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Garry Rayno's State House Dome: Medicaid expansion fight on horizon

State House Bureau

July 07. 2012 11:59PM

THE NEXT BATTLEGROUND: The question of whether New Hampshire will participate in the expansion of Medicaid remains very much up in the air, the uncertainty underscored by inquiries House Speaker William O'Brien made last week.

The questions come in the wake of the U.S. Supreme Court's ruling last month upholding the constitutionality of the Patient Protection and Affordable Care Act, otherwise known as Obamacare.

As part of its decision, the Supreme Court said it was up to the states to decide whether to broaden Medicaid insurance coverage to include even more low- to moderate-income people than are already included.

What has not been made clear is who in New Hampshire will decide whether the state expands its Medicaid program. Will it be the governor, the Health and Human Services commissioner, the Joint Health Care Reform Oversight Committee established by lawmakers, or the General Court?

Normally, lawmakers would have the final say, together with the governor, through the budget process because state money would be needed to pay New Hampshire's share of the low-income health insurance program. But in this instance, Obamacare would foot the bill for the first three years, bypassing the state budget process.

Many questions will have to be answered quickly by federal Health and Human Services officials. O'Brien, meanwhile, last week sent a letter to New Hampshire Health and Human Services Commissioner Nicholas Toumpas asking to be kept abreast of any decisions or guidelines from the federal government.

'While we understand that there are no concrete answers coming from Washington yet, we request that when US HHS identifies how states can proceed on exercising their options on Medicaid expansion, you answer the following questions:

1. Will the decision to expand Medicaid be an 'opt in' or 'opt out' process? (In other words, do states have to 'opt out' of the process in order to avoid automatic inclusion?)

2. Who will be responsible for deciding whether to expand Medicaid?

3. Will this decision require affirming or proscribing legislation to implement?

4. What will be the deadline for choosing to accept the expansion population?

5. If a state chooses to expand its Medicaid population, can that decision later be reversed without jeopardizing (the federal participation)?

6. If the requirement is an 'opt out' process, what will be the deadline for making that decision?

7. If the state chooses to expand Medicaid, but not to the level envisioned by the Affordable Care Act, what would be the financial impact to state taxpayers?

Several Republican-controlled states, such as Louisiana, Wisconsin and Florida, have already said they will not expand the program, although the federal government would pay 100 percent of the cost for the first three years and then gradually drop to 90 percent in 2020, where it would remain thereafter.

Gov. John Lynch has not said what New Hampshire would do.

The two Republicans running for their party's gubernatorial nomination, Manchester attorney Ovide Lamontagne and conservative activist Kevin Smith, have both said they do not support expanding the program to cover an additional 20,000 to 40,000 state residents.

Democratic gubernatorial candidate Jackie Cilley has said she leans toward expanding the program. Her opponent Maggie Hassan's spokesman, Matt Burgess, said Hassan 'would work with the Legislature and businesses to determine how best to use the federal dollars available to extend affordable health insurance to more of our hard-working citizens.'

The deadline for deciding is not far off, and much needs to be settled in New Hampshire before the end of the year.

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OFF THE COMMITTEE: In a related matter, O'Brien has removed the lone Democrat on the six-member Joint Health Care Reform Oversight Committee, Rep. Kathleen Taylor, D-Franconia. The reason given: She voted with three senators to accept a $330,000 federal grant to help set up a state-based health insurance exchange called for in the Affordable Care Act.

O'Brien was quoted saying he did not want a House member to vote to expand Medicaid.

Responded Taylor: 'In the past 14 years that I have served in the Legislature, I have never been involved in any controversy of this nature. I have been a full participant of the Joint Health Care Reform Oversight Committee and looked forward to continuing my work with the committee.''

A committee meeting scheduled for July 25 'is to establish the essential benefits of the ACA for New Hampshire citizens. The committee will make recommendations for health care coverage - or not - for citizens with diabetes, heart disease, mental health and many other issues.

'It is obvious to me that Speaker O'Brien is working hard to not allow New Hampshire to implement an expansion of Medicaid benefits for our vulnerable citizens.'

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STATE SENATE PRIMARIES: There are nine primaries in state Senate races, including one on the Democratic side and two against incumbents, including Senate President Peter Bragdon of Milford.

On the Democratic side, the only contest is in District 5, where former Rep. Sandy Harris of Claremont goes against Rep. David Pierce of Hanover.

There is also a primary on the Republican side in District 5, where Tea Party activist Cynthia Coolidge Howard of Claremont takes on Joe Osgood of Claremont.

Bragdon is facing a challenge from Daniel Dwyer of Merrimack in the newly redrawn District 11. Merrimack is the largest town in the district now.

District 23 incumbent Russell Prescott of Kingston faces a challenge from Dennis Acton of Fremont.

Three Republicans are facing off for the District 1 seat, including Frank Dumaine of Colebrook, Mark Evans of Berlin, the biggest community in the district, and Debi Warner of Littleton.

The District 6 race will see the return of former Rochester Mayor and Sen. Dick Green in the redrawn district. He faces Rep. Sam Cataldo of Farmington.

Another three-way race is for the District 9 seat left open when Sen. Ray White decided not to run again. All three candidates are from Bedford, though the redrawn district stretches into the Monadnock region.

Former District 7 Sen. Andy Sanborn wants to return to the Senate, but faces competition from longtime Bedford Rep. Ken Hawkins and from Michael Kenney.

And the open District 17 seat vacated by Sen. Jack Barnes will see Rep. John Reagan of Deerfield facing Howard Pearl of Loudon.

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SAYING GOODBYE: Three people closely tied to the State House died recently: Reps. Daniel Carr, D-Ashuelot, and Leo Pepino, R-Manchester, and longtime lobbyist Liz Murphy.

Carr, a typographer and type founder (a person who makes metallic types for printers), was serving his second term in the House.

Pepino, who also served as a Manchester alderman, was in his 12th term in the House when he passed away last week.

Pepino would walk into the State House press room, and the first words out of his mouth would be, 'You're missing something,' and then he would proceed to tell you what 'you were missing' without having to be asked.

He slowed down a great deal in the past few years, but could always be counted on to keep things lively, and he enjoyed a good fight.

Before becoming a lobbyist, Murphy had served one term in the House of Representatives and was not shy about telling you she was the first Democrat elected from Carroll County.

Liz was always your friend and happy to help in any way she could as long as you didn't quote her directly.

You come to know people in a special way working at the State House as you share not only the legislative experience, but also the long, sleepless nights in the Legislative Office Building while key bills - most often the budget - are negotiated at the end of the session.

The sessions usually present hurry-up-and-wait situations, and there is time to chat about what is going on and whose kids are going to which college.

At the State House, what often seem like 'punch-drunk sessions' are an experience few people share, and bonds develop that last lifetimes.

To everything there is a season and a purpose under heaven.

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Garry Rayno writes State House Dome weekly for New Hampshire Sunday News. He may be reached at

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