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Garry Rayno's State House Dome: Coming down to crunch time
Front and center in that war between the House and Senate will be Medicaid expansion. It is perhaps the one issue that could doom negotiations and send both sides back to their corners to regroup.
The other reason given by Republican senators for opposing expansion is the unknown factor involved in implementing a new program. As Sen. Andy Sanborn, R-Bedford, argued recently, expansion and its ramification are very complicated matters. Time is needed to sort all that out, he says, before lawmakers can decide what is best for the state.
In theory, expanding Medicaid would lower the amount of free or charity care that nonprofit hospitals provide to low-income patients who cannot pay for the services they receive.
The hospitals view the situation as an opportunity to leverage higher Medicaid reimbursement rates from the state. The rates do not come close to covering the cost of services. Ten of the state's largest hospitals have sued over the issue in federal court, but the case is still pending.
Also in the picture are the three national managed care companies that the state hired to run the program under the assumption Medicaid would be expanded. At the time, expansion was mandatory under the Affordable Care Act (ACA), but the U.S. Supreme Court ruled otherwise.
So the equation everyone is trying to decipher is whether expanding Medicaid by 60,000 people would reduce uncompensated care costs enough to lower what the state pays to hospitals to offset it and whether Medicaid costs would be reduced enough under Managed Care to pay for that expansion?
If the expansion happens, the state would receive more than $400 million in federal dollars in the upcoming biennium while spending very little money beyond administrative costs, according to Health and Human Services officials, while the state would not have to contribute until three years down the road.
The ultimate question becomes, if the Legislature comes to a stalemate, does Hassan move forward on her own to expand Medicaid?
Moving forward by executive order would surely make New Hampshire a test case. Other states' governors have backed expansion, but as yet no legislature has blocked their governor's decision.
Continuing the Pressure: Hassan will be one of the featured speakers at press conference Tuesday dubbed "Why NH Can't Wait for Medicaid Expansion."
Hassan will be joined by at least three state residents currently without health insurance who would be covered if the state decides to expand Medicaid.
The press conference is at 11 a.m. in the Legislative Office Building.
Reporters and their news organizations that cover the Legislature are usually included, but were not this time.
Also, two positions that used to be listed as officers of the Senate - the Senate clerk and the Senate sergeant at arms - are now listed as Senate staff while the House continues to list the House clerk and House sergeant at arms as House officers.
They said the clerk is not a constitutional officer but rather elected and paid by the Senate, so is part of the staff.
A Thank You: Sens. Nancy Stiles, R-Hampton, and Lou D'Allesandro, D-Manchester, were absent from Thursday's Senate session.
The Senate Finance Committee hurried through its final work on the state budget Tuesday so D'Allesandro could leave on his trip.
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