With three weeks to issue report, commission inches ahead with Medicaid expansion discussion
With three weeks to go before its deadline to issue a recommendation, the commission studying whether New Hampshire should expand its Medicaid program seems poised to recommend that it do so – if sufficient safeguards are in place.
At issue now are details that could determine whether the recommendation is supported by any of the commission’s four conservative members.
“I’m quite sure there is a majority that is set and good to go,” said Commissioner Charlie Arlinghaus, president of the Josiah Bartlett Center for Public Policy, one of the commission’s conservatives. “There are others who are not saying ‘no’ but have concerns. . . . It might be possible for them to have concerns and suggestions that are worked out in bits and pieces.”
Under the federal Affordable Care Act, states can expand their Medicaid programs to all adults who earn below 138 percent of the federal poverty level. In New Hampshire, that would add about 49,000 people to the program. The nine-member commission is required to issue a report by Oct. 15 so the Legislature could vote on the issue in a special session before the end of the year.
If the state does expand Medicaid starting Jan. 1, the state would collect an additional $2.44 billion in federal aid.
Arlinghaus and Sen. Nancy Stiles, a Republican from Hampton, suggested that while starting the expansion Jan. 1 would give the state access to the most federal funding, the start date should be contingent on the federal government approving any waivers the state submits to customize the program.
The waiver several commissioners seemed to support last week would require people who are newly eligible for Medicaid to use the state’s Health Insurance Premium Payment program to supplement employer-sponsored coverage, if it’s available.
The rest of the newly eligible enrollees would choose one of the three companies that recently took over care management for the state’s Medicaid program.
Stiles also repeatedly emphasized the need to include “circuit breakers” that would end the program if federal funding dips below promised levels, or if the requirements for coverage expand without adequate increases in funding.
Arlinghaus recommended instead including a sunset provision that would end the program at a certain time regardless of the federal funding, unless it is proactively renewed by the Legislature.
Commissioners, even those who agreed on many other topics, still disagreed widely on the issue of cost-sharing for patients, such as co-pays or premiums.
“We’ve heard evidence from those who support expansion, from those who oppose expansion, from those who are neutral on expansion, that cost-sharing doesn’t work with this population,” said Travis Harker, a primary care physician at the Concord Family Health Center and president of the New Hampshire Medical Society.
“It would be an exaggeration to think (co-pay requirements are) really going to drive changes.”
Rep. Tom Sherman, a Rye Democrat and a gastroenterologist at Exeter Hospital, disagreed.
“I do think there’s value to incentives, (and) we should look at this when we have more data,” he said.
Sen. Peggy Gilmour, a Hollis Democrat, questioned whether the commission or the Legislature even could add to the cost-sharing that will be required by the private care management companies.
“They will have their own plan for cost-sharing. . . . We said we are turning management over to the private companies. We’ve got to let them do this out of the gate and re-evaluate at contract time,” she said.
Consultants have compiled all of the testimony given to the board in a draft report – with the recommendation section left blank – that is available on the state Department of Health and Human Services website.
Members will discuss an alternative to expansion at a meeting next Tuesday, to be based at least partly on a plan suggested by Avik Roy, a senior fellow at the Manhattan Institute.
Roy’s proposal would give certain eligible people subsidies to buy private insurance for catastrophic coverage.
(Sarah Palermo can be reached at 369-3322 or
firstname.lastname@example.org or on Twitter @SPalermoNews.)