House passes Medicaid expansion bill, rejects marijuana legalization amendment

Thursday morning, legislation the House and Senate largely agree on – continuing expanded Medicaid – looked like it may become the most divisive. 

Both chambers have shown strong support for continuing the program, which provides insurance to more than 60,000 lower-income Granite Staters who don’t qualify for traditional Medicaid. The program, 90 percent of which is paid for by the federal government, is set to end this year.

They disagree, however, on how long to extend it, with the Senate insisting it be made permanent and the House agreeing to a two-year extension. 

Thursday the House members moved to leverage that divide by amending the Senate’s Medicaid expansion bill to include legislation legalizing marijuana, a House priority the Senate killed last week. In exchange, the amendment would give senators a permanent expansion of Granite Advantage, the state’s version of expanded Medicaid.

Rep. Andrew Prout, a Hudson Republican, reminded House members they have passed marijuana legalization bills several times. What they hadn’t done, he said, was “attach it to something important.”

Prout’s effort failed. The House rejected adding the marijuana amendment to Senate Bill 263 118-241, the biggest vote split of more than 30 amendments voted on Thursday. The House then went on to pass SB 263 as it came to them, with a permanent continuation of expanded Medicaid, 193-166. The bill will now go to the House Finance Committee for a second look because it involves state spending. 

This isn’t the end of the chambers’ Medicaid expansion duel. The House included the two-year expansion in its budget, and any changes will likely come back before representatives when the budget gets a final vote in June.

Granite Advantage, which has widespread support among medical providers, health advocacy groups, and the business community, has been credited with reducing the number of uninsured residents, improving health outcomes, and saving the state and hospitals money.

Marijuana legalization was one of more than 30 amendments House members filed ahead of Thursday’s vote, an indication of how important the House believes SB 263 is to the Senate. Several amendments, all of which failed, would have enhanced eligibility demands such as requiring drug testing, an annual exam, and work requirements. 

In 2019, a federal court blocked the state’s attempt to add a 100-hour-a-month work requirement, saying the federal government had not sufficiently considered the potential for work requirements to cost beneficiaries their coverage. 

The Kaiser Family Foundation estimated that in October 2022, 70 percent of all New Hampshire adults enrolled in Granite Advantage and traditional Medicaid were working. It did not separate out only Granite Advantage members.

Some amendments would have extended this year’s expiration of the program by a few years. 

Others were unrelated to Medicaid. 

• Rep. Josh Yokela, a Freemont Republican, sponsored amendments that would clarify when a minor can possess a hypodermic needle and set new requirements for sealing public records. Both failed.
• An amendment from Rep. Kelley Potenza, a Rochester Republican, would have set limits on the governor’s state of emergency powers, similar to legislation the Senate killed in April. It failed by a larger margin than most amendments. 
• Rep. Kristine Perez, a Londonderry Republican, sponsored an amendment that would expand the wellness check required for eligibility to include screening for multiple drug use, particularly in the areas of cardiology and mental health, to avoid dangerous drug interactions and side effects. It failed.