Liz Canada: 0:00

I'm going to be honest with you, K ristine. I don't know a lot about Medicaid. I know it, but I don't know it.

Kristine Stoddard: 0:06

It is very complicated, and there are so many parts of it that are influenced by different policies, whether at the state level or the federal level.

Liz Canada: 0:17

Yeah. It's like a spider web.

Kristine Stoddard: 0:19

It is a spider web. A boring policy. And it's hard to speak in generalities without... missing some piece of information. But unless you want like 10 hours of podcast, that's what we're going to have to do.

Liz Canada: 0:34

Well, look, I'm happy to do a 10-part series just on Medicaid.

Kristine Stoddard: 0:41

You might want another guest.

Liz Canada: 0:55

Welcome to New Hampshire Has Issues, the podcast that dares to ask, why does it appear that our lawmakers really don't like low-income people? Kristine, let me hear your tagline. Welcome to New Hampshire Has Issues.

Kristine Stoddard: 1:12

The podcast that dares to ask why everyone in New Hampshire should care whether or not their friends and neighbors have health insurance.

Liz Canada: 1:21

I cannot wait to get into this because I, I'm just going to be honest that I don't know why it's controversial that we should want everybody on health insurance. It feels like, I mean, Welcome to New Hampshire has issues. The podcast that dares to ask why would we want people to go bankrupt from needing to go to the doctor? Why is that the position some people are taking? It makes no sense to me.

Kristine Stoddard: 1:45

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

Liz Canada: 1:56

I mean, your eight-year-old sounds like they got it. Like, that's correct. Why should you be paying to go to the doctor when you should just be able to go to the doctor? Period.

Kristine Stoddard: 2:05

But America has this thing called health insurance. Yeah. that you can have commercial health insurance.

Liz Canada: 2:11

Should I cheer? USA, USA. Is this the time where I do this? Is that the time to chant? No. Am I doing it

Kristine Stoddard: 2:17

right? Definitely not on

Liz Canada: 2:20

this one. Okay. All right. Not this one. I am your host, Liz Canada. And joining me today is Kristine Stoddard, who is a healthcare policy ultra nerd. And that is exactly who I need to help me understand Medicaid, because I hear about it a lot. In my job, I hear about it. But out in the news, especially right now with, you know, I had Phil Sletton on a few episodes ago talking about the budget. He alluded to changes to Medicaid. You know, the budget that was passed by the Trump administration, like that has some impacts on Medicaid. But I got to be honest with you. What the heck is Medicaid? So that is why, Kristine, I've asked you to come on because I think there's some misconceptions about it. I think there are some like I hear the word and then I have a feeling and I'm not sure how I'm supposed to feel about it. And I'm hoping you can help folks understand. understand what it actually is, and whether or not we need it. Do we need Medicaid?

Kristine Stoddard: 3:22

We do. Okay, episode over.

Liz Canada: 3:25

Thank you. Great. I like to start every episode with a simple question. What the heck is Medicaid? What is it? And why is it even an issue in New Hampshire?

Kristine Stoddard: 3:35

Medicaid is just health insurance. That's all it is. It's health insurance. healthcare and particularly low-income children. elderly people who live in nursing homes, adults, low-income adults, and people in New Hampshire with complicated medical needs. They're not the boogeyman. Those people all sound great. Exactly. You want to help them. You want to help them be healthy. They're our friends. They're our neighbors. They're our constituents if we're elected officials. These are the people that you interact with when you go get coffee in downtown Concord. These are the people that answer your questions when you go to the library. They're the people that hand you your coffee through a drive-thru window. These are people. They are Granite Staters, and they deserve our support and our respect, not our animosity.

Liz Canada: 5:00

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: 5:22

Yes, there are a lot of industries in New Hampshire that do not offer health insurance. This could be the construction industry. This could be big box stores, Home Depot, Walmart. It could depend on how many hours you work. It could depend on whether or not you work for a sole proprietor. If you have a 1099, if you're a carpenter like my husband is, he doesn't have health insurance through his employer. He's a 1099. He contracts with other carpenters to do work for them. And he has health insurance through my job. And a little secret I will share with you. My husband has an autoimmune disease. Not through anything that he did wrong. He was born with an autoimmune disease that can be hereditary. We got legally married in our kitchen in Concord, New Hampshire months before our wedding because my husband's employer did not offer health insurance. And because he has an autoimmune disease, he has to take biologics. Biologics are very important. Oh, yeah. So we got married, didn't tell anyone so that he could get on my health insurance. And that's a reality that people 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: 6:39

