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HealthBeat

In testimony, N.H. Business and Industry Association announces support for Medicaid expansion

Lawmakers yesterday heard official testimony from dozens of New Hampshire residents as both chambers of the Legislature begin considering how and whether to expand Medicaid in the state.

One business group officially announced support for expanded Medicaid in New Hampshire yesterday, as another testified they might not be ready for what the expansion proposals expect.

The Business and Industry Association board of directors voted yesterday morning, just hours before Executive Director Jim Roche testified to a special Senate committee, to endorse expanding the program to low-income adults, as authorized by the federal Affordable Care Act, also known as Obamacare.

Roche, whose group represents more than 400 companies in industries ranging from advanced manufacturing to higher education and tourism, listed several caveats to its support, including a provision that the program should be re-evaluated if federal support – supposed to total 100 percent of cost through 2016 – falls short.

“Any proposal to expand the state’s Medicaid program should demonstrate it will not lead to additional cost-shifting to the business community and will lead to improved access, lower rates of the uninsured and better outcomes,” he said.

“An expansion of the state’s Medicaid program should maximize use of the private health insurance market to the extent allowed under federal law and minimize the effect of crowd-out,” or individuals who drop private employer-sponsored coverage to choose Medicaid.

Distinct bills being considered by the House and Senate both propose dramatic expansion of the state’s Health Insurance Premium Payment, or HIPP program, designed to do exactly that.

Approximately 150 people are enrolled in HIPP, which pays the employee portion of the insurance costs for people who are eligible for Medicaid but have access to an employer-sponsored insurance plan.

Both proposed bills would expand that number to as many as 10,000 people.

For people without insurance options through an employer, the two bills differ.

The House version would give all adults earning between 100 and 138 percent of the federal poverty level, or about $11,500 and $15,900 for a single person, support to purchase a plan on the new federal insurance marketplace.

All those earning up to 100 percent of federal poverty would be given access to managed care plans as part of the state’s Medicaid program.

The House proposal also shutters a joint legislative health reform oversight commission that has tended to put up roadblocks to Obamacare in New Hampshire, and removes the prohibition on the state government overseeing and operating the marketplace where insurance policies under the act are sold to individuals and small businesses.

Under the Senate proposal, authored by Senate President Chuck Morse of Salem, people without access to insurance through their work would have one year of premium support that they could use to purchase a plan on the exchange, or off, through one of the three companies that offer managed care plans for current Medicaid recipients.

In 2015 and 2016, the premium support would only go toward private plans on the exchange.

Kevin Klein, chief marketing officer for Well Sense, one of the three companies offering managed care plans for the state’s Medicaid program, said at the Senate hearing his company has a few reservations about the plan.

Managed care means the state provides the companies a fixed dollar amount per person enrolled. When the state contracted with Well Sense, New Hampshire Healthy Families and Meridian Health Plan, the contracts included the expectation that the state would expand Medicaid, adding to the number of people the companies might be paid to cover.

“We entered a competitive bidding process and feel we have a contract to cover this population. We’ve spent a couple million dollars to get to the point where we’re at, (and) we would have to invest a couple million dollars more. We don’t have the infrastructure to support working on the exchange today. . . . It’s unlikely it would happen in 2015, but you’d have our full commitment to look at it,” Klein said.

The hours of testimony before both chambers brought few surprises beyond the BIA endorsement of expansion and Klein’s reserved criticism.

Current and former residents of the Phoenix House addiction rehabilitation facility in Dublin testified that a lack of health coverage makes relapse a looming possibility in their fights to resume productive lives.

Religious leaders testified that expanding coverage is a moral obligation, and medical providers testified that people without insurance often forgo treatment until chronic conditions are in crisis, and then rely on emergency rooms for care that’s paid for by the rest of the system.

Conservative members of the Legislature testified that expanding will be expensive now and in the future, and would be politically impossible to end even if the federal government drops its share of the funding.

The committees will meet tomorrow to vote on their different versions of the bill.

Meanwhile, a group of consultants and industry insiders chosen by Democratic Gov. Maggie Hassan, Morse and Speaker of the House Terie Norelli continues to meet and negotiate toward a potential compromise for the full Legislature to vote on next week.

The special session for the Legislature to consider expansion ends Nov. 21.

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

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