Medicaid expansion's benefits extolled before House Finance Committee
In testimony on Monday before the House Finance Committee, the Concord Democrat used the word "bipartisan" at least four times, calling the Senate compromise similar to bills previously passed in the House.
"More than 50,000 people, mostly hard-working, tax-paying, low-income residents of New Hampshire will get coverage," she said. "Hospitals will face less uncompensated care; and $600 million in federal funds will flow to the state, which will help grow our economy and jobs."
Senate Bill 413, the subject of the hearing, creates a 2 1/2-year pilot program that would address the question of how to provide health insurance for residents who do not qualify for Medicaid under current guidelines, but also do not qualify for subsidies on the insurance exchange at healthcare.gov because the Affordable Care Act assumed that states would expand Medicaid as the law requires.
The Supreme Court struck down that requirement, and some states have chosen not to expand Medicaid, leaving millions of Americans in what has been called "the doughnut hole" of health care coverage.
Under SB 413, New Hampshire residents in the doughnut hole would be broken into two groups - those who have jobs where qualified health insurance is offered (about 12,000) and those who do not (about 38,000).
Those with the potential for coverage at work would get state subsidies to pay the premiums to private insurers, while the rest would go into the state's Medicaid program pending federal approval of a waiver that would allow them to be covered by private insurers, with the state using federal Medicaid money to pay the bills.
If the waiver is denied, the legislation calls for the expansion to be terminated.
Representatives of the state's hospital association, business and industry association and advocates for the disabled spoke in favor of the legislation.
"There will be continual legislative review," said Larsen. "We can repeal laws if we find them unaffordable."
Republican Rep. Neal Kurk of Weare asked Larsen if expanding government-funded health insurance to those earning up to 138 percent of the federal poverty level would rob them of their ambition.
"Are we providing a disincentive for people to achieve the American dream?" he said.
She replied that most of the population affected by expansion consists of the working poor. "I don't believe this will disincent their work ethic," she said.
Opponents also worried about spiraling costs, and the fact that the federal share of the program will go from 100 percent to 90 percent in three years.
"When (not if) the federal government reduces its commitment, Medicaid expansion will draw resources from many other things we value," said Bedford Republican Laurie Sanborn, the House GOP policy leader.
She said House Republicans would like the bill killed, but failing that, she urged the committee to establish safeguards that would limit or cap the state's exposure to future expenses.
"We have a hard enough time saying 'no' now to this program," she said. "I think it's going to be very hard to say 'no' later when people are already signed up."