Let's get into the details of your marriage, Kristine. Tell me more about it. What's happening? Who's paying which bills and so forth? This is what New Hampshire needs to know. We need to know everyone's... Actually, that is what lawmakers are trying to do is get into all of the details of everyone's personal lives but we will set that one right aside

Kristine Stoddard: 6:59

so he could not work without health insurance his he has psoriatic arthritis and which affects your joints and if you're a carpenter who's on a roof oh yeah you need your joints to work properly so that you don't drop an impact gun or something like that or a nail gun and I don't know the names of tools.

Liz Canada: 7:22

Let's get into the details of tools now. We got into the marriage and now we're getting into the tools.

Kristine Stoddard: 7:27

He literally could not work without this medicine because his knuckles were swelling. His joints in his feet were swelling. And my husband is like the epitome of health. He exercises every day. He's very, very healthy with this one exception. And he could not work because he did not have access to a biologic But we got married months before our actual ceremony so that he could access health insurance, access biologics, and continue to work. Otherwise, he would have been unemployed.

Liz Canada: 8:02

You've got the employer-sponsored health insurance. You have my spouse has employer-sponsored health insurance, has the health insurance through their job. And then you have individuals who... aren't married to somebody who has a job with health insurance and so what are their choices

Kristine Stoddard: 8:22

so if they can afford it if they're lucky enough to afford it they can go on the marketplace and buy their health insurance

Liz Canada: 8:30

not the facebook marketplace there's

Kristine Stoddard: 8:32

no health insurance on the you could try

Liz Canada: 8:35

you know what i haven't checked actually i don't know so what is this marketplace

Kristine Stoddard: 8:40

so the affordable care act created like a one-stop shop for health insurance and And on that health insurance website, you can go and choose what you need out of health insurance, how much you want to pay. And if you have certain incomes, then you get different benefits. So you might get subsidized health insurance or premium subsidized health insurance through the marketplace. It just depends on your income. If you cannot afford those marketplace plans because you do not make enough money, so say you work minimum wage in the state of New Hampshire. Minimum wage in the state of New Hampshire is below the federal poverty level. So you would qualify for what is called Medicaid. And if you are my age, say 40, almost 46, you would qualify for Medicaid expansion, also known as granted advantage. New Hampshire, our minimum wage is $7.25. We are one of the few states, right? $7.25. A $5

Liz Canada: 9:49

bill, two $1 bills, and a quarter. Yes. That is how much money we're talking 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 to pay someone that little. And because of that, people can go without health insurance prior to the Affordable Care Act. They couldn't afford health insurance. Prior to the Affordable Care Act, if you had a pre-existing condition, insurance carriers didn't have to insure you. They could say no, or they could say, we'll insure you for these services, but not this service because you have a pre-existing condition like say you have eczema or something random we'll do all of your other dermatology appointments but we're not going to cover anything related to eczema that's why you need to go to the doctor because you have this condition that exists that you need treatment for so the ACA comes into effect and says insurance carriers you can't kick people off anymore because you have pre-existing conditions and so they made this marketplace where people can go and choose what they want from for 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 the ages of 19 and 64 could access Medicaid. Again, it's just health insurance.

Liz Canada: 11:29

It's another type of health insurance.

Kristine Stoddard: 11:32

Yes. So they could access Medicaid and most of their expenses would be paid for Mm-hmm. who can otherwise not afford it. All Medicaid is is health insurance. It's not a horrible thing. It's not a horrible thing to be on Medicaid. Medicaid covers kids. It covers elderly people living in 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 have health insurance. insurance coverage.

Kristine Stoddard: 12:42

Right. You cannot afford, based on your income levels, to buy health insurance or pay for those 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 name names, but there are some lawmakers who seem not super into Medicaid. What do they want people to do instead?

