CONCORD — New Hampshire cannot expand its Medicaid program providing health insurance to the poor and disabled without lawmaker approval, said House Speaker William O’Brien.

In a letter to Gov. John Lynch, O’Brien noted two laws passed last year require the approval of several House and Senate committees, the Executive Council and consultation with the House and Senate before the Medicaid program could be expanded under the Affordable Care Act.

O’Brien urges the governor to convene a meeting of House and Senate leadership, the Executive Council and state officials to discuss the issue.

The recent U.S. Supreme Court decision that upheld the Affordable Care Act also allowed states to decide if they want to expand Medicaid eligibility to include individuals with incomes up to 133 percent of the poverty level. Under the act, states had to expand the program.

Under the federal plan, an individual earning $14,856 or a family of four with income less than $30,656 would be eligible for Medicaid coverage.

The federal government would pay 100 percent of the cost for the first three years from 2014 to 2017, and then gradually reduce its share to 90 by 2020, where it would remain.

O’Brien said expanding Medicaid in New Hampshire would increase program rolls between the Department of Health and Human Services’ estimate of 27,000 and the Urban Institute estimate of 51,000.

“Obviously, with a program that is already placing enormous, and eventually unsustainable, fiscal pressure on state budgets, this is a matter that must be given serous consideration,” O’Brien said.

Several states with Republican governors such as Wisconsin, Texas, Louisiana and Florida have already said they will opt out of the expansion.

Lynch has not said whether he believes the program should be expanded in New Hampshire.

“The departments of health and human services, and insurance continue to gather information about the Affordable Care Act so the governor can assess the information and work toward making a decision that is in the best interest of New Hampshire and its people,” said Lynch’s press secretary Colin Manning. “The governor routinely speaks with lawmakers on a variety of issue and certainly will speak to them about this issue if it’s necessary.”

Since the Supreme Court’s decision, O’Brien has worked to put the brakes on any expansion of the Medicaid program here.

Earlier this month he wrote a letter to state Health and Human Services Commissioner Nicholas Toumpas asking that Toumpas inform lawmakers about the program’s possible expansion.

O’Brien was also concerned about a provision in the federal law requiring states to maintain the eligibility standards that were in place March 23, 2010, when the law was signed for both Medicaid and the Children’s Health Insurance Program.

The intent was to block states from reducing services before the health insurance exchanges begin Jan. 1, 2014. The Children’s Heath Insurance Program provisions continue until Sept. 30, 2019.

If a state violates the requirement, it could lose all its federal funding for both programs.

Soon after the Supreme Court decision was announced, O’Brien removed the lone Democrat on the six-member oversight committee, Rep. Kathleen Taylor, D-Franconia.

The reason given for her removal was she voted with the three senators to accept a $330,000 federal grant to help set up the state’s health insurance exchange.

O’Brien said he did not want a House member to vote with the three senators to expand Medicaid.

In his letter to Lynch, O’Brien notes while the law requires the federal government to pay at 90 percent of the cost of expanding Medicaid eligibility, the federal government has not lived up to past promises such as paying 40 percent of the cost of special education when it pays less than 20 percent.

O’Brien said the federal government’s commitment is “meaningless” and instead the expansion costs will be borne by state taxpayers.

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Garry Rayno may be reached at grayno@unionleader.com.