CONCORD — The commission studying Medicaid expansion under the Affordable Care Act will decide today on its recommendations.
The Commission to Study Expansion of Medicaid Eligibility spent Tuesday discussing a plan that would pay the premium for those on employer health plans, and use the health insurance exchange and the current Medicaid plan to add about 49,000 people to the program.
Rep. Thomas Sherman, D-Rye, made the proposal, saying "My vision of Medicaid expansion has radically changed from when we started back in July."
The plan would begin coverage for those adults between 19 and 64 years old between 100 and 138 percent of the federal poverty level as soon as possible but would require the federal government to agree to changes in two major areas.
Making the Health Insurance Premium Payment program mandatory for those who qualify for expansion and have employer insurance, and using the exchange to cover part of the population would both require federal waivers.
Under Sherman's plan the legislature would need to reauthorize the expansion if federal support and benefits change or if the program is larger than anticipated.
"We share most of the same values," Sherman said "But we are likely to disagree on the role of government in health care, and the role of government in Medicaid expansion."
Sherman's proposal is similar to what state health and insurance officials have discussed as possibilities that would allow the state to develop its own expansion plan rather than simply add more people to the Medicaid program.
However Sherman's plan did little to address concerns of some Republicans on the committee who have pushed for alternatives to expansion. However, commission chairman James Varnum asked for alternative proposals to be submitted Monday, and none were proposed.
"What do you say to all the people under the ACA and limited (health care provider) networks that do not have a choice of doctors and hospitals but have co-pays and co-insurance?" Sen. Andy Sanborn, R-Bedford, asked. "Yet we are going to tax them to provide a financial health benefit for others they can't get themselves?"
Republican commission members did make recommendations, including limiting expansion to those below 100 percent of the federal poverty level including all Medicaid programs such as those for pregnant women and children's health insurance.
Sen. Nancy Stiles, R-Hampton, noted Arkansas was granted a waiver for its proposal to cover new enrollees from 0 to 138 percent of the poverty level through the health insurance exchange. She suggested the state follow suit.
Rep. Neal Kurk, R-Weare, urged the commission not to begin the program unless the state has the federal waivers in hand. "Don't go in hook, line and sinker, full-bore ahead regardless of what happens," he said.
The commission is expected to begin voting on its recommendations today.
"We need to do more tomorrow than what we did today," said Sen. Peggy Gilmour, D-Hollis. "We can't have this discussion tomorrow or we'll never finish this."
The committee has an Oct. 15 deadline for making its recommendations and will meet twice next week to review what is expected to be a draft of its proposals as well as a minority opinion opposing expansion.
New Hampshire is one of eight states who have yet to make a decision on whether to expand Medicaid eligibility.
The battle over expansion has fallen largely down partisan lines as Democrats favor expansion and Republicans oppose it.
Expansion is supported by Gov. Maggie Hassan and the Democrat-controlled House, while the Republican-controlled Senate said it needs far more information and time before deciding.
When the two sides could not agree at the end of the session in June, budget negotiators agreed to form the commission.
If New Hampshire decides to expand Medicaid eligibility to 138 percent of the federal poverty level, state health and human service officials say that will add 49,000 people to the program over the next 7½ years, while the federal government will pay $2.4 billion to health care providers. The state is expected to spend about $18 million for expansion over the period.
Under Medicaid expansion, the federal government would pay 100 percent of the cost for the first three years and then gradually reduce its share to 90 percent by 2014 and thereafter.