethat they've worked for 100
hours a month or else we'regoing to take their health
insurance away.
Liz Canada (43:14):
Okay.
Tell me about that.
This is a new requirement?
Work requirements?
Kristine Stoddard (43:18):
Yes.
Yes.
So Medicaid was created toprovide better access to health
care services.
It is, for the millionth time,just 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
(43:40):
New Hampshire to Yes.
Liz Canada (43:42):
How does one prove that they working?
Do they have to take a video ofthemselves?
Do they have to go to theDepartment of Health and Human
(44:03):
Services and fill out like what?
Kristine Stoddard (44:05):
I don't know.
So imagine all of the paperworkthat has to be done and all of
the steps that have to be takenfor a human to verify that
they're employed.
They have to get something fromtheir employer.
They have to find paperworkthat demonstrates they're
employed.
They have to drive to the DHHSdistrict office or mail it or
(44:27):
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 have substance use disorder.
The state can't just go look atall of the claims for your
(44:48):
substance disorder treatment intheir system because our system
doesn't work that way.
So they have to take thisperson battling substance use
disorder with all of these otherthings going on, has to make an
appointment with their healthcare provider that's weeks out,
has to get the health careprovider to sign a form.
The health care provider has tomake a determination.
(45:10):
The other phrase that we usedwas medically frail.
That's not a medical term.
So we have to, as a health careprovider, decide whether or not
our patient is medically frail.
Liz Canada (45:20):
Medically frail?
Kristine Stoddard (45:22):
Yeah, I don't even know what that means.
Like
Liz Canada (45:23):
Tiny Tim from A Christmas Carol?
Kristine Stoddard (45:26):
I don't know.
Liz Canada (45:27):
I meant to read a passage from A Christmas Carol.
Because this is...
All of the debates againstMedicaid and against...
supporting folks with lowerincomes is just the opening
scenes of a Christmas carol ofEbenezer Scrooge being like then
let them die like you
Kristine Stoddard (45:44):
You really do like analogies that's another
good one
Liz Canada (45:46):
I'm sorry yes it's the English teacher brain of
like trying to find them butthat's how it feels he's like
yes aren't there poor housesaren't there places workplaces
to go
Kristine Stoddard (45:57):
how this feels right so we're creating
more barriers for people who areeligible for Medicaid we're
creating more barriers for themto access health insurance that
they are legally eligible toaccess to save money.
New Hampshire has tried a workrequirement before and it didn't
work.
We had to stop it because itwas costing the state so much
(46:22):
money and we weren't able tocontact enough people who would
be subject to the workrequirement to get them to
comply with the workrequirement.
So we paused it.
It stopped.
It's actually current law, andit's not in effect because it
doesn't work.
Liz Canada (46:39):
The work requirement doesn't work, but they put it
back in this time.
Kristine Stoddard (46:43):
Yes.
Liz Canada (46:45):
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 weare again.
Kristine Stoddard (46:50):
Right.
It's like that Taylor Swiftsong.
Liz Canada (46:54):
Oh, which
Kristine Stoddard (46:54):
one?
I've seen this film before, TheExile.
I love that song.
It doesn't work, New Hampshire.
You're going to waste money.
We shouldn't be doing it.
Liz Canada (47:04):
We shouldn't be doing it.
And people will lose theirhealth care if they don't do it?
Kristine Stoddard (47:08):
They will.
Liz Canada (47:09):
How soon after?
If they don't prove that theyhave worked for 100 hours, what
happens?
Kristine Stoddard (47:14):
We don't know yet what It's going to look
like because now federal lawsays states, if you want
Medicaid dollars, you have tohave a work requirement.
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
(47:37):
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.
Liz Canada (47:49):
Holding health insurance hostage.
Yes.
Fantastic.
Really glad that's what we'respending our time on.
Such
Kristine Stoddard (47:56):
a good use of money.
Liz Canada (47:57):
Such a good use of money and time and resources.
Kristine Stoddard (48:01):
Such a good use of our very limited revenue
because people chose toeliminate gigantic sources of
revenue.
Liz Canada (48:08):
Well, well, well.
To save money really means thatyou're betting on people not
doing it.
and therefore losing theirhealth insurance.
You're making a bet againstpeople.
Kristine Stoddard (48:20):
We are betting that Granite Staters
don't want to work.
We are choosing to see theworst in our friends and
neighbors.
We're choosing to see people asanything but human beings.
And at the end of the day...
It actually doesn't save anyonemoney.
(48:41):
It doesn't save the statemoney.
It doesn't save you money as ahealthcare consumer.
It doesn't save the healthcareprovider money.
It actually costs a ton ofmoney for the state of New
Hampshire to implement a workrequirement, like millions and
millions of dollars.
So we're actually spendingmoney to do something that that
(49:03):
doesn't help anyone, thatdoesn't save any money, for
what?
To prove a point?
Liz Canada (49:09):
I don't know.
I mean, I joke and not jokeabout Ebenezer Scrooge, but are
they just hoping those peoplewill die and not have to cover
them?
What are
Kristine Stoddard (49:20):
they trying to do?
I would love to believe...
that they think they're tryingto help people who are
unemployed access work.
But we know that's not thecase.
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
(49:43):
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.
(50:05):
So why are we going throughthese extra steps just to prove
a point?
In the first year ofimplementing a work requirement,
it is going to cost the stateSo just the state, not health
care providers, which we shouldalso talk about because the
burden is going to be borne bythem as well.
It's going to cost the statealone almost $4 million in the
(50:30):
first year, almost $3.8 millionin the second year, $3.8 million
in the third year.
So we are wasting money toprove a point that research
already shows is not real.
Liz Canada (50:44):
Right.
We're spending money to justifycutting money?
Kristine Stoddard (50:50):
So how can anyone assume that this is done
to benefit people, people whoaren't working to get them
working, when the only savingsis generated by them losing
their health insurance?
Yeah.
Hopefully my kids don't listento this because this is me
assuming the worst, but I don'tsee any other way the math works
(51:10):
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.
Let's be exceedingly
Liz Canada (51:22):
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, get thethings that they need to get
healthy.
In whatever healthy way needsto happen.
(51:43):
And that should be the extentof their participation in this
conversation.
They should just be able to getthe health care that they need.
Yes.
You shouldn't have to earn it.
Prove it.
Prove you need that healthcare.
Kristine Stoddard (51:57):
Prove you have skin in the game.
Prove you're worthy of aninsurance card to put in your
pocket.
