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Garry Rayno's State House Dome: Common ground eyed on Medicaid expansion

State House Bureau

October 05. 2013 3:43AM

The likelihood of New Hampshire joining the ranks of states deciding to expand Medicaid eligibility under the Affordable Care Act became a little better last week.

The Commission to Study Expansion of Medicaid Eligibility had more agreement on a conceptual plan than many observers anticipated, and Senate President Chuck Morse signaled he is willing to work with Gov. Maggie Hassan on an expansion as long as it includes private insurance coverage among the alternatives.

The Republican-controlled Senate has been the stumbling block to expansion, with former Senate President Peter Bragdon saying the state needed more time to consider its options. Morse, who replaced Bragdon last month, has not taken as hard a line.

Friday, Morse said he and Senate Majority Leader Jeb Bradley, another expansion skeptic, met with Hassan and explained the Senate's goals.

"We want to make sure we look at the whole universe and talk about it,'' Morse said, "but I would like to see them on private insurance.''

The Senate has five goals: Provide better access to affordable health care for low-income residents through private insurance; increase use of managed care; protect the state against federal unfunded liabilities; require some co-pays or incentives; and increase what Medicaid pays providers.

Morse called the commission's conceptual plan a good starting point.

The commission had general agreement on a proposal from Rep. Thomas Sherman, D-Rye, to cover adults whose income is up to 138 percent of the federal poverty level; use private insurers to cover some of that population through employers' existing health plans or through the state's health insurance marketplace; and provide benefits equal to what is required under Medicaid plus mental health and substance abuse treatment services.

The committee did not agree to delay joining expansion until it had a federal waiver in hand for the private insurance aspects of the program or to end state involvement if the federal government reneged on its financial support or increased benefit levels.

A majority of the committee voted not to put limits on the state's participation, but did agree the program would have to be reauthorized by lawmakers if the federal government did not live up to its promises or if additional benefits were required in the future.

A few tweaks here and there, and Morse's goals are met. Granted, some of those tweaks may be hard to make, but reading the tea leaves, the two sides are not that far apart.

Hassan is now free to try to convince a couple of the Republican senators that expansion is in their best interest. With a 13-11 Republican-Democrat split, one Republican would not do and two would be like putting a bull's-eye on their backs for a primary. Get three or four, however, and things would become a lot safer.

Coming into an election year, some of the key Republicans are in districts that could swing either way, and that is probably the best bargaining chip Hassan has right now.

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NEW BILLS: House members had until last Friday to file bills for the 2014 session, and when the dust settled, nearly 600 requests had been sought. More will come when study committees finish their work.

Senate members have just begun their filing period.

Recent events drove some requests. For example, Sen. David Pierce, D-Hanover, and Rep. John Cloutier, D-Claremont, want Anthem to include more hospitals in its provider network, including Valley Regional Hospital in Claremont, though it is not identified directly.

Also. several bills were filed about tightening security at supervised visitation centers following the Aug. 11 murder-suicide by Manchester resident Muni Savyon, who killed his 9-year-old son before taking his own life. Rep. Keith Murphy of Bedford wants to metal detectors installed at the centers, while Bradley wants the centers licensed.

A year ago, convenience store clerk Jackie Whiton of Antrim was fired for refusing to allow a customer to buy tobacco with an Electronic Benefit Transfer (EBT) card which the state uses for cash assistance to the poor.

Her cause was taken up by then House Speaker Bill O'Brien, but this year his deputy speaker, Pam Tucker has filed a bill that would limit what could be purchased with the cards.

In the last fiscal year, the state distributed more than $23 million in assistance through the EBT card, with 78 percent taken as cash through ATMs.

Some want the state to prevent the purchase of such things as alcohol, tobacco, junk food or adult entertainment, but under current law, that is impossible.

Many Concord residents were upset when the police chief sought to use a federal grant to purchase a BearCat armored police vehicle, and Rep. J.R. Hoell of Dunbarton has introduced a bill to prohibit the state and local communities from using federal funds to purchase "military-style vehicles.'' There will be bills dealing with casino gambling from two Manchester representatives, Pat Long and Steve Vaillancourt, and attempts to decriminalize possession of small amounts or marijuana, two topics that were either killed last session or held for more study.

The past session had few bills dealing with abortion rights, but 2014 will be different. One bill would declare life begins at conception and another would ban abortions after 20 weeks of pregnancy.

There will also be attempts to prohibit the use of hand-held electronic devices while driving and to allow "liquid cremation,'' both issues lawmakers have dealt with in the past, as well as a bill that would allow "death with dignity,'' or assisted suicide, for the terminally ill.

O'Rouke Returns: Author P.J. O'Rourke will be the featured speaker at the Josiah Bartlett Center for Public Policy's annual dinner Nov. 21.

Senate President Morse will receive the 2013 Libertas Award for his commitment to fiscal discipline and open government.

O'Rourke emceed the inaugural dinner, in 2011. His 15 books include "Parliament of Whores," "Holidays in Hell," and, soon to be published, "The Baby Boom".

The dinner will be held at the Grappone Center in Concord. For more information, go to

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NO QUESTIONS: The Legislative Ethic Committee recently advised lawmakers invited to the Business and Industry Association's annual dinner Oct. 23 they could go even though the value of a free ticket is $125, well in excess of the $25 gift limit.

There are many exceptions to the gift limit law, and the committee found one that allowed the 24 senators along with House leadership and key committee chairs and vice chairs to attend the event.

The BIA organization is a formidable lobbying organization, but so is the NH Auto Dealers Association, which won as big a victory as any special interest group this past session with the Auto Dealers Bill of Rights.

The organization has invited all lawmakers to attend the NH Auto Show Oct. 18-20 at the NH Sportsplex in Bedford. Each lawmaker is offered two tickets, but the tickets are only worth $5 so there is no problem with the ethics law on this one.

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REST IN PEACE: Many years ago, Nils Larson was the House Education Committee chairman and pushed for statewide kindergarten and greater state funding of education and often battled with then-state Board of Education Chairman Ovide Lamontagne and Gov. Steve Merrill, though they were all Republicans.

Larson was a progressive Republican when conservatives were beginning to take over the party, and he was never bashful about stating his views no matter how divergent from the majority.

He served as an education adviser at the time to newly elected Democratic Gov. Jeanne Shaheen and was critical in helping her work with the Legislature to craft an answer to the Claremont II decision, which said the state used an unconstitutional funding method to pay for education.

Larson was a real gentleman who truly believed he was in Concord to serve the people of the state to the best of his abilities.

He was also a delight to work with and as well-informed on education issues as any legislator at the time, having served on the Newfound Regional School Board, many years as its chairman.

Larson died in August and his obituary appeared this week. He was 79 years old.

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