No deal on Medicaid expansion

A special session of the Legislature closed yesterday with no deal for expanding Medicaid to an additional 50,000 low-income adults, despite leaders on both sides of the political aisle saying they remain willing and eager to reach a compromise.

The Republican-controlled Senate voted on three amendments to its original bill, ultimately approving one, 13-11 along party lines, before tabling the bill in the early afternoon.

“People of goodwill need to keep working together,” said Senate Majority Leader Jeb Bradley of Wolfeboro. “We’ve seen in the last week that instead of people being serious, it’s been politicized,” he said, pointing to rallies Gov. Maggie Hassan, a Democrat who supports a different form of expansion, has held in the home districts of several senators.

In a statement released at the end of the day, however, Hassan indicated there was little good will left between the parties on the issue.

“We offered Senate Republican leadership nearly everything they asked for; all we wanted was a plan that would actually work from day one and for the long term. But Senate Republicans refused to budge, putting ideology first and the people of New Hampshire second,” she said.

“Our providers are ready for expanded health coverage, our businesses are ready, our people are ready, and I am ready. . . . I hope that at some point, a few Senate Republicans will set ideology aside and step forward to do what is right,” Hassan continued. “Until then, it is the people who are hurt, and it is the people whom senators must answer to.”

The proposal left on the Senate’s table at the end of the day would not give any of the newly eligible people access to the same coverage received by people already in the state’s Medicaid program. Instead, it would give them federal funds to purchase insurance on the federal insurance marketplace, but only once the federal government approves all necessary waivers.

Those waivers could take anywhere from one to two years to write, submit and be approved, and approval may hinge on whether multiple insurance companies offer plans on the marketplace for sale. Currently, only Anthem Blue Cross Blue Shield offers plans for sale there.

“It may not be perfect. That doesn’t mean it won’t work,” said Sen. Bob Odell of Lempster, a Republican who had been targeted by Democrats as a potential swing vote.

Democrats sought a plan that would give people coverage through the state’s managed Medicaid program until the waivers are approved, then move them onto the marketplace with federal funds for buying plans.

Sen. Peggy Gilmour, a Democrat from Hollis, proposed an amendment with a two-year deadline to move people onto the marketplace, with automatic sunset provisions if several interim deadlines for writing and submitting the waiver applications weren’t met. It would have postponed the starting date until after the federal government approved the most widely supported provision – that eligible people with access to health care through their employer should be given federal dollars to help pay for the premium.

It also would have changed the membership of the commission that would have overseen the writing of the waiver applications, and it would have given the state Department of Health and Human Services oversight of the trust for federal funds for premium assistance.

That amendment was defeated, 13-11, along party lines.

In the House, Republicans lacked the votes to block the Democratic Medicaid expansion plan. But they deployed a variety of procedural maneuvers as delaying tactics during yesterday’s debate, and unsuccessfully offered five floor amendments to the bill itself.

“I suggest that we have the time, in the next session, to try to come to a reasonable compromise that does it right, both for the people who need the help and for the people who have to pay for it,” said Rep. Neal Kurk, a Weare Republican. “This bill doesn’t do it, but we can get it right.”

In all, the House took 21 preliminary votes over 4½ hours of debate before finally voting, 198-146, to pass its plan to expand Medicaid.

“The New Hampshire Access to Health Coverage program is the product of extensive study, thoughtful consideration, great innovations and significant compromise,” said Rep. Cindy Rosenwald, a Nashua Democrat.

“After four public hearings, the bipartisan recommendations of the Medicaid expansion commission and the testimony of experts throughout the process, it became clear that the people of New Hampshire need and want this opportunity for expanded access to health care, and that this plan is the best way for us to achieve that expanded access,” Rosenwald added.

That final vote fell largely along party lines: four Republicans joined 194 Democrats to support the bill, while one Democrat and 145 Republicans voted against it.

“For me, this is strictly a conscience vote. I just cannot bring myself to go back to my constituents who make $32,000 a year or less and say to them, ‘I’m sorry, but you’re not going to get insurance,’ ” said Rep. Bob Elliott of Salem, one of the four Republicans who voted for the bill. “I just can’t do that.”

The Senate quickly killed the House bill on a 13-11 party-line vote.

If the issue were to come up during the new session in January, any bills proposed would go before the public in committee hearings before votes by either chamber.

As the Senate voted to adjourn the special session, again on a party-line 13-11 vote, Senate President Chuck Morse said he expected to be considering the issue again.

“I agree there’s more to do, and I agree there’s a way to get there,” he said. “It’s not over.”



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