January 1st, 2014

N.H. tables Medicaid expansion program

After months of negotiations, New Hampshire’s legislature decided to table a proposal to accept the Affordable Care Act’s proposal for expanding Medicaid.

In a two-week special session called by Gov. Maggie Hassan, (D) the Senate voted along party lines to reject any of the proposed plans until after the legislature re-convenes on January 8. The move comes just weeks before the year-end deadline to commit to the plan for 2014, thereby refusing the first year of three years of federal funding.

As part of the Affordable Care Act, the federal government will provide 100 percent of the cost for the first three years to expand Medicaid to include coverage for residents who earn up to 138 percent of the federal poverty level. After three years, the states are expected to pay 10 percent of the cost. New Hampshire is one of only seven states without a decision on the expansion. Twenty-five states and the District of Columbia have opted to expand and 18 have rejected the plan. In New England, Maine is the only state to reject the plan. The others have all passed expansion.

Both sides of the debate have expressed disappointment in how the vote turned out.

“Today, members of the Senate Republican caucus let down the people of New Hampshire by refusing to compromise to develop a health care expansion plan that would actually work,” said Hassan in a statement. “Their refusal to discuss workable plans to allow New Hampshire to accept $2.4 billion in federal funds to provide critical health coverage to more than 50,000 hard-working people undermines the health and economic well-being of our families and businesses.”

The expansion is estimated to cover an additional 49,000 poor adults, according to the Associated Press. Other estimates have put that number from as low as 22,000 up to 58,000.

Earlier this year, the legislature set up a bipartisan panel which recommended expansion to take advantage of the federal funding.

While there is agreement within both parties that expansion should happen, the details on how to implement the plan vary. Republicans asked that the plan include moving new enrollees to the public marketplace rather than onto what they believe is a flawed Medicaid system, which was accepted. The rift came when deciding how long it would take to move those people with Democrats insisting that the one-year that Republicans demanded would not give insurers time to join a marketplace that has only one insurance company offering plans at this time. There was also disagreement on whether the plan would have to be re-authorized if the federal funding were to drop below 90 percent in the future.

“The real issue isn’t about Medicaid,” said Senate Republican Leader Jeb Bradley (R-Wolfeboro). “It’s about finding a way to help low-income workers afford health insurance. The Governor wants to do that mostly through the financially struggling federal Medicaid program. The Senate Republican plan would use federal dollars to instead make private health insurance more affordable for New Hampshire’s low-income residents. Broadly, both Democrats and Republicans have agreed that private insurance is the better option for New Hampshire residents, so what remains is crafting a plan that can achieve that shared goal.”

The legislature will take up the question in the next session, says Marc Goldberg, communications director for the governor’s office, with hope that it can be worked out quickly.

“Exact timing is unclear,” he said, “but the Governor will continue pushing to reach a constructive compromise as quickly as possible.”

By Catherine Robertson Souter

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