Liz Canada (52:03):
Right.
And the providers who areproviding this health care need
to have the revenue coming in.
to be able to provide thathealth care for these people who
need it.
Kristine Stoddard (52:13):
Right.
Because guess what, Liz?
Your high cholesterol stillneeds to be treated.
Shout out.
Shout out to my highcholesterol.
Your high cholesterol stillneeds to be treated.
We are
Liz Canada (52:24):
getting into why the heart attack is happening.
Kristine Stoddard (52:29):
Can you tell I just had my blood tested?
Liz Canada (52:32):
That's good.
You should be able to get thehealth care that you need and
the blood tests that you
Kristine Stoddard (52:37):
need when
Liz Canada (52:37):
you
Kristine Stoddard (52:38):
need them.
Right.
And I have health insurance, soI can access those services and
not be out $800 that blood workcosts.
So then when the providers loserevenue because their patients
lose insurance, they have to letpeople go, which means they're
(52:59):
fired.
Liz Canada (52:59):
Fewer providers.
Kristine Stoddard (53:00):
Which means they have fewer providers, which
means that provider just losttheir job, lost their health
insurance, lost their income.
that supports their family, andyou have to wait longer to get
your cholesterol levels checkedbecause they have fewer
providers.
Because policymakers chose toimplement policies that are
(53:23):
guaranteed to kick people off ofMedicaid.
So everyone, Liz, should careif Granite Staters retain their
Medicaid because it willinevitably impact every single
person in our state.
And that doesn't even get intowhat's happening at the federal
level because that's fun.
Liz Canada (53:45):
You have an interesting definition of the
word fun is what I'm hearing.
Let's hold on the federalpiece.
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.
(54:05):
And so they're prettyfrustrated to find out that our
lawmakers and our policymakersin New Hampshire have made the
conscious decisions tonegatively impact people who are
covered by Medicaid or whocould be and so forth.
What should they do, Kristine?
What does one do with all therage?
Kristine Stoddard (54:26):
Scream very, very loud into the void.
Liz Canada (54:29):
Yes.
Scream into the void.
Check.
I do that every day.
It's a good part of my morningroutine.
Kristine Stoddard (54:34):
Mountain bike before work.
That helps me relax.
Liz Canada (54:38):
Yeah.
I CrossFit.
It's one hour of my day that Iknow I cannot think about work
because I am too busy doing toomany wall balls.
Kristine Stoddard (54:46):
Right.
No time.
If I think about work, I crash.
And I get bruises.
Liz Canada (54:51):
You mountain bike.
I do mountain bike.
I crossfit.
So scream into the void.
Do something to maybe avoid
Kristine Stoddard (54:58):
anxiety attacks.
Yes.
Panic attacks.
Yep.
So you got to do that.
And then talking to yourfriends and neighbors, because I
bet you, Liz, you throw a rockor maybe...
I don't know, a tennis ball isa better choice.
No, rocks are great.
You throw a tennis ball fromyour front door and you hit
someone, they probably haveMedicaid.
(55:20):
Because guess what?
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 everyindividual.
Vote.
Vote.
Ugh.
(55:48):
that say health insurance ratesare going to go up.
(56:20):
Not just because of whathappened at the federal level,
it's also these choices that ourstate policymakers have made to
reduce state revenue and topush the burden and the cost
down onto
Liz Canada (56:31):
residents.
lunges like we've been doing atthe gym.
I do know what that is.
You're going to vote, ofcourse, but also you're going to
(56:53):
contact your lawmakers.
You don't have to wait untilelection day.
You can talk to them now.
Kristine Stoddard (56:57):
Right.
And it's actually better totalk to them now because they're
less busy, because they're notin the legislative session.
And they're also drafting billsright now.
So if there's something theycan do to help you or mitigate
the consequences that are goingto come because of this
legislation, they can do it now.
Liz Canada (57:16):
Kristine, thank you so much.
Thank you so much for yourtime.
Thank you for coming on hereand talking to me about
Medicaid, which is healthinsurance.
Kristine Stoddard (57:23):
That's all it is.
That's all it is.
Liz Canada (57:26):
Medicaid, not scary.
Not a scary thing.
Just health insurance.
It's great.
I literally have a post-it notehere on my desk that says,
would you rather do this or 90wall balls?
(57:46):
That is the question that Ihave here.
What is a wall ball?
You take a weighted ball andyou squat 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.
Kristine Stoddard (57:59):
What happens if it hits you on the head?
Like, is that a possibility?
No, you got to catch it.
Liz Canada (58:03):
You'll catch it.
You don't want to get hit.
Kristine Stoddard (58:05):
I wear bifocals, Liz.
You're asking a lot.
I'm going to be honest with you, K ristine.
I don't know a lot aboutMedicaid.
I know it, but I don't know it.
Kristine Stoddard (00:06):
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.
Liz Canada (00:17):
Yeah.
It's like a spider web.
Kristine Stoddard (00:19):
It is a spider web.
A boring policy.
And it's hard to speak ingeneralities without...
missing some piece ofinformation.
But unless you want like 10hours of podcast, that's what
we're going to have to do.
Liz Canada (00:34):
Well, look, I'm happy to do a 10-part series
just on Medicaid.
Kristine Stoddard (00:41):
You might want another guest.
Liz Canada (00:55):
Welcome to New Hampshire Has Issues, the
podcast that dares to ask, whydoes it appear that our
lawmakers really don't likelow-income people?
Kristine, let me hear yourtagline.
Welcome to New Hampshire HasIssues.
Kristine Stoddard (01:12):
The podcast that dares to ask why everyone
in New Hampshire should carewhether or not their friends and
neighbors have healthinsurance.
Liz Canada (01:21):
I cannot wait to get into this because I, I'm just
going to be honest that I don'tknow why it's controversial that
we should want everybody onhealth insurance.
It feels like, I mean, Welcometo New Hampshire has issues.
The podcast that dares to askwhy would we want people to go
bankrupt from needing to go tothe doctor?
Why is that the position somepeople are taking?
(01:42):
It makes no sense to me.
Kristine Stoddard (01:45):
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?
Liz Canada (01:56):
I mean, your eight-year-old sounds like they
got it.
Like, that's correct.
Why should you be paying to goto the doctor when you should
just be able to go to thedoctor?
Period.
Kristine Stoddard (02:05):
But America has this thing called health
insurance.
Yeah.
that you can have commercialhealth insurance.
