Although arbitrary, the first
hundred days of a president’s first term in office is often thought to be a
benchmark by which to measure that president’s early success. Exactly one
hundred days after stepping foot on the floor of the New Hampshire State House,
Garrett Muscatel—a junior at the College elected to serve as a house
representative for Grafton County—sat down with The Review to discuss his experiences surrounding policymaking and
reflect on his early successes.
Muscatel was placed on his top
choice for a committee—the Committee on Commerce and Consumer Affairs, a high
workload committee that reviews almost ten percent of all bills that are filed.
The committee is made up of a lot of small business owners and lawyers—the
chairman even owns an inn. Although Muscatel is the only college student on the
committee, he believes that his formal training at Dartmouth in economics and his
academic focus on public economics and healthcare has helped him uniquely
contribute to the Committee’s work. Members of the Committee often disagree
about particular policies, but, as Muscatel emphasizes “we never disagree about
the end goal of helping people.” It is this spirit of service that Muscatel and
the other members of the Committee on Commerce and Consumer Affairs have used
to work on influential bills that did end up passing the house.
The first bill that Muscatel
discussed during his conversation with The
Review was HB359—a bipartisan labeling bill that would require pharmacists
and health care providers to have a red sticker on the cap and a warning label
on the side of all prescription drugs containing opiates. “The way I saw the
bill and the way I framed it,” Muscatel commented, “was that it was about
choice—that’s why I came up with the idea to turn the bill into a red sticker
bill instead of a red cap bill. People should have the choice to take opiates.
But they also should be well-informed about the risks. Once you’ve been warned,
you should be able to take the sticker off.” Muscatel also explained that the
replacement of the cap with a sticker assuaged concerns that certain
representatives had about the red cap putting people in danger: would people
get mugged coming out of a pharmacy if there was a red cap on a bottle of
pills? Would the red cap make people more likely to steal the pills? In
evaluating the bill, the Committee came across a similar piece of legislation
in Utah— “This gave us the confidence to move forward with HB359. It had been
well-studied in a different state and Utah had seen positive results with
little drawbacks. It was something that we felt could make a real difference in
the ongoing fight against the opioid epidemic.”
The second bill that Muscatel
discussed in great, fervent detail was a bill that he created: HB717, a bill
prohibiting prescription drug manufacturers from offering coupons or discounts
to cover insurance copayments or deductibles. Upon first glance, this bill
seems odd— a bill banning coupons? How on earth could this save anyone money?
Muscatel knows that this bill is confusing. He explained that pharmaceutical
manufacturers use coupons to persuade people to switch their medications from
generics to brand names—increasing costs, but not making people any healthier.
Although the consumer feels as though their saving money, the insurance company
picks up the tab for the expensive, unnecessary brand-name drug. This
additional cost increases everyone’s premiums, and Muscatel hopes that
eliminating these coupons will make insurance more affordable. “It’s a classic bait and switch,”
Muscatel emphasized. “You think that you’re saving money, but you’re not. When
a lot of people use coupons, it causes insurance premiums to go up at the end
of the year. So, in the end, the coupons cost you and the state a lot of
money.” Muscatel also explained that this bill was based heavily on research. A
Harvard study that looked at the differences in copay coupon use between New
Hampshire and Massachusetts saw that coupon use resulted in 4% higher
prescription spending in New Hampshire in comparison to Massachusetts. 4% may
not sound like a lot of money, but it most certainly is. Muscatel further
emphasized to other effects of this bill. The government of New Hampshire may
lose revenue from certain taxes, but it should also spend less on health care—
“by keeping premiums down, it’s like a tax cut for anyone who pays for health
insurance.”
