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N.H. lawmakers to start meeting on Medicaid expansion

Today, lawmakers will begin meeting in a special session to negotiate a potential agreement on expanding access to health insurance to many of the state’s poorest residents.

Today’s meetings of the House and Senate will be for setting the rules of the session, which lasts until Nov. 21. Officials on both sides of the issue have said they are meeting frequently to negotiate.

Leaders of the Democratic majority in the House, along with Democratic Gov. Maggie Hassan, have said they want to expand Medicaid effective Jan. 1 to ensure access to all available federal funding. Republicans in the Senate, lead by Sen. Chuck Morse of Salem, want any deal to focus on increasing access to private insurance plans, not Medicaid.

Medicaid is available in New Hampshire for children and parents in very low-income families, senior citizens and people with disabilities.

Under the federal Affordable Care Act, states can expand the Medicaid program to all individuals earning up to 138 percent of the federal poverty level, or about $15,900 for a single person and $32,500 for a family of four. The federal government would pay 100 percent of the cost for the first three years and then gradually reduce its share to 90 percent by 2020. About 58,000 additional people would be eligible for coverage in New Hampshire.

A bipartisan commission recommended last month that the state expand Medicaid to all eligible participants, but it should require that anyone with access to an employer-sponsored plan first sign up for that and receive state funding for the individual’s share of the premium costs.

Yesterday, Hassan said the decisions for all involved should keep uninsured New Hampshire residents at the forefront of their minds as they deliberate.

“What we will all be focusing on is that our decision affects real people with real lives,” she said. “Finding a way forward will allow them to get access to the care they need.”

Morse said this week his priorities are simple but different from those of the governor and House leaders: “58,000 people going on Medicaid (is) not acceptable to the Republican Senate,” he said.

“We won’t be voting for Medicaid expansion.”

Instead, he’s hoping “to work toward a compromise that creates better access to private health insurance plans.”

He said Tuesday he’s confident some pieces of such a plan, such as expanding the state’s premium assistance program to approximately 24,000 people with access to insurance through their employers, could be in place within 60 days. Granting premium assistance to other people to purchase plans on the federal marketplace could be achieved within a year, he said.

Several other states have worked under the federal guidelines for Medicaid expansion to develop programs giving more people access to private insurance.

In September, the federal government approved one: Arkansas officials’ request to use Medicaid dollars to purchase private health insurance for about 225,000 residents.

The state applied through a waiver that requires changes to Medicaid cost the federal government the same or less than traditional Medicaid expansion.

Approval for those waivers typically lasts for five years, but a different federal authority will be granting waivers for expanded Medicaid after 2016, so the Arkansas plan is only approved through then.

Unlike New Hampshire, where Anthem Blue Cross Blue Shield is the only company selling plans on the marketplace this year, and is only offering 11 plans this year, more than 70 insurance plans are available on Arkansas’s marketplace from four companies, according to the Associated Press.

Arkansas is also different from New Hampshire in the way it administers its Medicaid program. While 2014 will be the first year of managed care in New Hampshire, with private companies accepting a per-person payment from the state, Arkansas’s program operates on a fee-for-service model.

In its approval of Arkansas’s plan, the federal government installed some requirements and restrictions. Medicaid offers several services that the plans being sold on the marketplace do not, including transportation to nonemergency medical appointments.

The federal government made approval of the premium-assistance plan contingent on the state ensuring people have access to that additional coverage, often called “wrap-around” services.

Iowa has also applied for a waiver to provide Medicaid to newly eligible people who earn up to 100 percent of the federal poverty level through a managed care contract similar to New Hampshire’s about-to-launch program, and to provide financial assistance for people earning up to 138 percent of the federal poverty level to buy insurance on the marketplace.

However, Iowa’s proposal included a request to waive providing wrap-around services and require individuals to pay a higher share of their health costs than is typically allowed under Medicaid.

Iowa officials proposed requiring a $20 monthly premium for new Medicaid enrollees who earn between 100 and 138 percent of the federal poverty level, but federal law limits total expense to recipients to no more than 5 percent of the household income. The state would waive some or all of the premium if people completed certain health-related activities, such as an annual physical.

