Garry Rayno's State House Dome: Lawmakers enter 'crunch time'
We are about to enter either crunch time, or the world series of lawmaking, depending on your perspective.
The House and Senate will try to reconcile different versions of the same bill in what are called "committees of conference" - when four House members and three Senators negotiate, but not always successfully.
All of them are orchestrated by two opposing corners on the third floor of the State House, the Senate President's office and the House Speaker's office.
Differences can be resolved in a quick walk between the offices, but sometimes it takes days to get from one side of the building to the other.
One thing to remember is that anything can happen. Bills once thought dead are miraculously resurrected, and sure things can become just paper in the trash.
All the cards are on the table, although most of the time the numbers and suits are invisible. Often, a half-dozen bills are intertwined not by subject matter, but strategically so one bill won't move forward without agreement on the others attached.
Everyone knows the most important conference committee this year will be the Medicaid Enhancement Tax.
If all goes as planned, there will be a joint conference committee on Senate Bill 369 and House Bill 1613.
The House bill has been amended to include the Senate's preferred solution to fix the MET. Two judges said it is unconstitutional because it taxes hospitals but not other providers of identical health care services.
The Senate wants to phase out the tax over a number of years and help offset the revenue with additional insurance premium taxes as more people sign up for insurance or qualify for Medicaid under the Affordable Care Act. It would also use matching federal money through the Medicaid program.
At the same time, the plan would boost reimbursement rates for Medicaid services, but reduce state payments for services that hospitals provide but are not paid for.
The House version would clarify lawmakers' intent to use the MET revenue for health care programs and eliminate a provision allowing the money to go into the general fund.
The two-step House plan would also expand the tax base to include other health care providers beyond hospitals - if the Supreme Court upholds the superior court rulings.
That's not a lot of common ground.
The Senate could kill the House's proposal when SB 369 comes back to the Senate, but that is not likely to happen.
If it did, that would leave only the House bill and the Senate plan, but the House negotiators would be in charge.
A House bill in conference would have a House member as chairman. That person calls the meetings and sets the agenda. If it is a Senate bill, the Senate chairman is in charge.
Those little details are taken into consideration by the Senate leadership and its staff when determining what actions to take on bills.
Another bill lawmakers may negotiate is House Bill 253, which would terminate the parental rights of a rapist who pleads guilty or no contest to sexual assault, or after a court finds the child was conceived during a rape.
The bill has bipartisan support across the political spectrum from the N.H. Coalition Against Domestic and Sexual Violence to the conservative Cornerstone Policy Research, and from the Diocese of Manchester to NARAL NH.
The bill goes back to the Senate because the House clarified that the mother may collect child support without having contact with her rapist.
The Senate may agree to the change or, even if there is not strong objection, ask the House to negotiate because there are other issues that need to be resolved and the bill can be used as a bargaining chip.
As Machiavellian as that sounds, each side decides what is important to them and how to achieve that goal without crossing the imaginary line into unwanted territory.
This is the time of year a degree in psychology is helpful, as well as tennis shoes and an extra pair of glasses to follow the bouncing balls.
Let the games begin.
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Medicaid Expansion: Key elements of the state's Medicaid expansion plan - or NH Health Protection Act - will go before the Joint Legislative Fiscal Committee this week, including a waiver request that would provide additional federal money to help cover existing services.
In a letter to the committee, Health and Human Services Commissioner Nicholas Toumpas says the transitional "alternative benefit plan (ABP)" will mirror the essential benefits required of carriers who offer policies on the state's health exchange, as well as several other benefits such as emergency transportation that are required for all qualified Medicaid patients.
"New Hampshire's ABP will not offer all of the benefits provided by the standard state Medicaid benefit. As pointed out, we are aligning the ABP with the Essential Health Benefits in the "Benchmark" plan for New Hampshire, which is the Mathew Thornton Blue Health Plan," Toumpas writes.
Some of the newly eligible will go onto the state's Medicaid managed care program because federal law requires the "medically frail," who have difficulty with daily activities such as bathing or dressing, have to have access to benefits not in the transition plan, Toumpas notes.
Also, the state will need to provide additional benefits to some who qualify for the Health Insurance Premium Payment program because some insurance policies offered by their employers do not include the essential benefits.
The information contained in requests for waivers or state plan changes to the federal Center for Medicaid Services, also establishes co-pays for prescription drugs as $1 for generics and $4 for brand drugs if the recipient's income is above the federal poverty level, but free if below the limit.
The information also indicates department officials believe the state can qualify for $78.6 million in additional federal matching funds, $61 million to match state programs, $11.6 million for cities and towns, and $6 million for counties.
Much of the state money to be matched would come from New Hampshire Hospital at $24.6 million and the Sununu Youth Services Center $14.7 million.
County matching funds are all from correctional facilities. Those for cities and towns are from health care and administration costs.
The waiver was first proposed by hospitals as a way for the state to recoup costs the state is eligible for but are not included in the state's Medicaid plan so there is no way to access the federal money. The state never sought a federal match for substance abuse treatment but that benefit will be included for the newly eligible and those who receive policies through the health exchange when they transition to private health insurance during the second year of the program.
Estimates have run from $50 million to $200 million for new federal money but it was always an open question.
Last week, Senate President Chuck Morse, R-Salem, who has long-pushed Toumpas and his agency to pursue the waiver, said he believes more work needs to be done on the waiver to make it acceptable to him.
The Joint Legislative Fiscal Committee meeting Thursday should be interesting.
Along with the waivers and state plan amendments, the committee will also be asked to approve Gov. Maggie Hassan's executive order to freeze general fund spending for hiring, equipment or out-of-state travel.
That is a contrast, expanding state health care programs while freezing state spending.
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Small Turnout: The House on Thursday did not have a working quorum when the day began at the early 9:30 a.m. start time.
With 10 vacancies, the House needs 258 representatives present to have a working quorum which means a simple majority decides whether a bill passes, killed or tabled.
Without a working quorum, every action requires a two-thirds majority which means the minority rules.
Word went out and enough members eventually showed up so the abortion buffer zone bill could be approved by a simple majority and not two-thirds majority, which would have doomed the bill.
Later in the day the numbers fell again but it just squeaked through on a majority vote 162-100.
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Representative's Talent: Singing the national anthem before the House session is a shared responsibility in that representatives are often tapped to lead the singing.
One day last week, Miss New Hampshire 2014 Megan Cooley did a more than admirable job with the piece that is very difficult to sing well. But the next day, House members heard another polished rendition from one of their own, Rep. Jane Cormier, R-Alton.
Cormier, in an obviously trained operatic voice, quieted Reps Hall and drew prolonged applause after her rendition.
Cormier lists her occupation as a music performer and teacher in the legislative Blue Book.