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November 12. 2013 7:43PM

Lawmakers urged to expand Medicare, find accord

CONCORD — The state's health care providers and the uninsured urged lawmakers Tuesday to expand Medicaid eligibility under the Affordable Care Act so more state residents will have access to health care.

"This bill is important to someone like me," said Kyle Boesch, 23, of Northfield, who said he is a recovering heroin addict who earns less than $300 a week from two jobs. "If something happens to me, I lose both jobs."

Boesch was one of many uninsured who testified at two public hearings on the separate House and Senate plans to expand Medicaid beginning Jan. 1 to include about 49,000 low-income adults.

The Senate plan would require all the newly eligible Medicaid recipients to purchase private insurance through the state health insurance marketplace beginning Jan. 1 2015, something that requires a federal waiver. The Senate proposal envisions more than one carrier offering policies on the exchange, something insurance officials said may not happen.

The House plan does not have a private insurance option until 2017, and then only if there are three insurers in the marketplace — including one of the three private managed-care companies the state hired to administer the Medicaid program.

Under the Senate plan, expansion would end Jan. 1, 2015 if federal officials have not approved a needed waiver; that is one of the key sticking points between the House and Senate.

"Let me be very clear," said Steve Ahnen, president of the New Hampshire Hospital Association. "It is absolutely essential that we find a way to get our patients covered — and that we don't lose this opportunity to do so now."

State health and insurance officials said the Senate plan has a very aggressive time line that may be difficult to achieve.

"We do not want to set ourselves up for failure by being overly ambitious," said Insurance Department Commissioner Roger Sevigny. He noted there is only one insurance carrier on the state health insurance marketplace — Anthem Blue Cross, Blue Shield — and moving too quickly to put the Medicaid-eligible population into the exchange could give Anthem an advantage that could hamper the state market.

Kevin Klein of Well Sense said his company has begun discussing whether it would offer private policies through the marketplace, but the earliest that would happen would be 2016. He said his company reached an agreement with the state with the understanding it would cover the under-served population, but now the Senate plan would have the company compete for that population through the marketplace.

"We spent a couple of millions dollars to get to this point," Klein said, "and we would have to invest a couple millions dollars again ... I'm not saying it is impossible, but it has to make business sense."

Sevigny said his department is not aware of any insurance companies developing plans to enter the market in 2015.

While most of the uninsured voicing support for Medicaid expansion preferred the House's plan, hospitals, physicians, nurses and other providers and advocacy groups urged lawmakers to come to an agreement and allow the expansion to begin Jan. 1.

"We urge you to get to yes on this," said Ken Norton of the National Alliance on Mental Illness NH.

Emergency room nurse Allison Nasar of North Swanzey said she sees patients return time and again because they cannot afford prescriptions.

"We are all paying for these patients every day," said Nasar who came to the hearing at the end of her shift at 7 a.m. Tuesday. "We pay for these patients in uncompensated care."

Under the proposals, adults under 65 years old who earn up 138 percent of poverty — about $15,000 for an individual and $32,500 for a family of four — would be eligible for Medicaid health insurance, either through an employers' private insurance or through the state's Medicaid system beginning Jan. 1.

The House and Senate committees meet Thursday to vote on the bills and any proposed changes. Gov. Maggie Hassan's office, and House and Senate leaders continue to negotiate behind closed doors trying to reach a compromise before lawmakers vote on expansion Nov 21.

grayno@unionleader.com


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