Details of Medicaid expansion plan emerge

The bipartisan group of senators behind a Medicaid expansion deal announced last week said they’ve created a system unique to New Hampshire that will give low-income people access to health care while increasing health care competition and decreasing uncompensated care costs.

“I think the federal government could’ve built a model much like we’re building now for the whole thing and been better off,” Senate President Chuck Morse, a Salem Republican, said in a briefing with reporters yesterday.

Lawmakers have been working for more than a year on legislation to provide new health insurance coverage to more than 50,000 low-income people, made possible by new federal dollars under the Affordable Care Act. But in the past, both parties were unable to come to an agreement, even during a two-week special session held in November dedicated to Medicaid expansion.

This bill would give premium subsidies to about 12,000 new people with employer-based health plans. An estimated 45,000 additional people would get federal money to help them buy plans on the insurance marketplace. The expansion plan backed by the federal government would put these people into existing Medicaid programs, so New Hampshire needs a waiver to use the money for private plans instead.

Senators from both parties said yesterday that they’re confident their caucuses will support the bill, which Republicans are declining to call Medicaid expansion. Instead, the bill calls the plan a “health protection program.” A full version of the bill should be available today, and the Senate Health, Education and Human Services committee will hold a hearing Tuesday.

In addition to Morse, the two Republicans sponsoring the expansion are Senate Majority Leader Jeb Bradley of Wolfeboro and Sen. Bob Odell of Lempster. On the Democratic side, Sens. Peggy Gilmour of Hollis, Lou D’Allesandro of Manchester and Senate Minority Leader Sylvia Larsen of Concord support the legislation.

The Democratic-led House has been supportive of Medicaid expansion, and the senators said they believe the House will support this new bill. Gov. Maggie Hassan endorsed this expansion bill in her State of the State address last week and reaffirmed her support yesterday.

For the 45,000 people not on employer plans, the bill would provide coverage in several steps and could take that coverage away if the waivers aren’t approved. These newly eligible people would enter into the existing Medicaid managed care program July 1 of this year.

If the state does not receive a waiver by March 31, 2015, the program will end and those people will lose coverage June 30, 2015. If the state does get a waiver, these people will remain on Medicaid until the end of 2015, then begin purchasing private plans on the marketplace in 2016.

Coverage under this bill will stop if federal funding dips below 100 percent. The federal government only plans to fully fund the program through the end of 2016, dropping to 90 percent and then lower. This means the next Legislature will have to reauthorize the bill in order for coverage to continue.

With much of the bill’s success hinging on waivers, Bradley said he is confident that New Hampshire has produced a bill that, while unique, will be accepted by the federal government. Iowa and Arkansas have received waivers for similar plans, he said. (Arkansas’s plan is now facing a challenge from Republicans on reauthorization, the New York Times reported this week.)

“This is, I think in terms of reform, pushing the envelope more than other states, but . . . we’re not designing it to fail, let’s put it that way,” Bradley said.

Putting more people on health insurance plans will decrease uncompensated care payments that drive up everyone’s health care costs, he said. This plan will also likely bring the Medicaid managed care providers onto the exchange, creating more competition. (The state cannot get a waiver with only one provider on the exchange.) The bill also includes “personal responsibility measures,” like requiring eligible unemployed adults to seek help securing employment.

The bill also seeks a waiver to get more money from the federal government on Medicaid services not already being reimbursed, such as substance abuse treatment or care for the incarcerated. To get the waiver, New Hampshire must show it’s pushing the trend of drug usage down. This extra money will also help complement the state’s mental health care system, Bradley said.

Overall, the senators from both parties expressed optimism about the bill’s future.

“I think it’s headed in the right direction, and now we have to convince the people in our parties that it’s the right thing to do for the state of New Hampshire, and we’ll do that I think,” Morse said. “Let’s get the bill out so we can have the public tell us what’s right and wrong with it.”

Larsen said that the dialogue between the two parties has been “healthy,” and the bill has much for Democrats to like.

“We’ve moved the interests of everyone to reach a solution that hopefully has widespread support, that provides and meets our goal – and everyone’s goal – of improving access to health care for what are mostly low-income, working people in our state.”

Hassan again expressed her support for the bill yesterday in a statement by urging both chambers to pass the bill.

“I thank Senators from both parties for their efforts to reach common ground on health care expansion, which will boost New Hampshire’s economy, reduce cost-shifting on businesses and improve the health and financial well-being of our families,” she said.



Correction: A previous version of this article incorrectly stated which Senate committee will work on the bill. The Senate Health, Education and Human Services committee will hold a hearing on the bill Tuesday.



(Kathleen Ronayne can be reached at 369-3390 or kronayne@cmonitor.com or on Twitter @kronayne.)