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House and Senate Each Offer Deal On Expansion, But No Compromise In Sight

Leaders in the Democratically-controlled New Hampshire House are seeking to cut a deal with Senate Republicans that would expand the state’s Medicaid program.  But hours after receiving the proposal Tuesday, members of the upper chamber said they can’t move forward with the plan, and offered their own course of action.

Medicaid expansion remains a key sticking point as lawmakers seek to finalize the state’s next budget by Thursday’s deadline.

The House plan yields to the Senate’s request to create a study commission on the issue. But it moves the timeline up dramatically, calling for a final plan by August of this year to present to a joint legislative body. The commission would look into the use of private insurance as a way to expand coverage.

If the commission can't craft a so-called ‘New Hampshire solution,’ the state would go ahead with a temporary expansion, expiring in 2016.

“I believe this proposal addresses concerns expressed by the Senate and moves the discussion forward,” House Speaker Terrie Norelli wrote in a statement.

Republicans, though, have been skeptical of any plan to offer Medicaid on a temporary basis, and also question the federal government’s ability to meet its financial obligation.

Under the plan, the Federal government pays 100% of the costs of expansion for the first three years, phasing down to 90% in 2020. The total price tag to the state during that time period is an estimated $85 million.  

While the Senate’s top budget writer Chuck Morse (R-Salem) called the House’s offer a “good first step,” Senate President Peter Bragdon rejected the proposal Tuesday evening.

In a statement, Bradgon wrote, “The Senate strongly believes an affirmative vote by the full legislature is required before any expansion of Medicaid can move forward in New Hampshire.  Unlike the House, we cannot agree to a plan that takes the legislature out of the process and may allow a fundamental redesign of the state’s largest and most expensive program to go forward by default.”

Bragdon presented a counterproposal, calling for a 10-member study commission that would report its conclusions by December 31, 2013, making it unlikely the state would move forward with expansion in early 2014, as House Democrats are hoping.

In addition to studying the use of private health insurance for newly eligible residents, the commission would look into the possibility of a federal block grant to fund the program.  

Other states, including Arkansas and Iowa, are also exploring alternatives to Medicaid expansion as proposed in the Affordable Care Act.

Last year’s ruling by the Supreme Court on the law said states must be given a choice in whether they expand Medicaid to include individuals earning less than roughly $15,000 per year. In New Hampshire, an estimated 58,000 residents would enroll.

The two sides are expected to continue debate on the issue Wednesday morning in Concord.