Liz Canada (02:11):
Should I cheer?
USA, USA.
Is this the time where I dothis?
Is that the time to chant?
No.
Am I doing it
Kristine Stoddard (02:17):
right?
Definitely not on
Liz Canada (02:20):
this one.
Okay.
All right.
Not this one.
I am your host, Liz Canada.
And joining me today isKristine Stoddard, who is a
healthcare policy ultra nerd.
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.
(02:42):
But out in the news, especiallyright now with, you know, I had
Phil Sletton on a few episodesago talking about the budget.
He alluded to changes toMedicaid.
You know, the budget that waspassed by the Trump
administration, like that hassome impacts on Medicaid.
But I got to be honest withyou.
What the heck is Medicaid?
(03:02):
So that is why, Kristine, 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 how I'msupposed to feel about it.
And I'm hoping you can helpfolks understand.
understand what it actually is,and whether or not we need it.
Do we need Medicaid?
Kristine Stoddard (03:22):
We do.
Okay, episode over.
Liz Canada (03:25):
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?
Kristine Stoddard (03:35):
Medicaid is just health insurance.
That's all it is.
It's health insurance.
(04:02):
healthcare and particularlylow-income children.
elderly people who live innursing homes, adults,
low-income adults, and people inNew Hampshire with complicated
medical needs.
They're not the boogeyman.
Those people all sound great.
(04:22):
Exactly.
You want to help them.
You want to help them behealthy.
They're our friends.
They're our neighbors.
They're our constituents ifwe're elected officials.
These are the people that youinteract with when you go get
coffee in downtown Concord.
These are the people thatanswer your questions when you
(04:43):
go to the library.
They're the people that handyou your coffee through a
drive-thru window.
These are people.
They are Granite Staters, andthey deserve our support and our
respect, not our animosity.
Liz Canada (05:00):
Some folks have health insurance through their
jobs.
Yes.
I am married.
Bragging.
So I'm married.
My wife, she has the...
Yes.
Yes.
health insurance?
Kristine Stoddard (05:22):
Yes, there are a lot of industries in New
Hampshire that do not offerhealth 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,
(05:43):
he 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 willshare with you.
My husband has an autoimmunedisease.
Not through anything that he didwrong.
He was born with an autoimmunedisease that can be hereditary.
(06:05):
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 anautoimmune disease, he has to
take biologics.
Biologics are very important.
Oh, yeah.
So we got married, didn't tellanyone so that he could get on
(06:27):
my health insurance.
And that's a reality thatpeople face.
And no, it was not fraud.
We're still married.
We have two kids.
I pay for his car, you know,whatever.
Liz Canada (06:39):
Let's get into the details of your marriage,
Kristine.
Tell me more about it.
What's happening?
Who's paying which bills and soforth?
This is what New Hampshireneeds to know.
We need to know everyone's...
Actually, that is whatlawmakers are trying to do is
get into all of the details ofeveryone's personal lives but we
will set that one right aside
Kristine Stoddard (06:59):
so he could not work without health
insurance his he has psoriaticarthritis and which affects your
joints and if you're acarpenter who's on a roof oh
yeah you need your joints towork properly so that you don't
drop an impact gun or somethinglike that or a nail gun and I
(07:19):
don't know the names of tools.
Liz Canada (07:22):
Let's get into the details of tools now.
We got into the marriage andnow we're getting into the
tools.
Kristine Stoddard (07:27):
He literally could not work without this
medicine because his knuckleswere swelling.
His joints in his feet wereswelling.
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 becausehe did not have access to a
(07:48):
biologic But we got marriedmonths before our actual
ceremony so that he could accesshealth insurance, access
biologics, and continue to work.
Otherwise, he would have beenunemployed.
Liz Canada (08:02):
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 whohas a job with health insurance
and so what are their choices
Kristine Stoddard (08:22):
so if they can afford it if they're lucky
enough to afford it they can goon the marketplace and buy their
health insurance
Liz Canada (08:30):
not the facebook marketplace there's
Kristine Stoddard (08:32):
no health insurance on the you could try
Liz Canada (08:35):
you know what i haven't checked actually i don't
know so what is thismarketplace
Kristine Stoddard (08:40):
so the affordable care act created like
a one-stop shop for healthinsurance and And on that health
insurance website, you can goand choose what you need out of
health insurance, how much youwant to pay.
And if you have certainincomes, then you get different
benefits.
So you might get subsidizedhealth insurance or premium
(09:04):
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.
Minimum wage in the state ofNew Hampshire is below the
federal poverty level.
So you would qualify for whatis called Medicaid.
(09:28):
And if you are my age, say 40,almost 46, you would qualify for
Medicaid expansion, also knownas granted advantage.
New Hampshire, our minimum wageis $7.25.
We are one of the few states,right?
$7.25.
A $5
Liz Canada (09:49):
bill, two $1 bills, and a quarter.
Yes.
That is how much money we'retalking about for the minimum
wage in New Hampshire.
Kristine Stoddard (10:01):
So policymakers have said that it
is okay to pay Granite Staters$7.25.
sense, regardless of your age,regardless of your work
experience, it is acceptable topay someone that little.
And because of that, people cango without health insurance
(10:21):
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 theycould say, we'll insure you for
these services, but not thisservice because you have a
(10:41):
pre-existing condition like sayyou have eczema or something
random we'll do all of yourother dermatology 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 and saysinsurance carriers you can't
(11:03):
kick people off anymore becauseyou 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
(11:26):
Medicaid.
Again, it's just healthinsurance.
Liz Canada (11:29):
It's another type of health insurance.
Kristine Stoddard (11:32):
Yes.
So they could access Medicaidand most of their expenses would
be paid for Mm-hmm.
who can otherwise not affordit.
(12:11):
All Medicaid is is healthinsurance.
It's not a horrible thing.
It's not a horrible thing to beon Medicaid.
Medicaid covers kids.
It covers elderly people livingin nursing homes.
It covers adults.
And it's essentially for
Liz Canada (12:28):
folks who, as you said earlier, cannot afford any
other health insurance option,like does not have anything else
available to be able to havehealth insurance.
insurance coverage.
Kristine Stoddard (12:42):
Right.
You cannot afford, based onyour income levels, to buy
health insurance or pay forthose health care services.
So
Liz Canada (12:51):
when I hear, I'm not going to name names despite how
badly I would like to namenames, but there are some
lawmakers who seem not superinto Medicaid.
What do they want people to doinstead?
