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UPDATED: Little agreement on Medicaid expansion or revenues

State House Bureau

June 17. 2013 6:21PM

CONCORD— Senate budget negotiators Monday morning reiterated their stand that Medicaid expansion under the Affordable Care Act ill not be in the state's 2014-15 operating budget.

"The Senate is not going to entertain this in the budget," said the Senate's chief negotiator Chuck Morse, R-Salem.

Senate President Peter Bragdon, R-Milford, said a decision as important as Medicaid expansion deserves as an exhaustive study as the House gave the Senate's casino gambling bill, Senate Bill 152.

The House appointed a super committee that spent three weeks studying the bill before voting 23-22 to kill the bill, which the House did.

Bragdon said administration officials failed to provide information he and Senate budget writers requested, and he added that Gov. Maggie Hassan never talked about expansion with him until Friday.

"We need to look under the hood," Bragdon said. "The Senate position is we are not opposed but what are all the options. What are other states doing? What are the options for New Hampshire?"

The Senate voted down party lines to create a study commission to review the impacts of Medicaid expansion on the state before deciding the issue.

Bragdon has said he is willing to discuss changing the committee's reporting date and what it will review as part of negotiations with the House.

Hassan and the House support expanding Medicaid to 138 percent of the federal poverty level — about $15,000 for an adult. Expansion is projected to add 58,000 people to the Medicaid rolls and bring in $2.5 billion over seven years to health care providers while costing the state from $27 million to $85 million.

On Monday, House members told Senate negotiators every delay means the state will receive less federal money, low-income workers will continue without health coverage and hospitals and other providers will continue to provide more and more services without compensation.

House Speaker Terie Norelli, D-Portsmouth, said the House is willing to work with the Senate to negotiate a compromise and has not drawn any lines in the sand over Medicaid expansion.

But she said Medicaid expansion is a critical issue. "I have heard from many constituents, I have heard from many in the health care community and from many members of our caucus that Medicaid expansion is a critical issue," Norelli said. "I want to work with (the Senate), I want to compromise, but it is critically important to have Medicaid expansion."

She said the Senate talks about finding a New Hampshire solution to expansion.

"I have not seen anything that tells me what the New Hampshire way is," Norelli said. "They have to bring something to table to talk about it."

House Finance Committee Vice Chairman Cindy Rosenwald, D-Nashua, said Medicaid expansion will not only improve the health of state residents, it will also save general fund dollars. She insisted the state could begin the program and then make changes to it.

Rep. Sharon Nordgren, D-Hanover, said Medicaid expansion, Medicaid managed care and the Medicaid Enhancement Tax are part of a package. She said managed care companies bidding on the state's program believed Medicaid would be expanded, but now they are in limbo.

But Morse said the state's managed care plan was turned down by the federal government because the state's reimbursement rates are too low and because of the state's handling of the Disproportionate Share Hospital (DSH) program.

Ten of the state's largest hospitals sued the state over Medicaid reimbursement rates saying they are too low to be able to sustain the program.

The suit is still pending, but Morse indicated the governor may have reached some agreement with the hospitals.

Several senators, Hassan and state health officials have been meeting to discuss a possible compromise, but have yet to reach an agreement that will satisfy the Senate's Republican leadership, which has opposed expansion at this time.

Bragdon said Monday, the House and Senate share the same goals of improving health care outcomes, reducing hospitals' uncompensated care, reducing the number of people using emergency rooms for routine health care and reducing the number of New Hampshire residents without health insurance.

But Nordgren reminded Senate negotiators, "the longer it takes to make a decision, the fewer months and years we have (at 100 percent federal reimbursement)."

The conference committee meets again today at 10 a.m.

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