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HealthBeat

Commission: Expand Medicaid through private health insurance

The State House dome.

(ALEXANDER COHN / Monitor file)

The State House dome. (ALEXANDER COHN / Monitor file)

The New Hampshire Legislature should expand Medicaid, six members of the commission studying the issue this fall said yesterday.

The proposal they approved is “a consensus and balanced approach that represents our shared values, and also respects the interest of our people and providers and insurance carriers,” said Rep. Cindy Rosenwald, a Democrat from Nashua.

Five other commission members agreed with her, including Sen. Nancy Stiles, a Republican from Hampton. Sen. Andy Sanborn, a Republican from Bedford, and Rep. Neal Kurk, a Republican from Weare, opposed the report.

Charlie Arlinghaus, president of the Josiah Bartlett Center for Public Policy and one of the commission’s conservatives, abstained.

Stiles called the vote “not an ending point but a first step.”

The outline approved yesterday recommends expanding state support for health insurance to all adults earning up to 138 percent of the federal poverty level, about $16,000 for a single person.

Under President Obama’s Affordable Care Act, the federal government will pay the full cost for expanding the program for the first three years, and contribute at least 90 percent every year after that.

Nationally, 24 states have already committed to expanding while several others have taken paths similar to New Hampshire’s extended study through this commission, and could rule on the matter in the coming months.

Under the plan endorsed yesterday, New Hampshire residents with access to insurance through their employer would be required to take that insurance, not Medicaid. The state would help pay for their portion of the premium costs under the existing – but currently voluntary – Health Insurance Premium Payment (HIPP) program.

Requiring HIPP enrollment for people who are eligible for Medicaid must be approved by the federal government through a waiver.

Stiles recommended, and the commission endorsed, making the receipt of that waiver a condition for expanding.

The proposal also calls for people earning between 100 and 138 percent of the federal poverty level to purchase a private health plan, with state support for their premium costs, on the new federal marketplace instead of enrolling in Medicaid.

However, the federal government has indicated it will only approve that kind of program if the marketplace offers a choice of insurance carriers, state officials said.

In 2014, Anthem Blue Cross Blue Shield of New Hampshire will be the only company selling plans there, though Harvard Pilgrim officials have said they will likely join in 2015.

In the meantime, people who earn less than 138 percent of the federal poverty level and don’t have access to employer-sponsored insurance would choose a plan offered by one of the three insurance companies managing the state’s Medicaid program.

Conservatives’ amendments

Commissioners rejected several proposals from the group’s conservative members.

One proposal, from Kurk, would have required enrollees to work or actively seek employment.

Stiles and other members expressed concern about how that could affect coverage for stay-at-home parents, among other groups.

The commission also rejected a proposal from Sanborn seeking to tie expansion to receiving federal funds to match other state health care spending.

The federal government could take as long as two years to approve that particular waiver, Health and Human Services Commissioner Nick Toumpas said.

Kurk also proposed – and the commission also rejected – automatically ending the program if enrollment or state costs exceeded previous estimates.

Stiles said after the meeting that future legislators will have access to data from the first few years of expansion, on which they should base decisions about the program.

“I am optimistic that the legislative body will take the information collected in the first year or two and take action based on that, whether to expand or modify or eliminate the program,” she said.

“We will also have a sense then of if the program is working to change behaviors and improve outcomes. . . . We’ll know once we’ve looked at the data.”

The commission will meet again Tuesday to vote on the final report by consultants from Maine-based BerryDunn, being written from the outline approved yesterday.

Once the commission votes to accept the report, the Legislature will need to meet in a special session to debate and vote on the matter.

In a statement, Gov. Maggie Hassan, a Democrat who supports expansion, said she looks forward to working with the Legislature to “quickly move forward and ensure that more New Hampshire families have access to affordable health care.”

The Democratically controlled House has already indicated support for expanding the program, but the Senate, where Republicans hold a 13-11 majority, has not.

Last week, Senate President Chuck Morse, a Salem Republican, said he hadn’t yet seen a plan he and the majority of his chamber could support.

The commission’s recommendation “is a good starting point toward finding common ground,” he said yesterday in a statement.

He and Sen. Jeb Bradley, leader of that chamber’s Republican majority caucus, both praised the decision to focus on access to private insurance where possible.

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

I'm wondering why the recommendation to use private insurance rather than Medicaid. Is it a fiscal motivation? (Does it cost the state less?) Or is it a doctrinal motivation - a preference for a free market solution rather than a government program?

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