Budget negotiators trade proposals on Medicaid expansion, but no agreement yet
State budget negotiators offered competing proposals yesterday on the critical issue of Medicaid expansion, with House Democrats asking to expand the program for at least three years starting in January and Senate Republicans offering to clear the way for a vote next year on whether to expand it.
Neither side refused to hear the other out, but they went home last night without reaching an agreement.
Time is running out. Committees of conference face a deadline of tomorrow to complete their work, meaning the next 24 hours will be critical for the budget negotiations.
If negotiators can agree on the specifics of a budget for the next two years, it will go to the Democratic-led House and Republican-led Senate next week for final approval before heading to Democratic Gov. Maggie Hassan’s desk.
But if a new budget isn’t in place before the new biennium begins July 1, the Legislature will need to pass a continuing resolution to keep the state government operating past June 30.
The House and Senate negotiators sought yesterday to break their deadlock over the question of whether to accept federal money under President Obama’s 2010 health care reform law to expand the Medicaid program and extend coverage to an estimated 58,000 low-income residents.
House Democrats and Hassan support expanding Medicaid starting next year, while Senate Republicans instead want to study the issue with a special commission that would submit its final report in late 2014.
The House Democrats were first yesterday to put an offer on the table.
Under their proposal, a special nine-member commission would work this summer to craft a New Hampshire-specific expansion plan. The Legislature’s 10-member Fiscal Committee – which is split evenly between Democrats and Republicans, senators and representatives – would vote on it in August.
If a plan isn’t approved by Sept. 1, the Department of Health and Human Services would be authorized to expand the Medicaid program through the end of 2016, while federal money would cover 100 percent of the expansion’s cost. (The federal government has said it’ll pay at least 90 percent in future years.)
“This proposal is really an honest attempt to be sensitive to the Senate’s desire to have the opportunity to review information on the Medicaid expansion before committing, and also to recognize the strong House position that expansion is the right decision, and our desire to implement it sooner so as to provide insurance to our low-income uninsured residents and take maximum advantage of full federal funding,” said Rep. Cindy Rosenwald, a Nashua Democrat and vice chairwoman of the House Finance Committee.
Sen. Chuck Morse, a Salem Republican and chairman of the Senate Finance Committee, called the House offer “a good first step.” And last night, Senate President Peter Bragdon, a Milford Republican, presented a counter-proposal.
Under the Senate’s proposal, a study commission would begin working this summer and issue a final report by the end of the year. That would clear the way for separate legislation expanding Medicaid to be debated next year and receive votes by the full House and Senate.
“We believe strongly that an affirmative vote by the full Legislature would be required before any expansion of Medicaid (could) occur. We will not accept a plan that takes the Legislature out of the process and may allow expansion to go forward by default,” Bragdon said.
Rep. Mary Jane Wallner, a Concord Democrat and the chairwoman of the House Finance Committee, thanked the Senate for its offer but didn’t immediately respond to it.
Medicaid expansion isn’t the only issue where the Senate and the House have yet to find common ground.
Wallner yesterday asked the Senate Republicans to recognize new revenue, including House revenue estimates that are $49.2 million above the Senate’s numbers, and restore $47.3 million in general fund spending.
That would include eliminating a $50 million cut to personnel that includes $20 million from the general fund, eliminating a $7 million cut to HHS, increasing funding for the New Hampshire Veterans Home and restoring money for Hassan’s proposed Office of Innovation and Efficiency.
In return, Wallner said, the House would accept $72 million in general fund spending added by the Senate in its budget, including $20 million for uncompensated care payments to hospitals and $3.4 million for new charter schools.
Morse said the Senate could agree on things like funding for the veterans home and eliminating the across-the-board cut to HHS. But he said he resented the implication that the Senate’s funding priorities could be cut, and won’t agree to the House’s revenue numbers.
“The reality is, we won’t accept this proposal and the Senate will not accept the $49 million in revenue. . . . I don’t believe we can come to a compromise on making a $49 million adjustment or cutting any of these lines that the Senate worked very hard on, to make sure that the people of New Hampshire were taken care of,” Morse said.
Rep. Dan Eaton, a Stoddard Democrat, responded that there has to be a give and take.
“I don’t think you can say that we can keep all of the Senate’s priorities and none of the House’s priorities,” Eaton said. “It is a barter. It is a conference committee. It is a compromise.”
Some agreements reached
The negotiators did reach tentative agreements yesterday on some smaller items in the budget.
∎ They agreed to go with the Senate’s proposed $10 million across-the-board cut to the Judicial Branch; the House had proposed a cut of about $9.6 million.
∎ They agreed to recognize $15.6 million more in revenue from several sources for the current fiscal year.
∎ They agreed to create a study commission to clarify what hospital revenues should be taxed under the state’s Medicaid Enhancement Tax.
∎ And they agreed on compromise language barring welfare recipients from using Electronic Benefit Transfer cards at liquor stores, gambling establishments and “retail establishments which provide adult-oriented entertainment.”
The budget conference committee will resume its work today at 10 a.m.
(Ben Leubsdorf can be reached at 369-3307 or
firstname.lastname@example.org or on Twitter @BenLeubsdorf.)