N.H. Senate Republicans present Medicaid expansion plan that relies on private insurance

Last modified: 11/8/2013 12:06:43 AM
Lawmakers opened a special session of the New Hampshire Legislature yesterday to begin discussing whether the state should expand its Medicaid program, as allowed under federal health care reform.

Within two hours, both chambers had approved rules for the session, recessed and proceeded into press conferences about their separate proposals, both of which would require approval from federal officials before being enacted.

The federal government would fund 100 percent of the cost of expanding until 2016, and gradually decrease funding to 90 percent in 2020.

A vote is scheduled for Nov. 21.

On a unanimous voice vote, the Senate quickly accepted the rules for the special session, and members spent the balance of the meeting praising ailing North Country Executive Councilor Ray Burton.

Republicans, who hold a 13-11 majority in that chamber, have said they will not support an expansion of Medicaid. Senate President Chuck Morse of Salem and Senate Majority Leader Jeb Bradley of Wolfeboro publicly presented their alternative at a press conference after the recess yesterday.

They propose creating a special trust for federal money to pay the premiums for about 24,000 low-income workers with access to employer-sponsored insurance, and to give about 34,000 other residents access to the state’s managed care Medicaid program for one year.

In the second and third years, the federal funding would help low-income people without employer-sponsored coverage to purchase private insurance on the federal marketplace, also known as the exchange.

The plan would contain work or training requirements along with co-pays, deductibles and wellness initiatives.

Bradley said the proposal protects New Hampshire medical providers because private insurance pays higher reimbursement rates than Medicaid, and it protects taxpayers by keeping the expansion separate from the general budget.

Democrats, including Gov. Maggie Hassan and a majority of members of the House, support a plan drafted by a commission last month that also uses the federal funding to help working individuals get insurance through their employer and enrolls most others onto managed care Medicaid.

Under that plan, only people earning between 100 and 138 percent of the federal poverty level will be given support to purchase plans on the exchange in 2015, not the entire eligible population, as the Senate plan proposes.

The Republican proposal also includes a sunset provision ending the program Dec. 31, 2016, unless reauthorized by the Legislature at that time.

Both proposals would require waivers from officials in Washington, D.C. Federal Medicaid regulations require that programs operating under a waiver are cost-neutral and provide the same services, including things such as transportation to nonemergency medical appointments, that Medicaid recipients would get in the traditional program.

“I remain hopeful that politics won’t get in the way,” Morse said, noting that the waiver will rely on cooperation from both parties in the state and New Hampshire’s delegation in Congress.

In the House, the Democrats’ bill was introduced only after about a half-hour of debate, which included attempts by some Republicans to scuttle the proposed rules for the special session and delay or block the introduction of the bill itself.

Rep. Bill O’Brien of Mont Vernon, the former Republican speaker of the House, asked his colleagues to vote against every motion during the special session, which he said “was set up for one purpose and one purpose only, and that is to expand the welfare state (which) consigns generations in the future to dependency on government.”

In the end, the House voted along party lines, 183-141, to introduce the bill, which also contains a repeal of a ban on the state operating the insurance marketplace.

“Throughout the process, Democrats have made many significant concessions, and repeatedly demonstrated a willingness to hear and discuss creative and uniquely New Hampshire solutions to best meet the needs of our citizens while at the same time reducing costs and increasing savings for our state,” House Speaker Terie Norelli said after the session ended.

Senate Minority Leader Sylvia Larsen of Concord said yesterday the timeline of the Republicans’ plan is particularly concerning to her.

She’d prefer the sunset clause to coincide with the end of the state budget year in June 2017, so the discussion of reauthorizing the program can be held in that context, she said.

Hassan also questioned the timeline of the Republican plan, which could be stalled by waiting for waivers from the federal government.

The federal government has not yet ruled on waivers for states to put people onto the exchange if only one company is selling plans, as is the case in New Hampshire with Anthem Blue Cross Blue Shield, and has not ruled on waivers for states that require more significant cost-sharing by enrollees than is typical for Medicaid.

“For every day that we delay past January 1, we stand to lose at least half a million federal dollars per day that New Hampshire can never recover,” she said in a statement.

Conservative lobbying groups also criticized the Republican plan.

Aaron Day, chairman of the Republican Liberty Caucus of New Hampshire, wrote in a statement that both parties’ plans are “financially unwise, and will lead to a further erosion of state sovereignty,” and advocated not adopting any expansion of Medicaid during the special session.

While only 10 members of the Senate, all Republicans, stood behind the podium as Morse and Bradley presented their proposal, they said they hope and expect to develop broad support for the final bill.

“Our goal is a plan that 24 senators can vote for,” Bradley said.

Consultants and experts tapped by Hassan, Norelli and Morse have been meeting since the commission issued its report last month. That group will continue to meet and negotiate, both sides said.

(Ben Leubsdorf contributed to this report. Sarah Palermo can be reached at 369-3322 or spalermo@cmonitor.com or on Twitter @SPalermoNews.)


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