CONCORD — The House and Senate moved closer Thursday, but an agreement on Medicaid expansion under the Affordable Care Act remains elusive.
The House and Senate want to expand eligibility for the state-federal health insurance program. The first year under both proposals would be virtually the same, requiring 13,000 to 15,000 recipients to continue existing employer coverage; the remaining 35,000 would use the state's new managed care Medicaid program.
After the first year, the two sides part ways. The Senate wants recipients to have private coverage within a year, while the House would wait three years — or until there are three insurance carriers offering policies on the health marketplace.
Thursday, a House committee approved a modified version of a plan based largely on the recommendations of the Medicaid study commission, on a 15-10 vote. A Senate committee approved a modified version of its plan on a 4-2 vote.
Senate Majority Leader Jeb Bradley, R-Wolfeboro, proposed giving state officials more time to develop a federal waiver request for the premium assistance program that is needed if the state requires Medicaid-eligible individuals to purchase commercial policies on the state exchange, although Medicaid dollars would pay the premiums.
Instead of requiring the waiver to be in place by Jan. 1, 2015, or expansion would end, the Senate is now willing to give state officials a year after the Health Insurance Premium Payment program waiver is approved. That approval is expect in the first few months of 2014. That waiver is needed to require recipients to remain on their existing employer policies.
"This gives a little more time to achieve that waiver and still addresses the governor's concerns that expansion start as soon as possible," Bradley said. "If we have a bridge (year) that goes on and on and on, we will not get the reform we want and reform is essential to our side of the aisle."
On Wednesday, Gov. Maggie Hassan and House Speaker Terie Norreli, D-Portsmouth, agreed to require all of the newly eligible Medicaid recipients to participate in the premium assistance plan to purchase private insurance.
They had originally included in the private insurance requirement only those earning between 100 and 138 percent of the federal poverty level.
Thursday, Hassan's office said the Senate proposal does not go far enough.
"The bill as amended still lacks workable, achievable and realistic time lines and includes no measures to ensure competition and cost-effectiveness on the exchange," said Hassan's communications director, Marc Goldberg. "Instead, it would delay critical health coverage for thousands of families, costing New Hampshire upward of $500,000 per day that we can never recover."
During the House Finance Committee meeting, the Democratic majority voted down eight Republican amendments — from capping the program's cost to a modified version of the Senate plan before passing the bill on a 15-10 vote.
Republicans said the new program amounted to a run-away entitlement program that would lower the state's standard of living.
"This is a jump into an entitlement pool," said Rep. Neal Kurk, R-Weare, "without checking the depth of the water."
But Democrats said the cost of the program should not be the measure's only criteria, noting expansion will help hard-working families who cannot afford health care.
"Again and again it's clear the people of New Hampshire want Medicaid expansion," said Rep. Sharon Nordgren, D-Hanover.
In the Senate, the Republican-controlled Committee on Special Session Legislation voted down three Democratic amendments on 4-2 votes that would have changed the make-up of a commission to develop a federal waiver, given the state more authority over the exchange and added the House's requirements before Medicaid recipients would have to buy private insurance on the marketplace.
The committee voted 4-2 to recommend its modified proposal.
The House and Senate return to Concord next Thursday to vote on the two plans.
House and Senate leaders and the governor's office continue to negotiate.