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On Expansion, Lawmakers Have Two Weeks To Reconcile Two Competing Plans

Ben McLeod
Flickr Creative Commons

  Lawmakers returned to Concord Thursday to debate a major part of the federal health overhaul law: expansion of Medicaid. In New Hampshire, such a move would provide insurance coverage to an estimated 50,000 low income residents.

Democrats in the House favor a plan vetted by the commission that spent the summer studying expansion. The proposal would provide health insurance for individuals earning up to about $16,000 a year. People who currently get health insurance through their job would have to keep that private coverage, though Medicaid would pick up the tab for any out-of-pocket expenses.

“Well, I think what the House has put forth is a plan that is workable, that is highly likely to succeed, and that is cost-effective,” says House Speaker Terri Norelli.

She was less enthusiastic about what might come out of the Senate.

“We do still have some concerns about the ideas that have been brought forward to us from the Senate about the workability of them, and particularly about the timelines.”

Senate President Chuck Morse, meanwhile, said what the House is proposing will need to change to fly in his chamber.

“Expanded Medicaid as they are presenting is not acceptable to the Republicans in the Senate,” says Morse.

To hear Senate Republicans talk, it’s unclear if they could support any proposal that contemplates actually expanding Medicaid. What they want to do is use federal funds to provide private insurance,  with the money flowing through a trust, rather than the state budget.

By 2015, they hope to have everyone who doesn’t get insurance from their job shopping for a plan through the new insurance exchanges…the same exchanges Republicans and some Democrats have been slamming for their operational glitches.

Senator Majority leader Jeb Bradley acknowledged the current exchange is far from perfect, but says overall, the plan protects New Hampshire tax payers.

“Unlike Washington, which is saying, ‘Do it our way,’ we want to provide a New Hampshire way that encourages personal responsibility, that moves people into that private insurance, and yes, uses federal funds to do so,” says Bradley.

That personal responsibility could include mandated job training or career counseling for able-bodied recipients, as well as nominal monthly premiums.

No other state has yet tried the Senate’s approach, and the likelihood that it would be approved by the federal government is unknown.

But it does expand health coverage to more low income Granite Staters, and it’s supported by Republicans seen as key in this debate, including Nancy Stiles of Hampton.

She backed the study commission’s plan now being championed by the House, and invited Governor Hassan to give this plan a fair look.

“With focused attention, the right people working on the process, and our Governor’s leadership, we can get this done. And I believe, we can get it done during this session,” says Stiles.

Much of the action in the coming days will take place behind closed doors, where negotiations with the Governor continue to take place.

Hassan publicly praised Republican Senators for their efforts to date.

“I’m heartened by the fact that folks I might call 'Medicaid expansion skeptics' in the Senate are coming forward with their own ideas and plans, and I am open to all ideas.”

All ideas, Hassan stressed, so long as they extend health coverage to more people and do so in a timely matter.

She set a goal for getting this up and going by January 1st. With a final vote on expansion scheduled for November 21st, that could be a very tight timeline to meet. 

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