Kristine Stoddard (13:07):
They want them to work for it and to prove
that there working for it andin fact most people on medicaid
are working
Liz Canada (13:15):
yeah again let's just say seven dollars and 25
cents an hour
Kristine Stoddard (13:20):
working full-time yeah you still do not
make enough money to pay foryour health insurance so combine
that with having kids a singledad with two kids one kid you're
making minimum wage or sixteendollars an hour at home depot
you can't afford your healthinsurance and So in that
(13:42):
example, now, thank you toMedicaid expansion, the dad can
access health insurance through,if he can't get it through his
employer, he can access itthrough Medicaid, through what
we call the granted advantage,and that his children can access
Medicaid also because of hislow income.
(14:03):
Pre-Medicaid expansion in NewHampshire, he would have gone
without health insurance.
The kids would have been ableto get 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,
(14:25):
could not access healthinsurance.
And policymakers at the time,it took many, many tries for us
to get Medicaid expansion passedin New Hampshire.
You would think it would justbe a slam dunk.
Here's a problem.
Here's a solution.
And by the way, the feds aregoing to cover 90% of the cost,
you'd think it would just be aslam dunk.
(14:45):
But no, we had to argue aboutit like four times.
Liz Canada (14:49):
Okay, that's wild that it was even a debate.
Kristine Stoddard (14:52):
Multiple times.
Liz Canada (14:52):
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 because knowing thatit would cost a lot of money.
Kristine Stoddard (15:10):
So, I'm not a doctor, but say he gets sinus
infection or a respiratoryvirus, and he can't afford to
take time off because he makes$7.25 that he needs to pay for
his kids' food.
Liz Canada (15:24):
Yep.
Kristine Stoddard (15:25):
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 atraditional primary care doctor
because he can't afford thebill.
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 pneumoniaand it's so bad he can't
(15:46):
breathe.
So then he goes to theemergency room because at this
point it's serious and he'sunable to work.
The hospitals have to see him.
Yeah.
Yeah.
And seeing a primary careprovider is a hell of a lot
(16:20):
cheaper than going to anemergency room.
Liz Canada (16:23):
Yeah, absolutely.
Kristine Stoddard (16:24):
Even the copay for someone who has
insurance.
It's so expensive to go to anemergency room.
The minute you walk in thedoor, you're spending hundreds
of dollars regardless.
Why wouldn't we want to givethe dad, other Granite Staters,
the option to have healthinsurance, to stay healthy, to
be able to work, to be able tosupport the economy by working,
(16:45):
to be able to keep his employeron task on target why wouldn't
we want these things not only isit the right thing to do like
we want people to be healthybecause that's important that's
being kind that's being a goodhuman guess what it also saves
us all money
Liz Canada (17:04):
okay now you're talking the language of people
who like want to I don't knowtake things away hold them for
themselves whatever it might be
Kristine Stoddard (17:15):
this is saying the quiet part out loud I
Oh,
Liz Canada (17:18):
great.
It's a podcast, so we can turnthe volume up.
Yes, let's do it.
Kristine Stoddard (17:22):
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.
Liz Canada (17:32):
Yes.
Wait a minute.
You're telling me that ifpeople have coverage under
Medicaid, that saves me, LizCanada, who has insurance in
another form, that saves me andpeople like me money?
Kristine Stoddard (17:47):
Yes.
How?
Because the more people who areinsured in a market.
So in New Hampshire, our marketis just the state.
That's how health insuranceworks.
It's not a national market.
It's a state market.
So the more people who havehealth insurance, the more
adequate reimbursement is givento health care organizations,
(18:10):
the more the risk of an insurerhaving to pay an astronomical
amount of money out is spreadamong Thanks for having me.
(18:38):
If you have a heart attack, Godforbid, Liz.
Liz Canada (18:44):
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 very closely.
Yes, go on.
Kristine Stoddard (18:53):
If you have a heart attack, you have health
insurance through your wife.
Liz Canada (18:58):
Yes.
Kristine Stoddard (18:58):
Her employer-sponsored health
insurance covers you and yourkids.
Yes.
So if you go to the emergencyroom, and granted advantage, our
Medicaid expansion program isintact.
People who are eligible toaccess it can access it
everything's working as itshould the wait times will be
shorter because people won't begoing to the emergency rooms who
(19:21):
don't have emergencies so yourheart attack is treated earlier
which means the insurancecompany reimburses the hospital
for a less catastrophic event
Liz Canada (19:34):
okay
Kristine Stoddard (19:35):
because your heart attack could cause all
sorts of other things
Liz Canada (19:38):
I love that you're calling it my heart attack.
It's not just anyone's heartattack.
It's my heart attack.
I love it. Kristine, you'regoing to feel so badly if I have
a heart attack sometime betweennow and when-
Kristine Stoddard (19:49):
I am, actually.
I shouldn't say that.
Liz Canada (19:52):
I'm gonna laugh I may I need to make sure this
episode is published beforeit happens
I would feel so awful
But in this in this scenario Liz's heart attack is
trying to go to the ER and thatdad who didn't have insurance
who wasn't able to see someonefor a sinus infection who had to
wait to go get care who then isgetting sicker and sicker over
(20:15):
the course of time because it isuntreated then has the only
option essentially to go to theemergency room And now you've
got heart attack Liz and thisdad going for the same spot when
dad could have been treatedmonths ago.
Kristine Stoddard (20:28):
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 anemergency room in a town like
Berlin and Franklin that have ahigh number of Medicaid
enrollees.
Now, those Medicaid enrolleeslose their insurance.
(20:48):
So instead of having access toa primary care care provider,
Franklin residents or Berlinresidents are forced to go to
the emergency room to accesscare because they can't afford
it otherwise.
So the people that have heartattacks or diverticulitis or
appendicitis or gallbladderissues, a gallbladder attack,
(21:09):
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 costs,
right?
(21:29):
They have to cover their costof reimbursing all of these
health care 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 and employer
(21:51):
sponsored insurance.
Liz Canada (21:54):
So why is there an argument about the costs of
Kristine Stoddard (22:00):
Medicaid?
Medicaid insurance, by changingthe eligibility for Medicaid
(22:27):
insurance, you're pushing peopleoff of their health insurance.
So the state looks like it'ssaving money, right?
In those budget sheets thatPhil talked about, it looks like
the state is saving money.
But guess who's paying for it?
Everyone else.
You're paying for it.
My heart attack is paying forit.
Yeah, exactly.
