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Guns, Gambling, Drugs and Medicaid Await Lawmakers

State lawmakers get back to work this week. The New Hampshire House meets today; the State Senate tomorrow. Joining me now to talk about some of the matters lawmakers will debate this year is NHPR’s senior political reporter, Josh Rogers.

OK Josh, lots of issues coming up quick this year.

Yes. There are more than 100 bills up for votes in the house this week. That’s more than I can remember being up for votes the first session day of the year, b UT lawmakers held a lot of bills for further work over the summer, so here we are……Some of these bills are on familiar topics. The house for instance, will again vote on a proposal to eliminate need for a permit to carry a concealed firearm……The Governor vetoed  --and lawmakers failed to override -- on similar proposal last year.That bill is on the docket for today…..

The house will also consider some gambling bills.

Yes, Keno, which was backed by the house last year, and which the Governor had wanted in her budget. This proposal would allow Keno, which is basically electronic bingo, in bars and restaurants where communities approved. 70 percent of the money would be paid out in prizes, 8 percent would go to operators, the rest would flow to the state, with 1 percent earmarked to fund problem gambling interventions……..As you recall, Keno was shot down in the state senate, which backed a full-fledged casino. The casino, meanwhile, was rejected by the house.

Might a similar dynamic play out this year?

Perhaps……There is a casino bill in the works in the State senate……Its got bipartisan backing, including from senate President Chuck Morse and Manchester Democrat Lou D’Allesandro. Both men have obviously been pushing for casino gambling here for years, and both have seen allowing Keno as a distraction from that.

One area, where lawmakers are expected to come together, though, is on legislation on dealing with the state’s opioid crisis.

Yes. Those bills aren’t on the docket today but will have expedited hearings next week. The bills include provisions to stiffen penalties for making and distributing fentanyl, basically bring them in line with those for heroin. The bills will also update requirements around the state’s Prescription Drug Monitoring Program, and force health insurers to follow American Society of Addiction Medicine guidelines when determining medical necessity for care, and remove the need for prior authorization for a persons first two outpatient visits for substance abuse treatment. They will also mandate age appropriate drug and alcohol education in public schools starting in kindergarten.

So those should move fast…..

The idea is to get them to the governor by month’s end.

Before you go let’s talk about an issue that will probably move with less speed, the reauthorization of Medicaid expansion.

The decision on Medicaid probably the biggest the biggest issue lawmakers will debate this year, and possibly a big political issue as we head towards the fall elections. Recall, that expanding Medicaid, which extended health insurance coverage to more than 40,000 people who didn’t have it, took some real doing to get through……Republicans, particularly in the house, had deep concerns the state would get stuck with lots of future expenses. Reauthorization hinges on the same question.

What do you mean?

Well, under the affordable care act, the federal government said it would pick up 100 percent of the cost of expanding Medicaid until the end 2016, after that share shrinks to 90 percent. When NH expanded Medicaid, or passed the NH health protection plan -- that rebranding helped the bill with some in the GOP -- a key point was that the law would sunset when the feds stopped picking up all the costs. Republicans, particularly in the house, don’t want the state – or at least the government -- to have to come up with the cash to keep the program running. So right now, a big question is how to raise the $20 to 25 million per year the state expects lose in federal funding.

Without it coming directly from taxpayers.

Exactly. So a number of things are under consideration. These range from asking for recipients to make a co-payments, to finding a way to get hospitals or insurance companies, or in all likelihood, both, to help make up the difference. Lawmakers might look to tap some of increased insurance premium tax money from the new private policies sold under NH’s expanded Medicaid program. Policies surrounding the state’s uncompensated care fund that sends hospitals money for serving the uninsured are being looked at also.  The bottom line, is piecing together enough money to as they say, hold the state harmless. And should a deal come, it may be another extension, that will need to get revisited in a couple of years.

Thanks Josh.

That’s NHPR’s Josh Rogers, who joins Morning Edition to talk politics often. You can follow him on twitter @joshrogersNHPR

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