Passing a plan bound to hit a road block in the Republican-controlled Senate, the Democrat-controlled House Wednesday signaled the issue of Medicaid expansion is alive and well for New Hampshire lawmakers.
Beginning the 2014 session with one of the issues that dominated the 2013 session, the House voted 182-154 to send the Senate a plan that would use the state's managed care Medicaid system to cover all newly eligible recipients until 2017 when about 15,000 would receive their coverage from private insurance through the state health insurance exchange.
The majority of Senate members have insisted private insurance cover all newly eligible recipients after the first year and there is no indication that has changed.
Gov. Maggie Hassan, who supports expansion, praised the House's action.
"Reaching a constructive compromise on a workable plan that allows New Hampshire to accept $2.4 billion in federal funds to expand Medicaid will strengthen the health and financial well-being of more than 50,000 hard-working people while boosting our economy and creating hundreds of jobs," she said. "These are real people and families, working men and women who deserve the security of health coverage. They are restaurant employees, construction and healthcare workers. They work in our schools and our local shops and grocery stores. And when they need care, without insurance their healthcare costs are shifted to all of our people and businesses."
But Senate leaders said the new plan will make it harder to reach agreement on expanding Medicaid.
Senate Majority Leader Jeb Bradley, R-Wolfeboro, said the House action undermines a bipartisan approach to the complex and costly issue, but declined to rule out reaching any compromise.
"We will continue to work through this process deliberately and carefully to ensure that any proposal is crafted in the best interest of New Hampshire's hardworking taxpayers, health care providers, and patients" Bradley said.
House Speaker Terie Norelli, D-Portsmouth, defended the House's action.
"We took this action after extended deliberation over the past year including four public hearings, a thorough commission report, two affirmative votes of the House and in recognition of the urgency for our citizens and state," Norelli said. "We welcome the State Senate to take this opportunity to continue the discussion and negotiations that promptly achieve passage of a workable plan to expand Medicaid eligibility."
The House plan would provide publicly-funded health insurance to about 58,000 low-income adults and is similar to what its sponsors — Reps. Tom Sherman, D-Rye, and Cindy Rosenwald, D-Nashua — proposed before the Medicaid Expansion study commission last fall.
Under the plan, the state would use the existing Health Insurance Premium Payment program for those with insurance from their employers and the existing Medicaid managed care program and private insurance to provide coverage to newly eligible low-income adults.
Under the Affordable Care Act, the federal government pays 100 percent of the cost until Dec. 31, 2016 and then gradually reduces its share to 90 percent by 2020.
The proposal also would have the state establish its own electronic health insurance exchange, reversing a 2012 bill that prohibited the state from running its own exchange.
Democrats argued for quick approval in order to receive the maximum in federal money and provide health insurance for the working poor. They said the state is losing $500,000 a day without expansion.
"We have spent a year studying Medicaid expansion. We have held four public hearings. We've worked hard toward compromise with the Senate we have not gotten there yet," said Rosenwald. "We believe this approach to Medicaid expansion is a good solution. If our friends across the wall have a different solution, we are willing to listen, but we cannot delay any longer."
Republicans insisted on establishing a program "that would fit New Hampshire's unique needs" and questioned if the state could afford the program over the long term with Rep. Leon Rideout, R-Lancaster, calling it a "reckless way to govern," and others said it is central to the government takeover of health care
They questioned why the proposal did not have a public hearing when far more study is needed.
Others charged Medicaid provides poor quality health care and shouldn't be approved for that reason alone.
"Medicaid is not good enough for the people of New Hampshire," Rep. Carol Mcguire, R-Epsom said, "and we should reject it on its own merits regardless of the costs."
But Sherman defended the medical care New Hampshire recipients receive, saying Medicaid is health insurance not the quality of medical services they receive.
Most lawmakers believed they would be debating the issue again this session after the Senate refused to approve expansion at a special session in November. Negotiations between Senate and House leadership and Gov. Maggie Hassan's office broke down over how long new recipients would be on the state's existing Medicaid program.
But few expected to deal with the issue on the first day of the session, until Norelli said in Op-Ed pieces this weekend that a new House plan would be offered.
New Hampshire is one of seven states that have yet to decide whether to expand Medicaid. To date 25 states plus Washington, D.C., have decided to expand Medicaid and 18 have rejected expansion.
Under the ACA, Medicaid eligibility would expand to adults 65 years old and under earning 138 percent of the federal poverty level, about $16,000.
The state's health care providers would be paid $2.4 billion over seven years for the health care of the 58,000 state residents eligible under expansion.