Your heart's paying for it.
(22:48):
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 isthe costs get pushed down onto
other health insuranceconsumers.
It also gets pushed down ontoproperty taxpayers, everyone
(23:09):
else in New Hampshire, becausetowns in New Hampshire have
welfare offices.
When someone loses their healthinsurance, they can access
help, hopefully, if everything'sokay, I guess, they can access
help through the townwelfar office.
Liz Canada (23:24):
Right.
Kristine Stoddard (23:26):
So who pays for the town welfare
office, Liz?
Liz Canada (23:54):
The town. a lot in the last few years serving in
that subcommittee about thetypes of calls that they get and
the types of support that ourtown is thankfully able to
provide people who need
Kristine Stoddard (24:06):
Yes.
Liz Canada (24:06):
But it is not an unlimited amount of money in a
town to be able to do this.
That's pushed all these costsall the way down to just our
community, just our town aswell.
Kristine Stoddard (24:17):
But guess who people blame when their
property taxes go up?
They blame town officialsbecause that's all they see.
They see their property billand they think, why are my
property taxes going up?
Well, it's because policymakersat the state level are making
policy choices that cost youmoney and you're going to pay
(24:39):
for it through your propertytaxes and with your health.
And
Liz Canada (24:44):
the issue as well is that when they make these
decisions, they don't follow therule of math class.
They don't show their work tosay, they don't use their
calculator, but they don't showtheir work and say, okay, so
we're going to make this change.
And because we've made thischange at the state level, the
towns are going to have to paybecause we've done that.
(25:08):
They don't show that work, butthat's what's happening
regardless.
Kristine Stoddard (25:35):
I'm trying to think
Liz Canada (25:51):
of an analogy.
I love analogies.
But it would kind of be like inour household, you know, if
you've got Molly and me.
Then you got the two boys.
And if we make the analogy oflike we're the state and the
boys are the local level, it'slike saying like, well, we
balance the budget.
We didn't need to spend anymoney on school lunches this
year.
Great news for us, huh?
And then the boys are like,wait, no, we still have to have
(26:13):
school lunch.
It's like, well, it's not inthe budget.
Yeah.
And then they're just gonnahave to figure it out on their
own.
Like there's still that needsto happen, even if we're just
like, no, cut that line and I'msaved.
Saved our expenses.
pretty great
Kristine Stoddard (26:26):
good for us kids in New Hampshire aren't
hungry they don't need to eatthey just want more things they
always want things
Liz Canada (26:32):
they always want money, K ristine I literally
dropped the boys off at theirfriend's house and I fed them
so many things so I'm like donot walk into their house and
say what's for dinner as soon asyou walk in because one that is
rude they're just hungry allthe time yeah and my younger one
was like this you know I'mgonna do it anyway I'm like I
know you are but please don'tjust walk into someone's house
and be like is there any foodhere.
In this little silly analogy,if Molly and I are like, no, we
(26:55):
did our budget and schoollunches didn't make the cut, the
boys are still going to need toeat.
Are they just going to have toscrounge for food?
What are they going to have todo?
Similarly to the state.
The state can say, actually, wecut that line at them.
But the local level has to pickup the tab.
Kristine Stoddard (27:11):
They have to figure it out.
Liz Canada (27:12):
Yeah.
Kristine Stoddard (27:13):
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 timeof year and they are what they
(27:34):
are.
So if the policymakers inConcord or D.C.
change Medicaid eligibilitytoday, there's nothing your town
can do about it.
But if today we changedeligibility 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
(27:55):
town welfare office more peopleend up coming to the town
welfare office the town welfareoffice has a discrete amount of
money they can only pay for somuch food for people you can't
just go raise taxes willy-nillyand decide to Bye.
Bye.
Bye.
and has just gobs of money, itdoesn't make any sense to me or
(28:26):
my moral compass to not wantpeople to have health insurance
because it's better foreveryone.
Liz Canada (28:33):
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.
(28:54):
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
(29:18):
property taxes.
It does.
Kristine Stoddard (29:19):
Right.
Towns and cities can only raiserevenue from a very limited
number of sources, especially inNew 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.
The state has more options andmore choices.
Liz Canada (29:39):
Kristine, I learned a lot from Phil.
Kristine Stoddard (29:42):
Don't you always?
Liz Canada (29:43):
I always do.
But that interest and dividendstax moment, I'm still thinking
about it.
I am still thinking about Yes.
It's wild.
Kristine Stoddard (30:03):
Policymakers chose to reduce the revenue
coming into the state of NewHampshire by eliminating the
interest and dividends tax,which, like you said, the bulk
of it was paid for by very, verywealthy people.
People who are not justsurviving on their pension.
It's people who have millionsand millions of dollars in
(30:23):
assets.
People who earn hundreds ofthousands of dollars on their
interest and dividends.
Liz Canada (30:28):
Money that was just generating in an account that
they've essentially donenothing.
Right.
Generating
Kristine Stoddard (30:36):
passive income.
roads, like schools, likehealth care?
(31:06):
Why would you just say, oops,never mind, we don't need that
revenue?
You're creating a problem,which is exactly why we're in
the 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
(31:27):
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,
policymakers made.
Liz Canada (31:37):
A majority of policymakers made.
Not
Kristine Stoddard (31:40):
every single one who's there.
That's a very good point.
Liz Canada (31:43):
Enough.
A majority of the folks did.
Kristine Stoddard (31:46):
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.
That's just the way insuranceworks.
Liz Canada (32:07):
Let's talk about the folks who are covered by
Medicaid, because I know that alot of them are kids, are
younger people, right?
And there's also a lot of folkswho are maybe 65 and older, and
they're older folks who needhealth coverage as well.
Kristine Stoddard (32:27):
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.
Liz Canada (32:40):
And does that mean that they all are in families
that have lower incomes?
Kristine Stoddard (32:57):
thing is less expensive.
For another, it's better foreveryone.
So there are children who havespecial needs that also access
Medicaid.
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.
(33:18):
They are the highest spend inour Medicaid program because
nursing home care is expensive.
I don't know how old you Buthealth care for geriatric
patients is very, veryexpensive.
And in-home care is veryexpensive.
So if you have a child whoneeds a feeding tube or has an
(33:42):
immune disorder that doesn'tallow them to go to school, they
can access health care servicesin their home with Medicaid.
And it's literally life ordeath for some people.
Without health care services,people who are medically complex
die.
And Medicaid is their lifeline.
