Politicians give mixed grades to John Stephen's performance at HHS

Many assume run for Congress will be Republicans next step

John Stephen, the embattled Republican commissioner of Health and Human Services in a government ruled by Democrats, will leave office this Friday two months before his term expires. As head of the largest state bureaucracy, he often wielded as much power as his boss, the governor, at least before the Democrats took power. He launched numerous controversial projects over the objections of Governor John Lynch, and GOP lawmakers approved them much the way Stephen asked for the first three years. This last term the House and Senate undid much of his work.

“There were many things the governor and I agreed on,” Stephen said. “I took an oath office to exercise my statutory duties to the best of my ability. You have to make tough decisions. Not everyone is going to agree with them.”

The courteous rivalry between the two savvy and driven workaholics fueled rumors they would face each other some day in a gubernatorial campaign. Now it might happen. Stephen refuses to tip his hand.

“We can talk about my future after Aug. 14,” he said. “But I’ve always enjoyed public service and will continue to do it in some capacity. I learned to take it very seriously growing up with a dad who was a state senator.”

Statehouse insiders assume that means a run for governor or for Congress in a GOP primary battle against Jeb Bradley of Wolfeboro, who lost his seat to Carol Shea-Porter last year in the Democratic landslide. Stephen was one of seven Republicans Bradley defeated in 2002 before topping Democratic state senator Martha Fuller Clark of Portsmouth.

Few experts think Lynch is beatable if he tries for a third term, because his ratings remain high and he won last time with 74-percent of the vote. But Stephen might give him a strong enough challenge to protect the rest of the party slate from the Lynch coat tails that swept dozens of GOP incumbents from office. A credible campaign next year might position Stephen for a successful try in 2010, the same way Ronald Reagan made it to the White House.

Supporters of Stephen are throwing a $25-a-plate banquet for him Sept. 4 in Manchester to celebrate his tenure and thank him. But it includes a (dare we say it?) campaign-style presentation after the meal to highlight his accomplishments. So what is his legacy, if it’s not too early to say?

Stephen merged four area agencies for the developmentally disabled into two, including the absorption of the Conway-based Center for Hope into Northern Human Services. According to the commissioner, the resulting efficiencies removed 40 people from the wait list for community care.

He pushed to fully fund the statewide wait list in two years, while the governor submitted a budget this February to that job in four years. Lawmakers split the difference and passed a bill to end it in three years.

Stephen implemented roughly half of his GraniteCare reform of medical services for the elderly and disabled under Medicaid. He warned of a future healthcare crisis if business as usual endures after the huge generation of baby boomers ages into fragile health. The goal of GraniteCare was and still is to serve folks in their own homes and towns, not in more expensive nursing homes.

His department weathered the federally-mandated Medicare Part D crisis that forced 20,000 patients with both Medicare and Medicaid to use only Medicaid for their drug coverage. The change was chaos for the first two month, but many critics had predicted patients would die for lack of meds. That never happened, and the program has run smoothly after its rocky shake-out period.

The commissioner tightened the laws and rules for needy families on state welfare, pushing many parents into the workforce. His GraniteCare Select project died in the Joint Legislative Fiscal Committee three weeks ago when lawmakers left its fate to the next commissioner. It would have forced hospitals and other medical providers to bid for the right to perform elective medical care in their region.

In a letter to his staff, Stephen took pride in returning $143-million unspent to the general fund. That amount includes $21-million that lapsed from the nursing home line item, as he sought to divert long term-care patients into assisted living centers and home and community based care. That lost revenue has long been a huge issue with the 10 counties. They are suing the state over a budget that makes them pay the entire non-federal share of the Medicaid program for nursing homes and community care programs for the elderly. The state now pays for seven other Medicaid programs without county help.

Senator Kathy Sgambati (D-Tilton) is maybe the person best qualified to judge Stephen’s work. She served for half a decade as deputy commissioner of Health and Human Services, and her Senate committees include Finance and HHS. She knows the bureaucracy Stephen inherited, the new budget, and all the policymakers. She praised him for trying to shift the focus of care out of nursing homes, an approach that began with the closing of Laconia State School in the 1980s.

“He moved that philosophy forward,” Sgambati said. “It’s appropriate for long-term care patients and the disabled too.”

She said some of the changes in Temporary Aid to Needy Families were good, but some were injurious. The revised law this term gave the department wide flexibility to give low income parents the schooling and training to earn jobs that pay a livable wage and keep them off welfare for good.

She explained why lawmakers put off launching GraniteCare Select.

“The rates we pay providers are already too low,” she said. “We have to keep our provider community. Many of the patients would have had transportation problems.”

She explained why Democrats wanted to end the wait list in three years. The area agency system couldn’t absorb hundreds of new clients that quickly, and the proposed budget buys the time to do the job right.

“We were hesitant to flood the system with money without knowing it was ready to spend it well,” Sgambati said.

Rep. Fran Wendelboe (R-New Hampton) ran against Bradley and Stephen for Congress, and she has served on Health and Human Services and Finance in the House. She said Lynch and Stephen never had a working relationship and seldom talked to each other.

She praised Stephen for getting 44-percent of the low-income families on state welfare into compliance with federal work-search rules, one of the highest rates in the country. She thinks his next campaign is for Congress.

“That’s what I’ve heard, although he hasn’t discussed it with me personally,” Wendelboe said. “A number of people think he should run for governor, but Joe Kenney is thinking of running for governor too. I know Jeb is working very hard fro Congress. He’s been everywhere.”

Senator Joe Kenney (R-Wakefield) considers Stephen a strong friend of the taxpayer, who protected clients while cutting red tape and trimming the bureaucracy. He thought the merger of the area agencies in his district went smoothly for the most part.

“He’ll be remembered as a guy who badly wanted to end the wait list,” Kenney said. “It’s something my constituency really wanted.”

Belknap County Commissioner Chris Boothby of Meredith said he could never trust Stephen to keep his word. Boothby is a prime mover in a lawsuit filed this month by the counties to avoid paying anything for Medicaid.

“He never delivered on his promises,” Boothby said.

Rep. Judy Reever (D-Laconia) is mostly pleased to see Stephen leave, saying he’s too driven by the bottom line and not by human needs. As vice chair of Lakes Region General Hospital Board she knows how his administration affected hospitals.

“It hurt them,” she said. “GraniteCare Select was going to save money on the backs of poor people with no transportation to get to the lowest bidders, who might sacrifice quality. We’re talking people here, not cars. We have to ask ourselves what we would want in their situation.”