The federal government has not yet ruled on Iowa’s application.

(Sarah Palermo can be reached at 369-3322 or or on Twitter @SPalermoNews.)

Legacy Comments31

GWTW, Google, gaggle, gobble, who cares? I feel I demean myself by even responding to your or Sail's gibberish.

Log in

You are correct, Sail, but overall no one is going to respond to any of those facts. Instead they will call you an extremist, right winger, etc. Insisting that those facts are not facts and calling you a troll.

Obamacare is destined to pay for itself or at least it was supposed to until the Republicans started messing around with it. The GAO reports that it will bring down the deficit. Paul Ryan's budget even uses the savings from Obamacare to lower the deficit. As for the storm in the Philippines, I have never seen or heard such mean spirited people that can take a human tragedy and try to turn it to politics.

You are the one that mentioned the storm in this comment string in the first place...and your reason? Trying to score a cheap political point about Fox. And then, in the ultimate display of hypocrisy, you accuse others of exactly what you just did. Dont you have anything better to do?

on a daily basis Tillie is akin to the "pot calling the kettle black"

Always have to bring in race, don't you Sail?

Tillie - you may want to google that phrase and then apologize to me.

Sail, that was a form of sarcasm, you may want to goggle the meaning of the word. How did you people exist before the internet? Did you ever just know something because you were well informed,educated and well read?

Reply to tillie below...its "google"

HEADLINE : the hostile liberal takes a failed stab at Sarcasm

Excuse me, but weren't you the one that decided before any other storm was mentioned that you just couldn't stand the word "unprecedented" in a story about the Sandy survivors? Yes or No? You know I don't care what you and little "me too" group think. There is global warming and climate change and it will affect you too. You can build all the underground bunkers you want, stick your fingers in your ears, and cover your eyes but it won't stop it. To be honest with you until I started reading these right wing posts, I thought all the people that thought like you guys lived in the deep south and never got past 8th grade.

The most powerful and destructive hurricanes all occurred before "global warming" and CO2 of less than 400ppm. But I'll take your angry namecalling post as a sign that my my previous comment hit the mark.

It is not about revenue, it is about the government spending in an ever expansive way and the take over all aspects of life. By the way, the top 10% pays 90% of all taxes, in essence the middle class pays very little.

Well Tillie, then maybe you could enlighten us where the money will be coming from for programs, how business will manage to afford health care, and what happens when half of the folks in the US do not work. What happens when the govt keeps printing money? All we keep hearing from folks is that the govt needs to keep footing the bill for more services, yet we have less and less folks contributing by paying taxes. Now if we have more folks on Medicaid, who pays for that? The lefties just do not get it. Sure would be nice if you would give examples of how your ideas will work. But then again, many folks believe the govt is one big bank, that you can keep making withdrawals from and never have to make deposits.

Of course we get it. You just don't like the answer. The money comes from the same place our national defense spending comes from, and our public education, and our public safety, and a myriad of other services you probably would not want to go without. What makes health care any different? If it's ok to spend public money on education for all citizens, why is it not ok to spend public money on insurance for all citizens? How do we pay for it? Raise the damn taxes on people who can afford it. Get them back closer to the level they were before Republicans started slashing them beyond sustainable levels. Yeah, many of us (including me) would pay more in taxes, but we wouldn't have to shop for and pay for insurance, would we?

straight from the Socialist Manefesto

I bet Chuck Morse has decent health insurance.

intelligent people usually do

I am a public school teacher living on a budget, and an active, lifelong NH voter. I hope the good people of New Hampshire will extend accessible, affordable health care to all those living in the state who need it. I am hopeful that the voters of the state will contact their representatives to let them know that it is unacceptable to have the poor and financially struggling of our state continue uninsured. We'll never get a better opportunity to extend a helping hand to those in need of affordable health care in our state.

who is going to pay for it?

Has anyone asked Rep. Morse WHY it's unacceptible to have additional people on Medicaid? I really would like to understand the objection. It also occurs to me that this low income population may also have difficulty with transportation, so serving them through the marketplace may not make sense for many of them. The one insurer in the marketplace has a narrow network, so people will need to travel to get to providers. For middle-income folk, that's an inconvenience, but for low income it may be an impossibility.