Kristine Stoddard: 13:07

They want them to work for it and to prove that there working for it and in 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 for your health insurance so combine that with having kids a single dad with two kids one kid you're making minimum wage or sixteen dollars an hour at home depot you can't afford your health insurance and So in that example, now, thank you to Medicaid expansion, the dad can access health insurance through, if he can't get it through his employer, he can access it through Medicaid, through what we call the granted advantage, and that his children can access Medicaid also because of his low income. Pre-Medicaid expansion in New Hampshire, he would have gone without health insurance. The kids would have been able to get health insurance, but the dad who's responsible for these children, who wants to work so that he can put food on their table, who wants to go to their band concerts at school, who needs to be healthy to work, could not access health insurance. And policymakers at the time, it took many, many tries for us to get Medicaid expansion passed in New Hampshire. You would think it would just be a slam dunk. Here's a problem. Here's a solution. And by the way, the feds are going to cover 90% of the cost, you'd think it would just be a slam dunk. But no, we had to argue about it 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 dad would have had no health insurance and would have gone either to the doctor and had exorbitant costs associated for being able to go there or not gone at all because knowing that it would cost a lot of money.

Kristine Stoddard: 15:10

So, I'm not a doctor, but say he gets sinus infection or a respiratory virus, 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 fact that he's sick. And he can't go to a traditional primary care doctor because he can't afford the bill. He's forced to wait to see a health care provider because he doesn't have health insurance and he can't afford it. So he ends up with pneumonia and it's so bad he can't breathe. So then he goes to the emergency room because at this point it's serious and he's unable to work. The hospitals have to see him. Yeah. Yeah. And seeing a primary care provider is a hell of a lot cheaper than going to an emergency 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 an emergency room. The minute you walk in the door, you're spending hundreds of dollars regardless. Why wouldn't we want to give the dad, other Granite Staters, the option to have health insurance, to stay healthy, to be able to work, to be able to support the economy by working, to be able to keep his employer on task on target why wouldn't we want these things not only is it the right thing to do like we want people to be healthy because that's important that's being kind that's being a good human 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 know take 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 turn the 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 the state money, it saves people who have insurance through their employer money. Wait a minute.

Liz Canada: 17:32

Yes. Wait a minute. You're telling me that if people have coverage under Medicaid, that saves me, Liz Canada, who has insurance in another form, that saves me and people like me money?

Kristine Stoddard: 17:47

Yes. How? Because the more people who are insured in a market. So in New Hampshire, our market is just the state. That's how health insurance works. It's not a national market. It's a state market. So the more people who have health insurance, the more adequate reimbursement is given to health care organizations, the more the risk of an insurer having to pay an astronomical amount of money out is spread among Thanks for having me. If you have a heart attack, God forbid, 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 your kids. Yes. So if you go to the emergency room, and granted advantage, our Medicaid expansion program is intact. People who are eligible to access it can access it everything's working as it should the wait times will be shorter because people won't be going to the emergency rooms who don't have emergencies so your heart attack is treated earlier which means the insurance company 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 heart attack. It's my heart attack. I love it. Kristine, you're going to feel so badly if I have a heart attack sometime between now 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 before it happens

Kristine Stoddard: 19:56

I would feel so awful

Liz Canada: 19:59

But in this in this scenario Liz's heart attack is trying to go to the ER and that dad who didn't have insurance who wasn't able to see someone for a sinus infection who had to wait to go get care who then is getting sicker and sicker over the course of time because it is untreated then has the only option essentially to go to the emergency room And now you've got heart attack Liz and this dad going for the same spot when dad could have been treated months ago.

Kristine Stoddard: 20:28

Right. And dad and all of his friends, right? If you look at Berlin, New Hampshire, Berlin has a high number of Medicaid enrollees. So imagine going to an emergency room in a town like Berlin and Franklin that have a high number of Medicaid enrollees. Now, those Medicaid enrollees lose their insurance. So instead of having access to a primary care care provider, Franklin residents or Berlin residents are forced to go to the emergency room to access care because they can't afford it otherwise. So the people that have heart attacks or diverticulitis or appendicitis or gallbladder issues, a gallbladder attack, those people get pushed down the line, right? Because there's so many people in front of them. So what ends up happening is your insurance company has to pay more money eventually. It drives insurance rates up. If they're paying more, they have to charge their beneficiaries more because they have to cover their costs, right? They have to cover their cost of reimbursing all of these health care providers. So they have to spread the burden amongst their consumers. And now there's fewer consumers to spread it amongst because there's fewer insured people. So the more people that have health insurance, the lower our costs are as people who have access through and employer sponsored insurance.

