New Hampshire is one of just a handful of states that hasn’t yet answered the Medicaid expansion question. Remember, when the U.S. Supreme Court ruled on the federal health law last summer, it said Washington could not force states to expand their Medicaid programs that provides health care to the poor. States, instead, must be given a choice.
And so, for the better part of three months now, a special commission has been studying whether to add 50,000 more low income individuals to the program.
The nine voting members, including Democratic Representative Cindy Rosenwald, poured over reports, heard hours of testimony and debated a range of different ideas.
“I think we’ve done a lot of work on this subject,” says Rosenwald. “It is certainly the deepest dive I’ve done on anything in my ten years here.”
All that work produced a plan that supporters are calling a New Hampshire solution. Rather than just bringing the newly eligible onto Medicaid, people earning less than about $15,000 a year who get insurance through their job would have to keep that insurance, with the government picking up any out of pocket expenses. Everyone else would enroll in traditional Medicaid starting in 2014.
The idea will require federal approval, but Health and Human Services officials say the ‘okay’ could come quickly from Washington.
Still, there was disagreement on the potential costs to the state. Charlie Arlinghaus, a Republican appointee to the commission, warned that the number of enrollees may balloon beyond estimates.
“Everybody around this table thinks there are lot of people in our society who are in a difficult place and that to the extent that we are a wealthy society, we should do what we can to help out those people, who are in a difficult place,” says Arlinghaus. “However, there are financial concerns about it.”
Arlinghaus favored capping the number of people that could participate. He also wanted to kill the expansion if costs exceeded projections by more than 10%.
But the majority rejected those ideas. Democratic Senator Peggy Gilmour said the commission shouldn’t limit the ability of lawmakers to make their own decisions down the road.
“I have confidence that future legislatures can, essentially, think for themselves,” says Gilmour.
And Gilmour also has confidence the federal government will meet its funding commitments. Under the Affordable Care Act, Washington promises to pay 100% of the bill for expanded Medicaid for the next three years. By 2020, that funding drops to 90%, leaving New Hampshire with an estimated $20-30 million dollar annual tab.
Republican Representative Neil Kurk worries that could lead to an income or sales tax.
“As a result of this plan, should it go forward, it is very likely that starting in 2022, and beyond, we are going to have to implement another major revenue source,” says Kurk.
Along with his fiscal concerns, Kurk also pushed a welfare-style work requirement.
“A person who is financially eligible, and age eligible obviously, needn’t work at all, can stay at home on the hammock and doesn’t have to do anything? Is that the situation, that simply because you are alive and poor you receive this health care and you don’t have to do any work if you don’t wish to?”
The work requirement was rejected on a 7-2 vote. State health officials say the federal government wasn’t likely to approve that anyway.
But before Washington gets its say, the proposal still needs to win approval from the full legislature.
That’s a foregone conclusion in the Democratically-controlled house. But not so in the State Senate, where the GOP holds a slim two vote majority.
Republican Nancy Stiles, a potential swing vote in that chamber, did join the five Democratic appointees in supporting the commission’s recommendation.
But she cautions she hasn’t made a final decision.
“Because we do have concerns about future cost, we have concern about over-enrollment, we have all those concerns,” says Stiles. “But, I think those things can be dealt with as we move through the process.”
The process now moves to Governor Maggie Hassan, who will call a special legislative session sometime this fall to put the issue before lawmakers.
Hassan has said she wants Medicaid expansion to take effect by January 1st. In a statement following the commission’s vote, she didn’t mention any specific dates, but reiterated her support for expansion and her desire for a speedy resolution.
So far, New Hampshire’s approach to Medicaid expansion has been anything but.