The nation is broke and it is not the govts job to replace personal responsibility with nanny state socialism

The nation isn't broke, that is another Republican "talking point." Just want to bring to your attention, Sail, the mega storm hitting the Philippines, they probably don't mention it on Fox. Like the huge storm that hit India and the storms battling England and Europe. I feel it is my duty to keep you informed since you only pay attention to the weather in the US. Watch for further updates. yes...we are very very broke....

FACTS for low information democrats...... "To be fair to Katrina, Haiyan is a much smaller storm. Hurricane force winds only extend about 50 miles from the center; Hurricane force winds extended far more than 100 miles from Katrina's center. Unfortunately, we'll never know Haiyan's intensity, since there aren't any Hurricane Hunters to fly through and check. We don't even know if 870mb was near the lowest pressure".....but liberals will sensationalize the normally occurring weather as they believe their liberal media ..... it is their religion.

By all means, lets do away with nanny state socialism. Let's have people starving and dying in the streets, going without medical care and basic necessities. While we are at it lets also ban all abortions so we can keep these numbers high. Bring back workhouses and debtors prisons and the philosophy of survival of the fittest. Let's bring back the good times of Charles Dickens world. Yes indeed, that is a country I would love to call home.

Lets look at how the democrats policies have worked out for you..... People on Food Stamps in 2012; Record 47,791,996 , Obama´s Recovery: $1.3 Trillion Below Average.... the weakest since the Great Depression, Americans with a job fell by 735,000, to less than 144 million. Just 58.3% of adults were employed in October. Health Care Fukushima: 129 Million To Lose Their Plan, Real Wages Declined in 3rd Quarter; Down 3.2% Under Obama , Welfare Recipients Now Outnumber Full-Time Workers. EVERY ONE OF THOSE STATEMENTS IS A HEADLINE YOU CAN GOOGLE

Your right the goverment is broke. And we have the republicans to thank for that. They have continualy reduced the amount of revenue taken in from Business and the 1% by giving them huge tax breaks and exemptions while increasing spending on unessesary weapons systems and programs that the military does not want or need but that benefit their corporate friends . Close the tax loopholes and make the 1% pay at rate at least equal to what the middle class pays and we won't be in near as much debt as we are today.

Or perhaps these failed companies of "corporate friends" of Obama have contributed: Evergreen Solar ($25 million), SpectraWatt ($500,000), Solyndra ($535 million), Beacon Power ($43 million), Nevada Geothermal ($98.5 million), SunPower ($1.2 billion), First Solar ($1.46 billion), Babcock and Brown ($178 million), EnerDel’s subsidiary Ener1 ($118.5 million), Amonix ($5.9 million), Fisker Automotive ($529 million), Abound Solar ($400 million), A123 Systems ($279 million), Willard and Kelsey Solar Group ($700,981), Johnson Controls ($299 million), Schneider Electric ($86 million), Brightsource ($1.6 billion), ECOtality ($126.2 million), Raser Technologies ($33 million), Energy Conversion Devices ($13.3 million), Mountain Plaza, Inc. ($2 million), Olsen’s Crop Service and Olsen’s Mills Acquisition Company ($10 million), Range Fuels ($80 million) Thompson River Power ($6.5 million), Stirling Energy Systems ($7 million), Azure Dynamics ($5.4 million), GreenVolts ($500,000), Vestas ($50 million), LG Chem’s subsidiary Compact Power ($151 million), Nordic Windpower ($16 million), Satcon ($3 million), Konarka Technologies Inc. ($20 million), Mascoma Corp. ($100 million). Yes say-what it is all the fault of Republicans.

Itsa. your cherry picking again. For example AMONIX received over 5 million from the Bush administration. And Solyndra's loan was started by the Bush administration also and had many of it's key investors were republicans. So you can't place the blame solely on Obama. Besides which the total of what you cite comes nowhere near close to the amount of lost revenue given to the 1% in tax breaks, loopholes, and subsidies.

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