NH’s 1st District Democratic primary has become a ‘Who’s the most pro-healthcare’ competition

When Robert F. Kennedy Jr. visited New Hampshire in May, former Portsmouth City Councilor Stefany Shaheen stood outside the Concord press conference to let voters know it was his anti-science policies that convinced her to run for Congress.

Hampton Selectwoman Carleigh Beriont, the leading progressive in the race, has been pitching a single-payer Medicare for All system

Christian Urrutia, on the other hand, held a press conference in Manchester last week where he listed all the reasons why he believes he’s the only true Medicare for All candidate in the race.

Maura Sullivan counters them with “Medicare for all who want it.”

Sarah Chadzynski chastised the Medicare for All proponents for focusing on an issue she doesn’t believe is viable in a divided Congress, instead opting for piecemeal solutions.

Shaheen, Beriont, Urrutia, Sullivan, and Chadzynski are five of the eight Democratic candidates running in New Hampshire’s 1st Congressional District primary. Rounding out the ballot are Matthew Emerson, Bill Conlin, and Sarah Bella Spinosa. On Monday, state Rep. Heath Howard dropped out of the race and threw his support behind Beriont.

Throughout the campaign, healthcare has proven to be a key focus as candidates in a crowded primary field attempt to stand out in the eyes of voters. Sullivan, who holds a slight lead over Shaheen at the top of the most recent poll from St. Anselm College, called healthcare affordability her no. 1 issue.

Competing calls for Medicare for All

At the heart of the election’s healthcare debate has been expanding Medicare, the country’s public health coverage program, which mainly covers seniors over age 65. 

Five of the candidates are calling for Medicare for All in some form.

Sullivan proposed a “Medicare for all who want it” system. That means offering access to Medicare to everyone but allowing those who don’t want Medicare to keep their private insurance.

“I hear from folks all around our state that they’re just getting crushed for costs, and some want Medicare for All,” she said. “Others are worried about the government running their health care, and with the government the way it is right now, can you really blame them? And Medicare for all who want it gets that public option and the real competition that we desperately need.”

The other four Medicare for All proponents — Shaheen, Beriont, Urrutia, and Chadzynski — are proposing single-payer systems in which the private insurers are replaced by Medicare and governmental programs.

“I want to address what I believe is one of the great moral questions of this election today,” Urrutia said at a press conference on the banks of the Merrimack River last Tuesday. “And the question is, in the richest country on earth, are we prepared to deny life-saving health care to people because they can’t afford it?”

Urrutia said his plan would be paid for with a tax increase on employers and employees to pay for it but that it would be dwarfed by the savings people get from ditching insurance premiums.

Shaheen said she supports a single-payer system that eliminates private insurers, but she acknowledged that, if she couldn’t get single-payer, she would support a public option system like Sullivan’s.

Beriont echoed that sentiment, saying “I am somebody who would absolutely co-sponsor the Medicare for All legislation that’s been proposed right now, and also won’t necessarily say no to anything that would help provide better care for people in the Granite State as soon as humanly possible.”

Emerson, a former Democratic Party volunteer, had a more unique proposal. He doesn’t support immediate expansion of Medicare or Medicaid. He said he wants to create a third public health program that’s available to everyone, but is not Medicare or Medicaid.

“The goal is competition,” he said. “That is the No. 1 goal.”

But who’s the one who can actually make it happen?

In a race filled with Medicare for All advocates, some candidates have struggled to articulate to voters why they are the best candidate to turn the idea into law.

Shaheen pointed to her experience in the biotech industry as an executive for the Manchester-based biomanufacturer ARMI and founder of Good Measures, a company seeking to help people with chronic illnesses find support.

“I know how hard and complicated the system is,” she said. “I know the kinds of things we can do near-term, and the kinds of things we need to be prioritizing to deliver relief for people. And I think that experience will come through to the voters and make it very clear from my understanding the very complicated network of what it means to be a licensed provider in 50 different states.”

Shaheen is also the mother of a type 1 diabetic, something she has repeatedly said gives her an understanding of the stakes.

Sullivan said her proposal is designed to be viable. She argued her opponents’ plans would be nonstarters for their would-be colleagues in Congress.

“Folks can say all the great ideas they want, but if you can’t get them done, then Granite Staters are still hurting,” she said. “If I had a single term in Congress, what am I going to tell Granite Staters that I’m going to get done for them? This is something I think we can get done in a divided Congress, Medicare for all who want it.”

Still, Sullivan said her plan could be a first step in the path to a single-payer system in later years.

“I know how hard healthcare reform is,” she said. “And so I’m being very thoughtful about what I can get done and what I can deliver.”

Sullivan, a former Obama administration official and Marine Corps veteran, also said she’d capitalize on the camaraderie she holds with Republicans who also served in the military to work across the aisle.

For her part, Beriont said she’s the candidate to get it done “because I can explain clearly and directly to everybody how we can use that type of legislation along with fully funding our public schools to lower our property taxes here in New Hampshire; because I’m an organizer and I serve locally, and I am good at reaching consensus and bringing around to my point of view; and because I’ve just heard enough stories from enough people that I think can change the hearts and minds of anybody who thinks that it’s not a good investment at this point.”

