House Republicans debate Medicaid expansion bill backed by GOP leadership

Monitor staff
Last modified: 1/29/2016 1:20:53 AM
A Republican-authored bill to reauthorize Medicaid expansion faced its fiercest criticism from other Republicans during a public hearing Thursday, setting the stage of an intraparty fight over whether New Hampshire will keep more than 45,000 low-income residents on subsidized health insurance. 

The state’s Medicaid expansion program is set to end this year unless the Legislature votes to reauthorize it.

Rep. Joe Lachance, a Manchester Republican, is proposing a bill to extend the health care program by two more years. The proposal would institute new work requirements and co-payments for enrollees and also require hospitals and insurance companies to help cover the state’s expansion costs, which are expected to reach $50 million over the coming years. 

More than 150 people showed up to a House hearing on the bill Thursday, and most voiced support for continuing the program, which covers adults making less than 138 percent of the federal poverty limit, or about $15,900 a year.

The biggest hurdle will be the Republican-controlled House, where a number of members are unhappy with the program. Several testified against the legislation Thursday, saying the work requirements have no teeth, federal funding for the program is unreliable and expansion will downshift insurance costs onto other residents.

The bill “will have a negative impact on future budgets, on taxpayers and on health care costs,” said Rep. Laurie Sanborn, a Bedford Republican.

But bill supporters, including Senate President Chuck Morse, chief justice of the New Hampshire Superior Court Tina Nadeau, business leaders, health care advocates and insurance companies, pushed back. They argued that the program boosts the state’s economy by reducing uncompensated care costs, and giving previously uninsured residents access to key health care services including substance abuse treatment. 

“We support availability of access to health care,” said Dr. John Butterly, president of the New Hampshire Medical Society. “We see the health protection program working for our patients.”

The Legislature originally passed the state’s Medicaid expansion program, known officially as the New Hampshire Health Protection Act, in 2014. It is set to sunset at the end of 2016, as federal funding for the program starts dropping below 100 percent. 

Much of the reauthorization debate has centered on who will pay the state’s share of the program, which amounts to $10 million in the 2017 fiscal year, and $25.2 million the following year. Republicans have been adamant that taxpayers not foot the bill. And Lachance’s proposal achieves that, backers say, because the state share would be covered by proceeds from an insurance premium tax and voluntary contributions from insurance companies and hospitals.

“There are no new taxes. There are no increased taxes. There are no fees,” said Senate Minority Leader Jeb Bradley, a co-sponsor of the bill. 

The Department of Health and Human Services estimates it pays between $1 million and $2 million annually to support Medicaid expansion. And the remaining costs are subsidized by the federal government, which chipped in nearly $413 million this year for the program.

If federal funding ever drops below the promised 90 percent, or the hospitals and insurance companies don’t live up to their promise, the state’s expansion program would immediately end. 

Some Republicans said it’s a given the federal government would renege, and questioned what would happen then. “The federal government is not a reliable partner,” said Rep. Pam Tucker, a Greenland Republican who opposes expansion. “It’s hard to find an area where the federal government has lived up to its commitments.”

The bill also outlines several new requirements for Medicaid expansion recipients, all of which would need sign-off from the federal government. 

One requires people to pay an $8 co-payment when they visit the emergency room unnecessarily, and then charges them $25 for each “inappropriate visit” thereafter. 

Another calls for all “able-bodied” adults covered by the program to meet a weekly 30-hour work requirement that includes community service, and job training. The federal government has denied all other states that sought to implement work requirements, according to the Kaiser Family Foundation. Even if New Hampshire’s own work requirement is denied, the bill allows Medicaid expansion to continue. That’s a problem for some Republican opponents.

“If you think you are voting for a work requirement, then you leave that judgement up to CMS,” said Sen. Russell Prescott, referring to the federal Centers for Medicare & Medicaid Services. “You may not be voting for a work requirement because CMS may deny that.”

While some Democrats testified, none outright opposed the bill, and instead raised questions and concerns about work requirements and emergency room co-payments. The bill has eight Republican cosponsors and one Democrat, Rep. Peter Leishman, Peterborough.

The House Health and Human Services Committee will make a recommendation on the bill before it goes before the full chamber for a vote.

During a daylong hearing, advocates said the protection plan is leading to a decline in the number of uninsured patients, and at the same time decreasing uncompensated care costs.  More than 30 percent of expansion enrollees are visiting a primary care physician each quarter, and more than 10 percent have access to mental health services, said Health and Human Services Commissioner Jeffrey Meyers.

As the state faces a drug crisis that officials say claimed more than 400 lives last year, nearly 4 percent of Medicaid expansion enrollees are accessing substance abuse benefits.

Morse said Medicaid expansion offers federal money, and opportunities, the state shouldn’t pass up.

“Where else do you find $458 million to put into the economy of New Hampshire?” he said. “This is a good plan.”



(Allie Morris can be reached at 369-3307 or at amorris@cmonitor.com.)




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