Liz Canada: 21:54

So why is there an argument about the costs of

Kristine Stoddard: 22:00

Medicaid? Medicaid insurance, by changing the eligibility for Medicaid insurance, you're pushing people off of their health insurance. So the state looks like it's saving money, right? In those budget sheets that Phil 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 for it. Yeah, exactly. Your heart's paying for it. Your wife is paying for it. Everyone else now has to bear the burden because policymakers are kicking people off of health insurance. So what ends up happening is the costs get pushed down onto other health insurance consumers. It also gets pushed down onto property taxpayers, everyone else in New Hampshire, because towns in New Hampshire have welfare offices. When someone loses their health insurance, they can access help, hopefully, if everything's okay, I guess, they can access help through the town welfar 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 the types of calls that they get and the types of support that our town 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 costs all the way down to just our community, just our town as well.

Kristine Stoddard: 24:17

But guess who people blame when their property taxes go up? They blame town officials because that's all they see. They see their property bill and they think, why are my property taxes going up? Well, it's because policymakers at the state level are making policy choices that cost you money and you're going to pay for it through your property taxes and with your health. And

Liz Canada: 24:44

the issue as well is that when they make these decisions, they don't follow the rule of math class. They don't show their work to say, they don't use their calculator, but they don't show their work and say, okay, so we're going to make this change. And because we've made this change at the state level, the towns are going to have to pay because we've done that. They don't show that work, but that'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 in our household, you know, if you've got Molly and me. Then you got the two boys. And if we make the analogy of like we're the state and the boys are the local level, it's like saying like, well, we balance the budget. We didn't need to spend any money on school lunches this year. Great news for us, huh? And then the boys are like, wait, no, we still have to have school lunch. It's like, well, it's not in the budget. Yeah. And then they're just gonna have to figure it out on their own. Like there's still that needs to happen, even if we're just like, no, cut that line and I'm saved. Saved our expenses. pretty great

Kristine Stoddard: 26:26

good for us kids in New Hampshire aren't hungry they don't need to eat they 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 their friend's house and I fed them so many things so I'm like do not walk into their house and say what's for dinner as soon as you walk in because one that is rude they're just hungry all the time yeah and my younger one was like this you know I'm gonna do it anyway I'm like I know you are but please don't just walk into someone's house and be like is there any food here. In this little silly analogy, if Molly and I are like, no, we did our budget and school lunches didn't make the cut, the boys are still going to need to eat. Are they just going to have to scrounge for food? What are they going to have to do? Similarly to the state. The state can say, actually, we cut that line at them. But the local level has to pick up 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't raise property taxes, people go without. So like you said, your welfare office has a very limited amount of money right now, right? Right. Because taxes can't go up and down by the day. Right. They're set at a certain time of year and they are what they are. So if the policymakers in Concord or D.C. change Medicaid eligibility today, there's nothing your town can do about it. But if today we changed eligibility so that people lose their Medicaid health insurance and they then can't go to work which means they can't afford their food so they go to the town welfare office more people end up coming to the town welfare office the town welfare office has a discrete amount of money they can only pay for so much food for people you can't just go raise taxes willy-nilly and decide to Bye. Bye. Bye. and has just gobs of money, it doesn't make any sense to me or my moral compass to not want people to have health insurance because it's better for everyone.

Liz Canada: 28:33

I want to also be clear that town welfare offices are doing critical, such important work because I know that there are stories of individuals who are about to lose their homes or who have been staying in their car for weeks and months And then it gets so cold and they're finally going into the welfare office. That is really, really important. And your point is so true that we can't just say, well, you know, we need to bring in more money to the welfare office to do this because there's only so much a local community can do. There's a lot more that a state can do and a lot more that the country can do. And when they choose not to, it gets pushed down to us and our property taxes. It does.

Kristine Stoddard: 29:19

Right. Towns and cities can only raise revenue from a very limited number of sources, especially in New Hampshire. They can't just go create a tax or create a source of revenue. We're very limited as to how towns and cities can generate revenue. The state has more options and more 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 dividends tax 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 New Hampshire by eliminating the interest and dividends tax, which, like you said, the bulk of it was paid for by very, very wealthy people. People who are not just surviving on their pension. It's people who have millions and millions of dollars in assets. People who earn hundreds of thousands of dollars on their interest and dividends.

Liz Canada: 30:28

Money that was just generating in an account that they've essentially done nothing. Right. Generating

Kristine Stoddard: 30:36

passive income. roads, like schools, like health care? 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 we can't fund Medicaid because we don't have any revenue. Look at us. There's no money. Well, of course, there's no money. It's because you cut it. And That was a choice that the state 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 be impacted. Their constituents are going to be impacted. You're going to be impacted, even if you don't live near them, because your insurer is going to have to pay more money. So you're going to have to pay more to have that insurance through Molly's employer. That's just the way insurance works.