And that's not hyperbole.
(34:02):
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 amount ofincome.
Their parents, again, couldhave health insurance through
their employer, and they couldsave a little bit of money by
having the kids on insurancethrough Medicaid.
(34:24):
But Again, they're stillconsidered low income.
So they need access to healthinsurance that they can't
afford.
They need access to health careservices that they can't afford
without Medicaid coverage.
Liz Canada (34:39):
So what changes are expected to happen because of
the state budget or because ofthe federal budget or both?
What happened with Medicaidthis summer, essentially?
Because it all happened in Juneand July across the state and
the country.
Kristine Stoddard (34:55):
Yes.
And what happened in the stateis different than what happened
at the federal level inCongress.
So they're not in alignmentbecause those bill drafting
processes are different.
So in New Hampshire, our statebudget passed.
This is a budget year.
And in this budget, because wehad less revenue, because again,
(35:19):
legislators chose...
To reduce sources of revenue.
Liz Canada (35:24):
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.
They're like, you know what weneed is money.
And so here we are.
Kristine Stoddard (35:34):
So the legislature reduced the revenue
coming into the state over thepast six years.
And that means that when thelegislature decided to craft its
budget, they had less money towork with, which means...
they are paying for lessservices.
So the choices that they madeto the Medicaid program include
(35:55):
charging low-income parents whohave children on Medicaid
premiums so that their childrenhave health insurance.
Liz Canada (36:04):
Kristine, I love words like this because premium
is like, oh, it sounds so fancy.
What does premium actuallymean?
What does that word mean?
Yeah.
Kristine Stoddard (36:12):
So healthcare is so full of jargon.
I apologize.
Liz Canada (36:15):
No, I love it.
But what does lower incomefamilies have to pay a premium?
What does that mean?
Kristine Stoddard (36:21):
So that is the monthly amount of money that
they have to pay.
The amount of money they payeach month for their kids to be
insured.
And so...
In New Hampshire, this policychange means if you have a
family of three and you havekids on CHIP, which is kids
Medicaid, you have to earn justunder $68,000.
(36:45):
That's not a lot of money.
So that captures a lot ofgranite staters, right?
So that family of three isgoing to have to pay $230 a
month so that their child canaccess health insurance.
Hold on.
Wait.
Liz Canada (37:01):
I'm going to get my calculator, a.k.a.
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 going to do,
$7.25.
So they would need to work 31hours to pay that premium on a
(37:21):
$7.25 an hour job.
Kristine Stoddard (37:24):
And that doesn't
Liz Canada (37:26):
include...
Kristine Stoddard (37:27):
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.
Liz Canada (37:35):
For a cool 31 hours of work...
And just that you can pay forthe health insurance you already
have.
Yes.
True?
Kristine Stoddard (37:45):
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 islike $1,300.
You have to pay $1,300 and youhave to pay your health
(38:09):
insurance And if you do acomparison, I mean, it truly
depends on your employer andwhat kind of plan they offer.
But families in somecircumstances who have
employer-sponsored insurancewould be paying less than this
parent trying to provideMedicaid coverage.
And I make quite a bit morethan $7.25 an hour.
(38:34):
That's less of a burden on methan someone who makes minimum.
wage right
Liz Canada (38:40):
i believe there was a debate in the room where it
happened...
Hamilton, but in a bad way,where they talked about how they
they wanted to do the premiumthe way that it passed x they
didn't want it to be called anincome tax they're like we don't
want it to be called an incometax so we're gonna do this other
thing instead it's like no it'sstill you're it's still a fee a
(39:01):
premium on the income that yesyou can call it a banana but
it's still the same thing at theend of the day
Kristine Stoddard (39:09):
What is that phrase if it walks like a duck?
Liz Canada (39:12):
Yeah, and talks like a duck.
It's an income tax is what itis.
I don't know.
Kristine Stoddard (39:17):
Or a fee.
I know.
Liz Canada (39:21):
What's the difference between a tax, a fee,
a premium tax?
Semantics.
So $230 a month for a family ofthree making around like
$65,000 a year.
Yeah.
Kristine Stoddard (39:34):
So that's one of the great policy changes
that was put in place in thisbudget.
The other one was...
Liz Canada (39:41):
And this was at the state level, the state
lawmakers.
Kristine Stoddard (39:43):
Yes, this was at the state level.
Yeah.
So in addition to that, peoplewho are on Medicaid expansion or
what is called grantedadvantage
Liz Canada (39:52):
have to.
Why do we have all these secretcode names?
I have no idea.
Why are we calling it these?
It's like, it's not Medicaid.
It's granted advantage.
Wink.
It's not Medicaid.
It's chip.
Wink.
It's not an income tax.
It's a premium.
Wink.
Like, that's how I feel thatwe're.
Why are we doing this?
It's
Kristine Stoddard (40:09):
not Medicaid.
It's Katie Beckett.
It's Katie.
What?
What is Katie?
Katie Beckett is a Medicaid.
program in the state of NewHampshire.
Because that's a person's name.
Right.
It's also a Medicaid program.
Liz Canada (40:21):
It's like Jeremy Bearamy in The Good Place.
Like it's a concept of time.
It's Jeremy Bearamy.
Kristine Stoddard (40:27):
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.
Liz Canada (40:46):
A and B?
Kristine Stoddard (40:48):
A and B.
A-N-B.
N as in Nancy.
Aid to the needy blind.
Liz Canada (40:54):
Okay, yep.
Kristine Stoddard (40:55):
A-P-T-D.
Aid to the permanentlydisabled.
Medicaid for employed adultswith disabilities.
Medicaid for employed olderadults with disabilities.
In-and-out Medicaid.
Home and community-basedwaivers.
So here's a...
a category that also has fournames that are included.
In-home supports, DD, alsoknown as developmental
(41:19):
disabilities, acquired braindisorders, choices for
independence.
Liz Canada (41:23):
Are these all names of programs that's actually just
Medicaid?
Kristine Stoddard (41:27):
Yes.
They're all Medicaid.
Liz Canada (41:30):
That is so...
Interesting.
Kristine Stoddard (41:33):
It is, but you know what happens?
Normal people who don't live inour policy world, who go about
their days without thinking.
Who are those people?
And rightfully so, right?
Like, who would say KatieBeckett and think Medicaid?
It's just a
Liz Canada (41:54):
I remember seeing polling that shows that people
support the concepts ofMedicaid, support things like
CHIP, right?
Like, they support thosethings.
