TUESDAY is the day the nine-member Commission to Study Medicaid Expansion gets down to business. Its task: developing a plan with broad support that would allow state providers to accept $2.4 billion in federal Medicaid money over the next seven years to cover about 49,000 individuals.
Tuesday coincidentally is the first day the state's and the nation's uninsured can access the marketplaces or exchanges to purchase health insurance and ward off penalties that would go into effect if they do not have coverage beginning Jan. 1.
Medicaid expansion under the Affordable Care Act and the exchanges ostensibly are not related, but New Hampshire's and several other states' politicians want to connect the two.
The commission seeks a Medicaid expansion plan to address Senate Republicans' desire for a uniquely New Hampshire solution that uses private insurers to cover the newly eligible Medicaid recipients between 100 and 138 percent of the federal poverty level.
Since the first few commission meetings last summer, state health officials have touted the existing Health Insurance Premium Payment Program that currently serves several hundred people as a way for eligible recipients to stay on their employers' private health insurance while federal money pays the premium and covers auxiliary services equivalent to what Medicaid provides.
The state would not need any special exception or waiver from the federal Center for Medicaid Services as long as the program is voluntary, but it would if the state decides to make it mandatory.
State Medicaid Director Katie Dunn told the commission her agency believes it eventually can include between 12,000 and 13,000 individuals under the HIPP program.
The other key component of the conceptual expansion plan is requiring those between 100 and 138 percent of the poverty level to use the exchange to purchase insurance coverage while Medicaid pays the premium and co-payments.
That would leave the Medicaid program as the last resort mostly for the adults between 18 and 64 years old who earn less than 100 percent of the poverty level.
However, last week the state Insurance Department threw a monkey wrench into the caldron. With Anthem Blue Cross Blue Shield the only general health carrier in the exchange, the choice Medicaid requires for participants is non-existent.
The state has three insurers running the Medicaid Managed Care program that begins Dec. 1, so recipients have a choice of which company offers the best network for each individual and family.
The Health and Human Services Department had raised the red flag over using the one-carrier exchange early in the process, but the Insurance Department, until last week, maintained the requirement was for choice of plans, which Anthem offers with 12.
The Insurance Department's Jennifer Patterson told the commission that the exchange could be used beginning in 2015, when more carriers are expected to join, but not in 2014 because the period for the state and federal vetting process for carriers already had passed.
Several members of the commission want a definitive answer about the choice requirement from CMS before moving forward, but the commission has to decide on its recommendations next week to meet its Oct. 15 deadline.
Any delay may be a good thing, though, because the state's exchange has been slow to develop, and many people are in the dark about its operation.
In August, the federal government awarded the "navigator" contracts to Bi-State Primary Care Association, a charitable organization representing 12 community health centers and one rural health network, and to Planned Parenthood of Northern New England, leaving that organization three months to train its personnel.
The navigators are separate from a state education and outreach plan developed by the state Insurance Department but never approved by a legislative health reform oversight committee. Moreover, the $5.4 million federal grant for the project was never included in the state budget.
State insurance officials found away around the block by having a quasi-governmental group, New Hampshire Health Plan, apply for the grant.
The group manages the state's high-risk health insurance pool for individuals who are unable to obtain coverage from private insurers, but the high risk pool goes out of existence Jan. 1 under the Affordable Care Act.
The NHHP formally applied for the grant Aug. 29 and earlier this month sent out requests for proposals for providing assistance to those using the marketplace, and for education and outreach. The group hopes to have a kick-off event in the next couple of weeks, but the exchange begins Oct. 1.
Granted, health coverage does not start until Jan. 1, but is it any wonder many are finding good information about the exchange hard to unearth?
If the commission decides to go ahead with the private insurance option through the exchange, those eligible for Medicaid may be in a pickle. Under the best-case scenario, it will be difficult for the state to expand its Medicaid program by the Jan. 1 deadline to optimize the federal dollars available to the state.
But, more important, what will the Medicaid expansion plan look like if the exchange is off-limits for a year? And will two or three Republican Senators go along with Democrats in passing such a proposal?
The prospect of a special session to vote on the commission's recommendation is dimming as most realize the Jan. 1 start date is unrealistic.
Where does that leave people who qualify for expansion but cannot afford to purchase insurance on the exchange and adults below the poverty line who have no access to the exchange? The situation is confusing and convoluted, and that is not likely to change any time soon.
To go or not to go, that is the question.
The Legislature Ethics Committee meets Tuesday to decide whether lawmakers can attend the Business and Industries Association's annual dinner and awards celebration without violating the legislative ethics code.
Among those to be honored is former House Speaker Donna Sytek of Salem, who was the first woman Speaker of the House in New Hampshire.
The 24 senators and the chairs and vice chairs of House committees have been invited to attend the $125-per-head event free of charge.
House Ways and Means Committee Chairman Susan Almy, D-Lebanon, asked the Ethics Committee for an opinion as to whether accepting the invitation would violate the Legislature's code of ethics prohibiting gifts worth more than $25.
There are exceptions in the code, and they are many.
One exception the committee will review allows lawmakers to accept tickets or free admission to charitable, ceremonial or political events if a political contribution report is filed, the organization is a registered charity or the event is open to all legislators.
Another exception allows lawmakers to accept ceremonial plaques, objects or other awards if the value is less than $150. Yet another allows lawmakers to attend events on official business.
In years past, the Senate president and House speaker were invited to attend the annual meeting, but this is the first time in a while a large contingent of lawmakers has been invited.
The committee will have to make a fairly quick decision and may not be able to issue an official written opinion before the Oct. 23 event at the Radisson-Manchester.
The committee could decide whether accepting the tickets violates the ethics code, and that would be binding, with the written opinion to be issued later.
The Ethics Committee is scheduled to meet at 11 a.m. in Room 104 of the Legislative Office Building.
A bill to be introduced next year would require health organizations to treat the iron-laden blood of those with hemochromatosis and make it available for the state's blood supply.
People with hemochromatosis have too much iron in their blood, and one of the treatments is withdrawing blood once or twice a week until the extra iron is removed from the person's system. Currently, the blood that is removed is thrown away.
"Fifty to 60 pints of blood are thrown away every week," said Warren Leary of Alton, who suffers from the disease and is the former House sergeant-at-arms. "This bill would require (health organizations) to treat it and put it back into the blood line."
Leary has approached legislators for several years seeking to have a bill introduced to address the issue.
Rep. Ken Weyler, R-Kingston, has agreed to be the prime sponsor of the bill for next session, and Sen. Lou D'Allesandro, D-Manchester, has agreed to be the Senate sponsor.
Many hospitals around the country have been given federal waivers to use blood withdrawn because of hemochromatosis once the excess iron has been removed. Leary said he and several doctors will testify for the bill when it has a public hearing next year.
"I've been waiting for this for a long time," he said.
Garry Rayno covers the State House for the New Hampshire Union Leader and Sunday News. Email him at firstname.lastname@example.org.