A future problem Muscatel is passionate
about working on is something called Ambulance balance billing. A complicated
problem, Muscatel made it easy to understand: “An insurance provider will only
cover up to a certain amount for a service like an ambulance. The ambulance
costs something greater than that amount. So, at the end of your hospital stay,
you get billed by the ambulance service provider for the difference in their
price and what the insurer will pay. I want to work on preventing these huge
surprise bills that can wreck your life. If you have insurance, if you do
everything right, you shouldn’t need to worry about something like this. We
should be willing to provide to society the notion that you shouldn’t have your
life screwed up because of an accident.”
An average Tuesday, Wednesday, and
Thursday for Muscatel is exhausting. He wakes up early, drives an hour and
fifteen minutes to Concord, works until the late afternoon, makes the commute
back, and then gets started on his coursework and, of course, researching the
bills which flood his Committee. A dedicated Economics major, Muscatel is
grateful to Dartmouth for allowing him to make a course schedule and D-Plan
that works with his obligations. He is thankful to his professors and peers for
their support.
It is in this spirit that Muscatel
wants to improve the relationship between Dartmouth and the State House this
summer— “One of the goals we have this summer is thinking about the upcoming
year and what needs to be researched. Dartmouth has amazing faculty that are
well-versed in how complicated policy questions can be. Rocky has an awesome
policy research center that I want to get more involved with.”
The House is not in session over
the summer. But that does not mean that there isn’t work to be done. The bills
that the Committee did not feel comfortable voting on get studied over the
summer. Muscatel explained that the Committee is often cautious. “We have one
researcher and one staff member. As a busy Committee hearing around ten percent
of the total bills—91 bills out of a thousand went through the Commerce
Committee—it’s a fast process. We put a lot of work into reading through bills
and making sure that they’re going to be good policies. But sometimes we have
doubts about a bill and retain it in the spirit of due diligence. Then, over
the summer, we research retained bills and have something ready by the start of
session for the next year.”
At this point, I asked Muscatel how
his schedule differed month to month. Muscatel responded that January was spent
in Committee or Subcommittee studying and discussing different bills.
Sometimes, there were marathon executive days where Muscatel’s committee would
go through “42 or 43 bills in two days where a typical session was more like
two or three bills. It was a lot,” Muscatel commented, “but it was a good time.
We really did get through a lot and get a substantial amount of good work
done.” February got exciting—there were more full house sessions popping up
where Muscatel could vote on his first bills and make his first speeches. Now,
in April, the Commerce Committee is beginning to start on the twenty-four
Senate bills.
“I’m lucky that I’ve spent a lot of
time with government and working with legislatures,” Muscatel remarked on his
past experience surrounding policymaking. “I’ve worked on seven campaigns and
interned with Congresswoman Brownley and with California State Senator Stern.
The learning curve is undoubtedly steep. But I’ve had such wonderful mentors in
the other members of this district. I know I’ll be able to do a lot more work
next year because of their support.”
When asked about his most rewarding
experience in the house, Muscatel—for the first time throughout our
conversation—looked stumped and asked whether he could give more than one
answer. “It depends on how you define rewarding,” Muscatel commented. “Working
so hard on my copay coupon bill as something that’s going to help people and
lower the cost of healthcare was rewarding in and of itself. But it’s also
something that sounds complex and horrible at first glance— ‘who wants to ban
coupons?!’ When I got that bill to pass the house, that was a big
accomplishment, and it was also a great human moment. We all know each other in
the house, and everybody knows when everyone’s first floor speech is happening.
When I checked my phone later that day, I had at least 50 pictures sent to me
with messages of congratulations. I think that’s the most rewarding thing,
though. All of the representatives are normal people who care about the state
and aren’t interested in being career politicians. These are people with
full-time jobs who take time out of their life to make this state a better
place for everyone. The reaction when people find out that I’m a New Hampshire
State rep is never one of anger or disgust. It’s always ‘thank you for your
service.’ That’s because of my fellow state reps and those who came before me.
It’s a rewarding experience to be involved with people who make the state a
better place. That’s unique in this world.”
The post Representative Muscatel’s First 100 Days in Office appeared first on The Dartmouth Review.