And then if you say, what doyou think about Medicaid?
They're like, oh, I don't likethat.
It's like, no, you just saidyou liked it, but
Kristine Stoddard (42:08):
a
Liz Canada (42:08):
different name
Kristine Stoddard (42:09):
of it.
It's because we've created thismonster.
A stigma, yeah.
We've created a stigma wherethere shouldn't be one.
Liz Canada (42:17):
Ugh.
It's just health insurance,folks.
Kristine Stoddard (42:20):
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.
Which is a good
Liz Canada (42:39):
thing because I'm going to have a heart attack.
But yes, right.
Tomorrow.
It's going to be the ultimate.
hilarious 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.
No.
Kristine Stoddard (42:59):
But now we're making people who have very,
very little income pay for whatthey get.
We're making another policychoice.
We're making them demonstratethat they've worked for 100
hours a month or else we'regoing to take their health
insurance away.
Liz Canada (43:14):
Okay.
Tell me about that.
This is a new requirement?
Work requirements?
Kristine Stoddard (43:18):
Yes.
Yes.
So Medicaid was created toprovide better access to health
care services.
It is, for the millionth time,just 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
(43:40):
New Hampshire to Yes.
Liz Canada (43:42):
How does one prove that they working?
Do they have to take a video ofthemselves?
Do they have to go to theDepartment of Health and Human
(44:03):
Services and fill out like what?
Kristine Stoddard (44:05):
I don't know.
So imagine all of the paperworkthat has to be done and all of
the steps that have to be takenfor a human to verify that
they're employed.
They have to get something fromtheir employer.
They have to find paperworkthat demonstrates they're
employed.
They have to drive to the DHHSdistrict office or mail it or
(44:27):
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 have substance use disorder.
The state can't just go look atall of the claims for your
(44:48):
substance disorder treatment intheir system because our system
doesn't work that way.
So they have to take thisperson battling substance use
disorder with all of these otherthings going on, has to make an
appointment with their healthcare provider that's weeks out,
has to get the health careprovider to sign a form.
The health care provider has tomake a determination.
(45:10):
The other phrase that we usedwas medically frail.
That's not a medical term.
So we have to, as a health careprovider, decide whether or not
our patient is medically frail.
Liz Canada (45:20):
Medically frail?
Kristine Stoddard (45:22):
Yeah, I don't even know what that means.
Like
Liz Canada (45:23):
Tiny Tim from A Christmas Carol?
Kristine Stoddard (45:26):
I don't know.
Liz Canada (45:27):
I meant to read a passage from A Christmas Carol.
Because this is...
All of the debates againstMedicaid and against...
supporting folks with lowerincomes is just the opening
scenes of a Christmas carol ofEbenezer Scrooge being like then
let them die like you
Kristine Stoddard (45:44):
You really do like analogies that's another
good one
Liz Canada (45:46):
I'm sorry yes it's the English teacher brain of
like trying to find them butthat's how it feels he's like
yes aren't there poor housesaren't there places workplaces
to go
Kristine Stoddard (45:57):
how this feels right so we're creating
more barriers for people who areeligible for Medicaid we're
creating more barriers for themto access health insurance that
they are legally eligible toaccess to save money.
New Hampshire has tried a workrequirement before and it didn't
work.
We had to stop it because itwas costing the state so much
(46:22):
money and we weren't able tocontact enough people who would
be subject to the workrequirement to get them to
comply with the workrequirement.
So we paused it.
It stopped.
It's actually current law, andit's not in effect because it
doesn't work.
Liz Canada (46:39):
The work requirement doesn't work, but they put it
back in this time.
Kristine Stoddard (46:43):
Yes.
Liz Canada (46:45):
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 weare again.
Kristine Stoddard (46:50):
Right.
It's like that Taylor Swiftsong.
Liz Canada (46:54):
Oh, which
Kristine Stoddard (46:54):
one?
I've seen this film before, TheExile.
I love that song.
It doesn't work, New Hampshire.
You're going to waste money.
We shouldn't be doing it.
Liz Canada (47:04):
We shouldn't be doing it.
And people will lose theirhealth care if they don't do it?
Kristine Stoddard (47:08):
They will.
Liz Canada (47:09):
How soon after?
If they don't prove that theyhave worked for 100 hours, what
happens?
Kristine Stoddard (47:14):
We don't know yet what It's going to look
like because now federal lawsays states, if you want
Medicaid dollars, you have tohave a work requirement.
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
(47:37):
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.
Liz Canada (47:49):
Holding health insurance hostage.
Yes.
Fantastic.
Really glad that's what we'respending our time on.
Such
Kristine Stoddard (47:56):
a good use of money.
Liz Canada (47:57):
Such a good use of money and time and resources.
Kristine Stoddard (48:01):
Such a good use of our very limited revenue
because people chose toeliminate gigantic sources of
revenue.
Liz Canada (48:08):
Well, well, well.
To save money really means thatyou're betting on people not
doing it.
and therefore losing theirhealth insurance.
You're making a bet againstpeople.
Kristine Stoddard (48:20):
We are betting that Granite Staters
don't want to work.
We are choosing to see theworst in our friends and
neighbors.
We're choosing to see people asanything but human beings.
And at the end of the day...
It actually doesn't save anyonemoney.
(48:41):
It doesn't save the statemoney.
It doesn't save you money as ahealthcare consumer.
It doesn't save the healthcareprovider money.
It actually costs a ton ofmoney for the state of New
Hampshire to implement a workrequirement, like millions and
millions of dollars.
So we're actually spendingmoney to do something that that
(49:03):
doesn't help anyone, thatdoesn't save any money, for
what?
To prove a point?
Liz Canada (49:09):
I don't know.
I mean, I joke and not jokeabout Ebenezer Scrooge, but are
they just hoping those peoplewill die and not have to cover
them?
What are
Kristine Stoddard (49:20):
they trying to do?
I would love to believe...
that they think they're tryingto help people who are
unemployed access work.
But we know that's not thecase.
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
(49:43):
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.
(50:05):
So why are we going throughthese extra steps just to prove
a point?
In the first year ofimplementing a work requirement,
it is going to cost the stateSo just the state, not health
care providers, which we shouldalso talk about because the
burden is going to be borne bythem as well.
It's going to cost the statealone almost $4 million in the
(50:30):
first year, almost $3.8 millionin the second year, $3.8 million
in the third year.
So we are wasting money toprove a point that research
already shows is not real.
