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N.H. Medicaid expansion study panel aims to wrap up work next week

James Varnum, former president of Mary Hitchcock Memorial Hospital chairs a special commission Wednesday, Oct. 2, 2013 in Concord, N.H., charged with recommending whether New Hampshire should expand Medicaid. The panel has an Oct. 15 deadline to file a report. (AP Photo/Jim Cole)

James Varnum, former president of Mary Hitchcock Memorial Hospital chairs a special commission Wednesday, Oct. 2, 2013 in Concord, N.H., charged with recommending whether New Hampshire should expand Medicaid. The panel has an Oct. 15 deadline to file a report. (AP Photo/Jim Cole)

A plan to expand New Hampshire’s Medicaid program took shape yesterday. But after three months of work, the special commission studying the issue put off any final vote for another week at least.

The commission will meet Tuesday, a week before its report is due. Chairman Jim Varnum said he hopes it can wrap up its work then.

Its members took more than a half-dozen votes yesterday as they parsed and debated a plan drawn up by Rep. Tom Sherman, a Rye Democrat and commission member. They unanimously endorsed the principle that New Hampshire residents, ages 19 to 64, with incomes between 100 percent and 138 percent of the federal poverty line should get health coverage.

But those preliminary votes didn’t give much clue as to how the nine voting commissioners will line up on the final report, which is due Oct. 15 and will likely trigger a special session of the Legislature to debate and decide the expansion issue.

Gov. Maggie Hassan, a Democrat, and the Democratic-controlled House support accepting federal money that would cover most of the cost to expand the state’s Medicaid program, a pillar of President Obama’s 2010 health care reform law.

But the Senate, where Republicans hold a 13-11 majority, in June blocked Medicaid expansion from being enacted as part of the state budget. Instead, the study commission was appointed to recommend whether the state should expand Medicaid, and if so, how.

Five of the commission members were appointed by Democrats while four were appointed by Republicans, making it likely a majority will support expansion in the end.

Under Sherman’s plan, the state would expand its Medicaid program while providing several private options for newly eligible residents. He’s proposed expanding the state’s existing Health Insurance Premium Program, to pay premiums for employer-provided health insurance when it’s available, as well as giving people the option of buying health insurance on their own, such as the plans available on the new exchange.

Sherman’s plan would include a so-called “kill switch” or “circuit breaker:” If the federal government ever stopped paying at least 90 percent of the expansion’s cost, the Legislature would have six months to reauthorize the expanded program before it would end automatically.

That proposal was tentatively endorsed yesterday on an 8-1 vote. But a proposal by Rep. Neal Kurk, a Weare Republican, to set up a similar “kill switch” if the program’s total net costs for the state began to balloon at an annual rate of 20 percent or more was rejected, 6-3.

(Ben Leubsdorf can be reached at 369-3307 or bleubsdorf@cmonitor.com or on Twitter @BenLeubsdorf.)

It's amazing how many people believe poor people should be further punished and rich people should be further rewarded by society and the government. There are a lot of low paying and part-time jobs with no or inadequate health insurance. Are these people and the elderly and disabled who depend on Medicaid just "takers" or "useless eaters" unworthy of our assistance? Remember no one is healthy and young forever. Almost anyone could be in desperate financial straights at some point in their life. We'll all pay in any case if people depend on the emergency room because they don't have insurance. If only we were like our more humane neighbors to the north or across the Atlantic.

Don't expand medicaid. A great article in the Keene Sentinel a few days back explains why. Medicaid reimbursement is the reason why health insurance costs are so high in NH. It's forcing the average normal premium paying non indigent person to absorb the costs of medicaid recipients. NH does not need to expand into a welfare state. It's totally unneccessary and the people receiving medicaid are NOT the ones keeeping the NH economy vibrant and strong. We should be making sure that our back bone of society, the ones working the 30-50 hour work week are kept healthy and medically protected so they can keep doing their jobs and spending money in NH for all the things needed to keep our state functioning at the highest level of productivity possible. Not many medicaid recipients add much to the workforce dynamics. Enough with the bleeding heart mentality. No need to add more burdens to the people already paying enough to absorb the costs of the existing medicaid reicipients. DO NOT EXAPND MEDICAID IN NH. People can freely donate to a poverty health care fund if they want.

Desmond, like so many conservatives, is (to paraphrase John Kenneith Galbraith), " ... engaged in one of man's oldest exercises in moral philosophy; that is, the search for a superior moral justification for selfishness." The reality is far different. Medicaid, in its current limited state, is a far more efficient provider of health care services than is private insurance. That medicaid reimbursement does not meet 100% of what some for profit hospital describes as its "costs" is debatable, but even if true, represents only a tiny, tiny part of the problem. The real problem is that our current model places virtually 100% of the health care burden for working people directly on small, medium, and large companies that have chosen to do the right thing, and provide health care benefits for their employees. This system, a relic of World War II era tax law, makes it virtually impossible for American and New Hampshire companies to compete in the global marketplace. More than that, companies become the "payer of last resort" that do, in fact, end up subsidizing Medicaid payments to providers. But ask yourself this ... Why is it that for the same procedure, Medicaid patients get charged n, privately insured patients get charged n x 3, and uninsured patients get charged n x 10? The tiered charge system, just one of literally hundreds of unethical practices perpetrated on Americans by giant insurance corporations, sure appears to be in violation of the equal protection clause of the 14th amendment. I suggest New Hampshire expand Medicaid, which costs the state virtually nothing, and provide bare-bones decent medical coverage for the poor that need it. That's the moral, ethical thing to do here.

Ben Leubsdorf, were there roll calls on the votes?

another nail in the coffin for the USA caused by the debt & deficit democrats

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