Urrutia, who works as a lawyer and Army National Guardsman, said he’s “the credible progressive with a message of change.” Additionally, Urrutia has gone on the offensive, particularly against Sullivan and Shaheen, who have consistently been at the top of the polls.

“Maura Sullivan calls for Medicare for all who want it,” he said. “That’s just consultancy-speak for not-Medicare. It borrows the phrase Medicare for All, and then denies the single element that makes it important, which is a universal healthcare coverage that wraps in everyone together.”

Urrutia argued Sullivan’s proposal would create “a tiered system: the sick and the poor on the public rolls, the rich and the healthy on the private rolls.”

“Stefany Shaheen, look, I got to be frank with you,” Urrutia continued. “I spent a year on the campaign trail with Stefany Shaheen. I still don’t know her healthcare position. Her answers have been a word salad.”

Asked about those criticisms, Shaheen said, “I’d invite him to go back and think through the number of candidate forums starting on the very first day I launched this campaign, highlighting healthcare as the cause of the campaign and the cause of my life.”

Shaheen denies accusations she isn’t fervently pro-Medicare for All or that she recently changed her stance. However, previous statements she made appeared noncommittal.

“I support every option we need to fix this broken healthcare system, but that (single-payer) is not where we — we know we have to deliver change today with meaningful measures that happen today. We can’t wait for rebuilding the system to deliver relief for people,” she told NH Journal in June.

Criticism of senators’ caving in the ACA tax credits fight

Shaheen is the daughter of current U.S. Sen. Jeanne Shaheen. The elder Shaheen drew stinging criticism last year when she provided a key vote to end a Democratic-induced shutdown. Democrats had shut down the government in an effort to force Republicans to renew an expiring set of Affordable Care Act tax credits that Americans used to pay for healthcare. Eventually, however, Sen. Shaheen caved and, alongside a small group of Democrats, ended the shutdown before securing any definitive Republican promises on the tax credits.

The younger Shaheen, at that point months into her own congressional campaign, was outspoken in criticizing her own mother for the vote.

“As a result of those tax credits not being extended, 12,000 New Hampshire people today are without health insurance who had it a year ago,” she said in an interview last week, “because it has gotten so expensive that families can’t afford to keep their health insurance. So when it was clear that Speaker (Mike) Johnson wasn’t going to guarantee a vote, I knew I couldn’t support the deal.”

Virtually the entire field echoed Shaheen in opposing the move. Sullivan, for her part, said she’d make restoring that tax credit a top priority should she be elected.

Other proposals

Chadzynski concedes she doesn’t believe enough members of Congress will sign on to pass Medicare for All.

“I am absolutely a single-payer system proponent,” she said. “However, I think one of the biggest things that we’ve done as Democrats is overpromise and underdeliver.”

For that reason, Chadzynski wants to tackle something she thinks is more feasible: have the federal government take over what she calls “re-risk insurance,” a special type of insurance that insurers secure from other insurers to cover potentially high-cost patients. She thinks the government can do it cheaper.

“This is something we could get done in the next two years,” she said.

Chadzynski also wants to switch the entire healthcare system to a nonprofit model and put more guardrails on how insurance companies can dictate to providers how care is provided.

“If the whole system is moved over to a nonprofit model, then you level the playing field, and you don’t have the for-profit model as the reason for shutting down maternity wards,” she said.

Meanwhile, Beriont has emphasized antitrust laws as a tool to break up the corporate monopolies she argues have a harmful stranglehold on the U.S. healthcare system.

“I think that one of the reasons that our healthcare experience is so much of a nightmare and way too expensive is because we have like a handful of corporations that own our doctors and our pharmacies and our insurance companies and our hospitals,” she said. “They take a cut at every step of the way, and it’s so expensive for all of us.”

Emerson said he wants to focus on fighting Medicaid fraud. Asked for specifics on his plan to do so, Emerson said: “You need to have complete oversight, and that’s in the contracts we produce. That’s in making sure we severely limit no-bid contracts. That is looking at people who overbill Medicaid and Medicare.

“When you have a budget that’s in the trillions,” he said, “to think that there’s no one committing fraud, that’s almost like hyperbole.”

Conlin, who hasn’t polled above 1% in recent polls, did not respond to the Bulletin’s request for an interview.

Spinoza, the remaining candidate, told the Bulletin she doesn’t expect to win. She called her campaign “basically a messaging and accountability campaign this cycle” and in future cycles she’ll “double down and concentrate on electability.” She described herself as a “Democrat-Libertarian hybrid.”

The primary will take place Sept. 8. The Republican primary is also crowded. In November, the winner of the Democratic contest will face Portsmouth businessman Anthony DiLorenzo, Manchester state Rep. Brian Cole, Newfields businesswoman Hollie Noveletsky, Bedford finance professional Melissa Bailey, or Moultonborough businessman Lindsey Anderson.