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Supporters of Medicaid expansion in N.H. stake hopes on a special session this fall

  • Maggie Hassan, Democratic candidate for governor, held a town hall at Havenwood-Heritage Heights in Concord on July 6, 2012.<br/><br/>(John Tully/ Monitor Staff)

    Maggie Hassan, Democratic candidate for governor, held a town hall at Havenwood-Heritage Heights in Concord on July 6, 2012.

    (John Tully/ Monitor Staff)

  • Senate President Peter Bragdon, a Milford Republican,  sits for an editorial review board at the Monitor; Thursday, February 24, 2011.<br/><br/>(Alexander Cohn/ Monitor staff)

    Senate President Peter Bragdon, a Milford Republican, sits for an editorial review board at the Monitor; Thursday, February 24, 2011.

    (Alexander Cohn/ Monitor staff)

  • Maggie Hassan, Democratic candidate for governor, held a town hall at Havenwood-Heritage Heights in Concord on July 6, 2012.<br/><br/>(John Tully/ Monitor Staff)
  • Senate President Peter Bragdon, a Milford Republican,  sits for an editorial review board at the Monitor; Thursday, February 24, 2011.<br/><br/>(Alexander Cohn/ Monitor staff)

During the first few days of budget talks last week, House and Senate negotiators were greeted at the Legislative Office Building by a woman wearing a homemade can costume.

The message from the New Hampshire Citizens Alliance for Action was written on its side in bold letters: “don’t kick the can” down the road by delaying a decision to accept federal money and add an estimated 58,000 low-income New Hampshire residents to the Medicaid program.

But the final budget deal hammered out by Republicans who control the Senate and Democrats who control the House does delay that decision. Assuming the budget passes Wednesday, a special study commission will get to work next month and issue a final report by Oct. 15 on whether the state should expand Medicaid, and if so, how.

“If it is a real study, people’s minds will change. People’s thoughts about expansion will change,” said Charlie Arlinghaus, president of the Josiah Bartlett Center for Public Policy, a conservative think tank. “And I think much of the debate on both sides right now has been very political.”

Supporters of Medicaid expansion aren’t giving up – especially since it appears likely a special session of the Legislature will meet sometime between mid-October and the end of the year to vote on the issue.

“I think there’s been a definite partial kicking of the can down the road. It’s not what we wanted,” said Kary Jencks, interim executive director of New Hampshire Citizens Alliance for Action.

But, Jencks said, she hopes that the study commission will move the process forward and her group “will be working very hard to ensure that there will be a special session and a positive vote.”

Studying expansion

Expanding Medicaid to cover adults with incomes up to 138 percent of the federal poverty line is one of the pillars of the 2010 federal health care reform law championed by President Obama. The federal government would cover 100 percent of the cost of the expansion for the first three years, from 2014 through 2016, and pay at least 90 percent in future years.

In New Hampshire, a study last year by the Lewin Group estimated the state would take in about $2.5 billion in federal money over seven years and add an estimated 58,000 people to the Medicaid rolls. The state’s cost over seven years would be $85.5 million, according to the report.

When the Supreme Court ruled in June 2012 that Obamacare was constitutional, it also decided that states’ participation in the Medicaid expansion was optional, not mandatory.

Since then, 23 states plus the District of Columbia have decided to go forward with the expansion and 21 have decided to pass, with six still debating the issue, according to the Kaiser Family Foundation.

One of those six is New Hampshire.

When final negotiations on the state budget began June 14, Senate Republicans and House Democrats were on opposite sides of the issue of Medicaid expansion. The House, along with Gov. Maggie Hassan, wanted to use the budget to expand the program starting Jan. 1. The Senate wanted to study the pros and cons of expansion first, with a commission filing its final report by Dec. 1, 2014.

After trading offers and counter-offers for several days, a deal was reached early Thursday morning: the Senate gets its study commission, but the House gets a speeded-up timeline. Along with the rest of the budget, it goes before the House and Senate for final approval Wednesday.

The commission will have nine voting members: three senators, three representatives and three members of the public. Insurance Commissioner Roger Sevigny and Nick Toumpas, commissioner of the Department of Health and Human Services, will be nonvoting members.

Five of the nine voting members will be appointed by Democrats: two representatives and one public member by House Speaker Terie Norelli, one senator by Senate Minority Leader Sylvia Larsen and one public member by Hassan. Four will be named by Republicans: two senators and one public member by Senate President Peter Bragdon and one representative by House Minority Leader Gene Chandler.

The commission has a budget of $200,000 and a wide mandate to explore partial or full expansion as well as ways to tailor the program.

At one point during the budget negotiations, Bragdon, a Milford Republican, dismissed a House proposal for a study wrapping up by the end of July as “a make-believe study committee.”

Rep. Mary Jane Wallner, a Concord Democrat and chairwoman of the House Finance Committee, retorted that a shorter study could and should work.

“I know that when we get ready to do the work, we can get it done and we can get it done in a timely manner,” Wallner said.

Under the final agreement, the commission’s report will be due Oct. 15.

Arlinghaus, who describes himself as a skeptic on Medicaid expansion, said that’s still not ideal, and the commission won’t have the benefit of observing what happens in states that do expand their Medicaid programs next year.

“By the time they get things rolling, that’s three months of work,” he said. “That’s better than one month, and not as good as six.”

Special session likely

So what happens once the study commission’s report is out?

The Legislature typically comes back in January for the second year of its session, and legislation to expand Medicaid could be filed then. But the House proposed calling a special session before then to debate and vote on Medicaid expansion, so that if it passes the program could expand on or close to Jan. 1.

The Senate refused to commit to coming back early. But the study timeline leaves time for a special session to be called between mid-October and the end of 2013 to deal with legislation on Medicaid expansion.

Bragdon could balk at calling a special session then, but it’s not entirely his decision. The state Constitution also allows the governor and Executive Council to call a special session, and three of the council’s five members are Democrats, as is Hassan.

“I am confident that once members of the Legislature see the results of the study, they will want to move forward as quickly as possible through a special session,” Hassan said in a statement Thursday.

Groups that fought for Medicaid expansion during the budget process are now staking their hopes on that special session.

“While we are disappointed that the Senate was unwilling to move forward immediately with a decision to accept the federal funds for Medicaid expansion, we respect and appreciate the agreement to engage in brief and timely study that will allow for legislative action, via special session, shortly thereafter,” said Tom Bunnell, policy consultant for New Hampshire Voices for Health, in a statement.

Jeff McLynch, executive director of the liberal-leaning New Hampshire Fiscal Policy Institute, called the deal a “step in the right direction,” but said he was disappointed a specific date wasn’t set for a decision to be made.

“Thousands of New Hampshire families are still waiting and they need the security of knowing they will have access to affordable health care when they need it,” McLynch said in a statement. “We ask the study commission to meet promptly and move quickly to clear a path so the state can maximize the benefit from the 100 percent federal funding for Medicaid expansion that is available only through 2016.”

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

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