CONCORD — After negotiations came to a halt Wednesday, lawmakers are not optimistic an agreement will be reached in today's special session to act on Medicaid expansion under the Affordable Care Act.
In months of talks, Republicans and Democrats have failed to agree when expansion should begin and when the newly eligible Medicaid population should be transferred from the state Medicaid managed care program to private insurance purchased through the state health insurance marketplace.
Gov. Maggie Hassan has traveled around the state and into key Republican state Senate districts to push a proposal that would begin expansion Jan. 1, using both private insurance for those currently on their employer's private insurance and the state managed care Medicaid program.
Republican senators propose a similar plan, but unlike Hassan and the House, would require the newly eligible Medicaid recipients to move to private insurance within one year and to work and pay deductibles and co-pays.
Having people on Medicaid for two or three years or longer is not acceptable, said Senate President Chuck Morse, R-Salem. He said an open-ended plan would not get the private insurance market up and running.
Hassan said Wednesday the Senate refuses to budge on its plan. She said a compromise was offered Wednesday morning to begin the transition into private insurance by Jan. 1, 2016, but that was rejected by Morse.
That compromise plan will be offered by Senate Democrats today.
"We've been talking for almost five weeks and every time we get close to a deal, we're told (Morse) can't sell it to the Republican caucus so there's no deal," Hassan said. "Today the Senate President said it's too difficult and too hard and he doesn't see any point in talking further."
She said she is willing to continue talking and will be happy to talk to any individual senator, but beginning private insurance in one year is not workable. The Senate heard that from several insurance companies in the past few days, she said.
"I'm open to different concepts, but I would like to see a specific proposal from the Senate," Hassan said. "Every time we (make a proposal) they move the goalposts."
Morse said he is willing to keep talking, but it is too late to reach an agreement for the special session.
"A whole new model is not going to happen tomorrow," Morse said Wednesday. "We have (a model) on the floor now that exists already," he said, referring to the Senate Republicans' plan.
Senate Majority Leader Jeb Bradley, R-Wolfeboro, said the Senate plan addresses Democrats' key goals of beginning expansion as soon as possible to leverage federal money and to provide coverage to low-income adults.
The Senate plan would allow up to a year for the state to obtain a federal waiver for the private insurance assistance program modeled after a federally approved Arkansas plan. The Senate would also end expansion after three years, unless lawmakers voted to reauthorize it.
"We're not going to vote for something without testing it and making sure it holds together," Bradley said. "We do not want to have the kind of problems in New Hampshire we see unfolding in Washington."
Lots of amendments
The House faces 29 amendments — 28 from Republican representatives — when it meets beginning today at 10 a.m. Senate Democrats have several amendments they plan to offer as well, including the last compromise plan Democrats released Wednesday.
The House is likely to approve some version of Medicaid expansion, but the Senate does not appear to have the votes to approve any proposal.
Hassan said no matter what happens today, she will continue to fight to provide health insurance to the state's working families who cannot afford it without Medicaid expansion.
Morse acknowledged lawmakers will be debating the issue again in a little over a month.
"The issue is not going away," Morse said. "We'll be back here in January and debate it again."
New Hampshire is one of seven states that have yet to decide whether to expand Medicaid. To date, 25 states plus Washington, D.C. have decided to expand Medicaid; 18 have rejected expansion.
Under the ACA, Medicaid eligibility would expand to adults under 65 years old earning 138 percent of the federal poverty level, about $16,000.
The state's health care providers would be paid $2.4 billion over seven years for the health care of the 49,000 state residents expected to be eligible under expansion.