Liz Canada: 32:07

Let's talk about the folks who are covered by Medicaid, because I know that a lot of them are kids, are younger people, right? And there's also a lot of folks who are maybe 65 and older, and they're older folks who need health coverage as well.

Kristine Stoddard: 32:27

Yeah. So the biggest group of people who have Medicaid in the state of New Hampshire are actually kids. There's about 90,000 children who 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 for everyone. So there are children who have special needs that also access Medicaid. But children cost the least amount of money in the Medicaid program. We have elderly people and adults with disabilities who account for about 24,000 people. They are the highest spend in our Medicaid program because nursing home care is expensive. I don't know how old you But health care for geriatric patients is very, very expensive. And in-home care is very expensive. So if you have a child who needs a feeding tube or has an immune disorder that doesn't allow them to go to school, they can access health care services in their home with Medicaid. And it's literally life or death for some people. Without health care services, people who are medically complex die. And Medicaid is their lifeline. And that's not hyperbole. It's true. You also have kids whose parents, like you said, are what we consider low income, which means you live at a certain level. You make a certain amount of income. Their parents, again, could have health insurance through their employer, and they could save a little bit of money by having the kids on insurance through Medicaid. But Again, they're still considered low income. So they need access to health insurance that they can't afford. They need access to health care services 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 of the federal budget or both? What happened with Medicaid this summer, essentially? Because it all happened in June and July across the state and the country.

Kristine Stoddard: 34:55

Yes. And what happened in the state is different than what happened at the federal level in Congress. So they're not in alignment because those bill drafting processes are different. So in New Hampshire, our state budget passed. This is a budget year. And in this budget, because we had less revenue, because again, 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 that revenue. And then they did the budget. They're like, you know what we need is money. And so here we are.

Kristine Stoddard: 35:34

So the legislature reduced the revenue coming into the state over the past six years. And that means that when the legislature decided to craft its budget, they had less money to work with, which means... they are paying for less services. So the choices that they made to the Medicaid program include charging low-income parents who have children on Medicaid premiums so that their children have health insurance.

Liz Canada: 36:04

Kristine, I love words like this because premium is like, oh, it sounds so fancy. What does premium actually mean? 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 income families 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 pay each month for their kids to be insured. And so... In New Hampshire, this policy change means if you have a family of three and you have kids on CHIP, which is kids Medicaid, you have to earn just under $68,000. That's not a lot of money. So that captures a lot of granite staters, right? So that family of three is going to have to pay $230 a month so that their child can access 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 thing really fast. How much did you say? $230 a month. $230 a month divided by, you know what I'm going to do, $7.25. So they would need to work 31 hours to pay that premium on a $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 Social Security. That doesn't include the food that they have to buy. That doesn't include the rent that they have to pay.

Liz Canada: 37:35

For a cool 31 hours of work... And just that you can pay for the 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 things happening in the state of New Hampshire. We don't have enough access to housing. So rent is very, very expensive here. The average for a studio is like $1,300. You have to pay $1,300 and you have to pay your health insurance And if you do a comparison, I mean, it truly depends on your employer and what kind of plan they offer. But families in some circumstances who have employer-sponsored insurance would be paying less than this parent trying to provide Medicaid coverage. And I make quite a bit more than $7.25 an hour. That's less of a burden on me than 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 premium the way that it passed x they didn't want it to be called an income tax they're like we don't want it to be called an income tax so we're gonna do this other thing instead it's like no it's still you're it's still a fee a premium on the income that yes you can call it a banana but it's still the same thing at the end 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 it is. 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 of three 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 this budget. 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, people who are on Medicaid expansion or what is called granted advantage

Liz Canada: 39:52

have to. Why do we have all these secret code 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 that we'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 New Hampshire. 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 what their Medicaid programs look like. They get to decide which populations and which needs they cover. And so they name them after people. Katie Beckett is a real person. A and B is also a Medicaid program.

