Representative Muscatel’s First 100 Days in Office

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.”