Garry Rayno's State House Dome: All Medicaid expansion, all the time in Concord
At the special session Thursday, all sides praised the bipartisan Medicaid expansion commission and its recommendations to use private insurance where possible and the new managed care Medicaid program to provide health insurance for low-income adults.
The Senate plan is different in that it would require all the newly eligible recipients to use private health insurance purchased through the state health insurance marketplace beginning in 2015.
The two plans reflect different political philosophies. The Democratic-controlled House would rely on government-provided insurance to cover the majority of people who would be covered under expansion, while the Republican-controlled Senate would rely on private insurers to provide health insurance to the newly eligible.
Relying on private insurance, Morse said, would produce better outcomes for low-income adults, more support for health-care providers and greater protection for taxpayers.
The Senate plan sets a deadline of one year for the state to win a necessary federal waiver to allow all the newly eligible recipients to be transferred to private insurance. If the deadline was not met, the program would come to a halt.
The timeline and the decision of who should be on private insurance are the chief sticking points. The Senate wants everyone who is newly eligible to be on private insurance within a year, while the House wants to limit private insurance to only those people whose incomes fall between 100 and 138 percent of the poverty level. The House also does not want to start transferring people for at least three years, and then only if there are three insurance carriers in the marketplace. Currently, there is one carrier, Anthem Blue Cross Blue Shield.
The Senate may not have enough Republican votes to pass the plan crafted by Morse and Senate Majority Leader Jeb Bradley, R-Wolfeboro. There is at least one Republican who is not playing ball, and there may be one or two more.
There is room for compromise, but it will not be done in public before the two committees. It will be done on the upper floors of the State House by people shuffling back and forth between offices.
In this case, both the House and Senate have plenty to lose, and conventional wisdom says some agreement will emerge before the deadline, largely because the major health care providers in this state - the hospital organizations - want something done.
BARGAINING CHIPS: Both the Senate and House included provisions in their plans that are best described as bargaining chips that can be traded, including repealing the prohibition on the state having its own exchange, a law passed by the previous legislature.
Norelli and Sherman said the change is for technical reasons. They said the state needs its own version to properly recognize those who are Medicaid eligible but have insurance through their employer. Under both plans, those recipients would remain on their employer's insurance, but Medicaid would pay the premiums.
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- Both the House and Senate will hold public hearings on their separate proposals for expanding Medicaid eligibility on Tuesday.
- The Senate Committee on Special Session Legislation holds a public hearing on Special Session Senate Bill 1 beginning at 1 p.m. in Room 100 of the State House.
- The Senate and House committees meet again Thursday at 1 p.m. to decide on what recommendations to make on the bills. House Finance meets in Rooms 210-211 and the Senate Special Session Committee meets in Room 100.
NEW POET LAUREATE: An Acworth poet and educator is poised to be the state's next Poet Laureate, a post held by such luminaries of the literary world as Don Hall, Jane Kenyon, Maxine Kumin and Richard Eberhart.
She teaches writing at Keene State College and works with learning disabled students at Landmark College in Putney, Vt. She has also taught at Colby-Sawyer College in New London.
The state's Poet Laureate position has been vacant since March 31 of this year when former laureate W.E. "Walter" Butts of Manchester died.
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ROADS AND BRIDGES: The state of the highway system will be the topic of an informational meeting Nov. 20 between 7 and 8 p.m. at Manchester Aldermanic Chambers.
The program will be broadcast live on MCTV.
DEBT FOR RETIREMENT: Adhering to the old New Hampshire adage "No New Taxes" former Senate Minority Leader Bob Preston of Hampton approached the current Hampton area senator Nancy Stiles with an idea he considered years ago. A "Granite State" credit card would pay the retirement system for each card issued and a percentage of every transaction.
State government has 13,000 employees and the retirement system has 85,000 retired or active members plus their spouses and family members, according to Stiles and Preston.
"The success or failure of the affinity care program is up to the state employees, retirese, municipal and school district workers throughout the state to apply for affinity cards knowing that all income would be to their benefit for the now under-funded pension fund," Stiles and Preston said.
CORRECTION: In last week's column, attorney Arthur Cunningham was incorrectly identified. He argued several cases decided by the Air Resources Division, but was not an attorney with the division.