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 permanently disabled. Medicaid for employed adults with disabilities. Medicaid for employed older adults with disabilities. In-and-out Medicaid. Home and community-based waivers. So here's a... a category that also has four names that are included. In-home supports, DD, also known as developmental disabilities, acquired brain disorders, 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 in our policy world, who go about their days without thinking. Who are those people? And rightfully so, right? Like, who would say Katie Beckett and think Medicaid? It's just a

Liz Canada: 41:54

I remember seeing polling that shows that people support the concepts of Medicaid, support things like CHIP, right? Like, they support those things. And then if you say, what do you think about Medicaid? They're like, oh, I don't like that. It's like, no, you just said you 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 this monster. A stigma, yeah. We've created a stigma where there 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 who designs the program and how it's paid for. And, you know, Liz, through Molly's health insurance, you're not paying the cost of all of that health insurance. No. It costs her employer a lot of money 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 heart attack here on the podcast. We are not paying the full cost of the health insurance. No.

Kristine Stoddard: 42:59

But now we're making people who have very, very little income pay for what they get. We're making another policy choice. We're making them demonstrate that they've worked for 100 hours a month or else we're going 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 to provide better access to health care services. It is, for the millionth time, just health insurance. That is what it was designed to be. And in 2018, I believe, the state of New Hampshire asked Centers for Medicaid and Medicare to allow the state of New Hampshire to Yes.

Liz Canada: 43:42

How does one prove that they working? Do they have to take a video of themselves? Do they have to go to the Department of Health and Human Services and fill out like what?

Kristine Stoddard: 44:05

I don't know. So imagine all of the paperwork that has to be done and all of the steps that have to be taken for a human to verify that they're employed. They have to get something from their employer. They have to find paperwork that demonstrates they're employed. They have to drive to the DHHS district office or mail it or upload it on internet. What if they don't have the internet? There are exceptions that were built into that program. So if you have substance use disorder and you're actively engaged in treatment, you have an exemption. But guess what? You can't just say... I have substance use disorder. The state can't just go look at all of the claims for your substance disorder treatment in their system because our system doesn't work that way. So they have to take this person battling substance use disorder with all of these other things going on, has to make an appointment with their health care provider that's weeks out, has to get the health care provider to sign a form. The health care provider has to make a determination. The other phrase that we used was medically frail. That's not a medical term. So we have to, as a health care provider, 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 against Medicaid and against... supporting folks with lower incomes is just the opening scenes of a Christmas carol of Ebenezer 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 but that's how it feels he's like yes aren't there poor houses aren't there places workplaces to go

Kristine Stoddard: 45:57

how this feels right so we're creating more barriers for people who are eligible for Medicaid we're creating more barriers for them to access health insurance that they are legally eligible to access to save money. New Hampshire has tried a work requirement before and it didn't work. We had to stop it because it was costing the state so much money and we weren't able to contact enough people who would be subject to the work requirement to get them to comply with the work requirement. So we paused it. It stopped. It's actually current law, and it'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 work the first time was the work requirements, and yet here we are again.

Kristine Stoddard: 46:50

Right. It's like that Taylor Swift song.

Liz Canada: 46:54

Oh, which

Kristine Stoddard: 46:54

one? I've seen this film before, The Exile. 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 their health 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 they have 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 law says states, if you want Medicaid dollars, you have to have a work requirement. So we don't know yet what will happen if you don't prove that you're working. But we do know that people are going to lose their health insurance. Clinicians are going to lose reimbursement for the services that they provide. And people are going to go without care. Your insurance costs are going to go up if you're commercially insured. We know all of these things and we're still doing it.

Liz Canada: 47:49

Holding health insurance hostage. Yes. Fantastic. Really glad that's what we're spending 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 to eliminate gigantic sources of revenue.

Liz Canada: 48:08

Well, well, well. To save money really means that you're betting on people not doing it. and therefore losing their health insurance. You're making a bet against people.

Kristine Stoddard: 48:20

We are betting that Granite Staters don't want to work. We are choosing to see the worst in our friends and neighbors. We're choosing to see people as anything but human beings. And at the end of the day... It actually doesn't save anyone money. It doesn't save the state money. It doesn't save you money as a healthcare consumer. It doesn't save the healthcare provider money. It actually costs a ton of money for the state of New Hampshire to implement a work requirement, like millions and millions of dollars. So we're actually spending money to do something that that doesn't help anyone, that doesn't save any money, for what? To prove a point?

