Medicaid expansion compromise unlikely
Republican leaders yesterday shut down the possibility of a compromise on Medicaid expansion being reached before a special session ends today.
With no deal in sight by yesterday afternoon, “there are too many moving parts to try at the 11th hour and 59th minute,” said Senate Majority Leader Jeb Bradley of Wolfeboro.
“There’s been an opportunity lost in the special session, I’m afraid,” he said.
Gov. Maggie Hassan, a Democrat, said she was open to continuing negotiations but was told by Republican leadership that those efforts would be to no avail.
“I got told today this is too difficult and nothing is happening at the moment,” she said in a meeting with reporters.
The two sides differ on the question of when and how the state should expand the program, which is authorized by the federal Affordable Care Act. The federal law contains full funding for three years of health coverage for all adults ages 19-64 earning less than 138 percent of the federal poverty limit, or about $16,000 for a single person. That funding would gradually drop to 90 percent by 2020 and thereafter, though Republicans doubt any of the federal funding promises can be met and fear the expansion will expose the state to millions of dollars in liability.
About 58,000 people in the state would be eligible.
Democrats want to use the federal funding to offer premium assistance starting Jan. 1 to people with access to insurance through their employers, and give the rest of the eligible group coverage through the state’s managed care Medicaid program from Jan. 1 until January 2016, then move people onto the private insurance bought on the federal insurance marketplace.
The Republican plan crafted by Bradley and Senate President Chuck Morse of Salem holds off on launching the premium assistance plan by tying it to permission from the federal government to move the newly eligible people onto private insurance bought on the marketplace.
“I think the hard dates are very important to managing the process,” Morse said yesterday, specifically pointing to June 2014 as a potential start date for the premium assistance, and June 2015 for people to move onto the marketplace.
The plans also differ at the other end of the calendar: The Republican proposal ends completely after 2016, when federal funding is slated to drop to 98 percent. The Democratic plan requires the Legislature to reconsider expansion if the federal funding dips below what is prescribed in the Affordable Care Act.
Hassan said yesterday she was open to negotiating on those issues, but that Republicans will not extend the period of time when people are on managed care plans to a timeline she considers adequate to develop the insurance marketplace and secure federal permissions.
Senate Minority Leader Sylvia Larsen of Concord said in a statement her caucus will not vote for the Republican plan today.
“It is time for our Republican colleagues in the Senate to be willing to compromise and work with us on a plan that can be implemented with a timeline that our insurance providers, health providers and federal oversight agencies agree can be rolled out responsibly,” she said. “Despite how far we’ve come, despite how close our proposals are, Senate Republicans refuse to consider any timeline other than the unworkable plan in their bill.”
Both Morse and Bradley said Hassan unnecessarily politicized the debate, crippling chances for a deal.
In her remarks at the state Democrats’ annual Jefferson Jackson dinner Saturday, she said, “The bad deal (Republicans) are offering will hurt our citizens and state more than no deal at all.”
Hassan also made several stops this week in or near the home districts of Republican senators considered the most likely to break with their party and back the plan supported by the House, which Democrats control.
One, Sen. David Boutin of Hooksett, issued a statement following the event criticizing Hassan’s rally at Southern New Hampshire University.
“I fully intend to support the Senate plan,” Boutin wrote. “It meets our shared goal of increasing access to coverage while also taking vitally important steps to protect our taxpayers from the failures of Obamacare. If we work together, I believe we can get the necessary waivers from the federal government and can get thousands of New Hampshire residents enrolled in high-quality private health coverage early in 2014.”
Hassan also made stops in Plymouth, in the district of Sen. Jeanie Forrester; in Lebanon, just outside the district of Sen. Bob Odell; and in Hampton, the hometown of Sen. Nancy Stiles, who served this summer on the commission that drafted a plan, for which she voted, that forms the basis of the House proposal.
The press conferences were in response to Republican leaders’ intransigence, said Hassan spokesman Marc Goldberg.
“When they walked away from the table, the governor felt that she had to take the conversation to the people so they could hear what was going on in Concord,” Goldberg said.
Pressure in the other direction came from the Republican Liberty Caucus of New Hampshire, which identified 11 of the 13 Republican senators in a special section of the group’s website called “RINO HUNTING.”
Except for Sen. Andy Sanborn of Bedford and Sen. Sam Cataldo of Farmington, all Republican senators are called “Republicans in Name Only” on the site, with information about how to contact them to urge them to vote against expansion, and forms to fill out to suggest conservatives to run against them in primaries next fall.
Morse predicted the issue will not be resolved today but will come up when the Legislature reconvenes in the new year.
“I don’t think this issue’s going away. I think we’ll be back here in January debating it, and we will get a solution for the state of New Hampshire that works for the whole state, not just for one party,” he said.
(Sarah Palermo can be reached at 369-3322 or firstname.lastname@example.org or on Twitter @SPalermoNews.)