Liz Canada (50:44):
Right.
We're spending money to justifycutting money?
Kristine Stoddard (50:50):
So how can anyone assume that this is done
to benefit people, people whoaren't working to get them
working, when the only savingsis generated by them losing
their health insurance?
Yeah.
Hopefully my kids don't listento this because this is me
assuming the worst, but I don'tsee any other way the math works
(51:10):
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.
Let's be exceedingly
Liz Canada (51:22):
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, get thethings that they need to get
healthy.
In whatever healthy way needsto happen.
(51:43):
And that should be the extentof their participation in this
conversation.
They should just be able to getthe health care that they need.
Yes.
You shouldn't have to earn it.
Prove it.
Prove you need that healthcare.
Kristine Stoddard (51:57):
Prove you have skin in the game.
Prove you're worthy of aninsurance card to put in your
pocket.
Liz Canada (52:03):
Right.
And the providers who areproviding this health care need
to have the revenue coming in.
to be able to provide thathealth care for these people who
need it.
Kristine Stoddard (52:13):
Right.
Because guess what, Liz?
Your high cholesterol stillneeds to be treated.
Shout out.
Shout out to my highcholesterol.
Your high cholesterol stillneeds to be treated.
We are
Liz Canada (52:24):
getting into why the heart attack is happening.
Kristine Stoddard (52:29):
Can you tell I just had my blood tested?
Liz Canada (52:32):
That's good.
You should be able to get thehealth care that you need and
the blood tests that you
Kristine Stoddard (52:37):
need when
Liz Canada (52:37):
you
Kristine Stoddard (52:38):
need them.
Right.
And I have health insurance, soI can access those services and
not be out $800 that blood workcosts.
So then when the providers loserevenue because their patients
lose insurance, they have to letpeople go, which means they're
(52:59):
fired.
Liz Canada (52:59):
Fewer providers.
Kristine Stoddard (53:00):
Which means they have fewer providers, which
means that provider just losttheir job, lost their health
insurance, lost their income.
that supports their family, andyou have to wait longer to get
your cholesterol levels checkedbecause they have fewer
providers.
Because policymakers chose toimplement policies that are
(53:23):
guaranteed to kick people off ofMedicaid.
So everyone, Liz, should careif Granite Staters retain their
Medicaid because it willinevitably impact every single
person in our state.
And that doesn't even get intowhat's happening at the federal
level because that's fun.
Liz Canada (53:45):
You have an interesting definition of the
word fun is what I'm hearing.
Let's hold on the federalpiece.
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.
(54:05):
And so they're prettyfrustrated to find out that our
lawmakers and our policymakersin New Hampshire have made the
conscious decisions tonegatively impact people who are
covered by Medicaid or whocould be and so forth.
What should they do, Kristine?
What does one do with all therage?
Kristine Stoddard (54:26):
Scream very, very loud into the void.
Liz Canada (54:29):
Yes.
Scream into the void.
Check.
I do that every day.
It's a good part of my morningroutine.
Kristine Stoddard (54:34):
Mountain bike before work.
That helps me relax.
Liz Canada (54:38):
Yeah.
I CrossFit.
It's one hour of my day that Iknow I cannot think about work
because I am too busy doing toomany wall balls.
Kristine Stoddard (54:46):
Right.
No time.
If I think about work, I crash.
And I get bruises.
Liz Canada (54:51):
You mountain bike.
I do mountain bike.
I crossfit.
So scream into the void.
Do something to maybe avoid
Kristine Stoddard (54:58):
anxiety attacks.
Yes.
Panic attacks.
Yep.
So you got to do that.
And then talking to yourfriends and neighbors, because I
bet you, Liz, you throw a rockor maybe...
I don't know, a tennis ball isa better choice.
No, rocks are great.
You throw a tennis ball fromyour front door and you hit
someone, they probably haveMedicaid.
(55:20):
Because guess what?
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 everyindividual.
Vote.
Vote.
Ugh.
(55:48):
that say health insurance ratesare going to go up.
(56:20):
Not just because of whathappened at the federal level,
it's also these choices that ourstate policymakers have made to
reduce state revenue and topush the burden and the cost
down onto
Liz Canada (56:31):
residents.
lunges like we've been doing atthe gym.
I do know what that is.
You're going to vote, ofcourse, but also you're going to
(56:53):
contact your lawmakers.
You don't have to wait untilelection day.
You can talk to them now.
Kristine Stoddard (56:57):
Right.
And it's actually better totalk to them now because they're
less busy, because they're notin the legislative session.
And they're also drafting billsright now.
So if there's something theycan do to help you or mitigate
the consequences that are goingto come because of this
legislation, they can do it now.
Liz Canada (57:16):
Kristine, thank you so much.
Thank you so much for yourtime.
Thank you for coming on hereand talking to me about
Medicaid, which is healthinsurance.
Kristine Stoddard (57:23):
That's all it is.
That's all it is.
Liz Canada (57:26):
Medicaid, not scary.
Not a scary thing.
Just health insurance.
It's great.
I literally have a post-it notehere on my desk that says,
would you rather do this or 90wall balls?
(57:46):
That is the question that Ihave here.
What is a wall ball?
You take a weighted ball andyou squat 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.
Kristine Stoddard (57:59):
What happens if it hits you on the head?
Like, is that a possibility?
No, you got to catch it.
Liz Canada (58:03):
You'll catch it.
You don't want to get hit.
Kristine Stoddard (58:05):
I wear bifocals, Liz.
You're asking a lot.
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I’m Jay Shetty host of On Purpose the worlds #1 Mental Health podcast and I’m so grateful you found us. I started this podcast 5 years ago to invite you into conversations and workshops that are designed to help make you happier, healthier and more healed. I believe that when you (yes you) feel seen, heard and understood you’re able to deal with relationship struggles, work challenges and life’s ups and downs with more ease and grace. I interview experts, celebrities, thought leaders and athletes so that we can grow our mindset, build better habits and uncover a side of them we’ve never seen before. New episodes every Monday and Friday. Your support means the world to me and I don’t take it for granted — click the follow button and leave a review to help us spread the love with On Purpose. I can’t wait for you to listen to your first or 500th episode!
Stuff You Should Know
If you've ever wanted to know about champagne, satanism, the Stonewall Uprising, chaos theory, LSD, El Nino, true crime and Rosa Parks, then look no further. Josh and Chuck have you covered.
The Joe Rogan Experience
The official podcast of comedian Joe Rogan.