Liz Canada: 49:09

I don't know. I mean, I joke and not joke about Ebenezer Scrooge, but are they just hoping those people will 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 trying to help people who are unemployed access work. But we know that's not the case. Most people on Medicaid are working. I always tell my kids not to assume the worst in people. Assume the best. But despite hours and hours of testimony from healthcare consumers, from healthcare providers, from their own Department of Health and Human Services, telling them, policymakers, that they were that most people are working, that the people who aren't working, there's a legitimate reason. And that legitimate reason is already an exception that we built into the law in 2018. So why are we going through these extra steps just to prove a point? In the first year of implementing a work requirement, it is going to cost the state So just the state, not health care providers, which we should also talk about because the burden is going to be borne by them as well. It's going to cost the state alone almost $4 million in the first year, almost $3.8 million in the second year, $3.8 million in the third year. So we are wasting money to prove a point that research already shows is not real.

Liz Canada: 50:44

Right. We're spending money to justify cutting money?

Kristine Stoddard: 50:50

So how can anyone assume that this is done to benefit people, people who aren't working to get them working, when the only savings is generated by them losing their health insurance? Yeah. Hopefully my kids don't listen to this because this is me assuming the worst, but I don't see any other way the math works on this. It doesn't work. You're spending more money than you're saving, and so much harm is going to be done to actual people. Let's be exceedingly

Liz Canada: 51:22

clear here. All of these patients deserve health care. They are not doing anything wrong in this process. They deserve to be able to make an appointment, go to a health center, get treatment, get the things that they need to get healthy. In whatever healthy way needs to happen. And that should be the extent of their participation in this conversation. They should just be able to get the health care that they need. Yes. You shouldn't have to earn it. Prove it. Prove you need that health care.

Kristine Stoddard: 51:57

Prove you have skin in the game. Prove you're worthy of an insurance card to put in your pocket.

Liz Canada: 52:03

Right. And the providers who are providing this health care need to have the revenue coming in. to be able to provide that health care for these people who need it.

Kristine Stoddard: 52:13

Right. Because guess what, Liz? Your high cholesterol still needs to be treated. Shout out. Shout out to my high cholesterol. Your high cholesterol still needs 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 the health 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, so I can access those services and not be out $800 that blood work costs. So then when the providers lose revenue because their patients lose insurance, they have to let people go, which means they're fired.

Liz Canada: 52:59

Fewer providers.

Kristine Stoddard: 53:00

Which means they have fewer providers, which means that provider just lost their job, lost their health insurance, lost their income. that supports their family, and you have to wait longer to get your cholesterol levels checked because they have fewer providers. Because policymakers chose to implement policies that are guaranteed to kick people off of Medicaid. So everyone, Liz, should care if Granite Staters retain their Medicaid because it will inevitably impact every single person in our state. And that doesn't even get into what'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 federal piece. Yeah, it's a lot. No, this is incredible. So my last question for you is if folks are listening to this podcast and they're like, wow, I did not know. all this stuff about Medicaid. And so they're pretty frustrated to find out that our lawmakers and our policymakers in New Hampshire have made the conscious decisions to negatively impact people who are covered by Medicaid or who could be and so forth. What should they do, Kristine? What does one do with all the rage?

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 morning routine.

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 I know I cannot think about work because I am too busy doing too many 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 your friends and neighbors, because I bet you, Liz, you throw a rock or maybe... I don't know, a tennis ball is a better choice. No, rocks are great. You throw a tennis ball from your front door and you hit someone, they probably have Medicaid. Because guess what? Almost 200,000 people in our state are covered by Medicaid. If you go to the Merrimack County Nursing Home, those residents are thankfully insured by Medicaid. So it will affect every individual. Vote. Vote. Ugh. that say health insurance rates are going to go up. Not just because of what happened at the federal level, it's also these choices that our state policymakers have made to reduce state revenue and to push the burden and the cost down onto

Liz Canada: 56:31

residents. lunges like we've been doing at the gym. I do know what that is. You're going to vote, of course, but also you're going to contact your lawmakers. You don't have to wait until election day. You can talk to them now.

Kristine Stoddard: 56:57

Right. And it's actually better to talk to them now because they're less busy, because they're not in the legislative session. And they're also drafting bills right now. So if there's something they can do to help you or mitigate the consequences that are going to come because of this legislation, they can do it now.

Liz Canada: 57:16

Kristine, thank you so much. Thank you so much for your time. Thank you for coming on here and talking to me about Medicaid, which is health insurance.

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 note here on my desk that says, would you rather do this or 90 wall balls? That is the question that I have here. What is a wall ball? You take a weighted ball and you squat and then you throw it up as you get up and it hits the wall 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.