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Garry Rayno's State House Dome: Lawmakers tackle expanding Medicaid eligibility under Obamacare
The House and Senate will meet at 10 a.m. Thursday to set the ground rules for the next two weeks of hearings and meetings before a vote Nov. 21.
The House and Senate leadership and Gov. Maggie Hassan's office have already had countless meetings as they've tried to reach an accord to allow expansion to go forward next year and state health care providers to receive about $2.4 billion in federal money to pay for 58,000 newly eligible residents over the next seven years.
That has not changed since the 13 Republicans held firm and rejected Medicaid expansion during the budget-writing process earlier this year.
The commission issued its report last month.
The report essentially said the state should start the program Jan. 1 and use private insurance to cover as many of the newly eligible residents as possible, including expanding a program that pays the premiums of adults with health insurance through their employers.
The problem with having a similar program here is that New Hampshire has only one company on the exchange: the state's largest health insurer, Anthem Blue Cross Blue Shield.
Lawmakers are working with the three private managed care companies the state hired to administer the existing Medicaid program, trying to persuade at least one to offer policies on the state's exchange beginning Jan. 1, 2015.
The problem is that the private insurance has to cost the same or less than the current Medicaid program, a scenario that would be difficult to achieve.
A uniquely New Hampshire solution may be hard to achieve, but the pressure is on with just days remaining before the first day of the special session.
CASINO GAMBLING: Another big issue not involving health care this summer and fall has been expanded gaming and how the state should regulate it in the future.
The Gaming Regulatory Oversight Authority has listened to experts near and far, and from advocates on both sides of the issue and recently began putting together a regulatory scheme in case lawmakers ever vote to legalize casino gambling.
According to the poll done by the University of New Hampshire Survey Center, 59 percent favor a casino, while 33 percent oppose it and 8 percent are neutral.
With the exception of people who regularly attend church, majorities of all demographic and political groups favor a casino in New Hampshire, the center said.
The threat of casinos in nearby Massachusetts does little to change minds about expanded gaming in the Granite State.
The survey center contacted 603 randomly selected New Hampshire adults by landline and cell phone between Oct. 1 and 7, 2013. The margin of error is plus or minus 4.0 percent.
They worry the Massachusetts casinos will reduce state revenue and shift the costs of problem gamblers to state social service programs.
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SCRUBBER QUESTION: The Electric Utility Restructuring Oversight Committee has been trying to decide what to do to lower electric rates for residential and small business customers who continue to buy their power from Public Service of New Hampshire. Large users and many small users are now buying their power from alternative providers.
The Public Utilities Commission is in the process of determining how much of the $422 million scrubber costs ratepayers will have to pay, but Public Service asked the state Supreme Court to rule the law mandates customers pay the entire cost of the scrubber. That appeal brought the PUC proceedings to a halt.
The ramifications of who pays for the scrubber will have huge impacts on either Public Service power customers or the utility's stockholders.
The longer this battle goes on, the more expensive electric rates will be for Public Service's power customers. The company collects a rate of return on its $422 million investment of about 9 percent a year or $38 million which goes automatically into rates.
PALLIATIVE CARE REPORT: People and health care providers need better information about the treatment of pain and discomfort due to illness or trauma, according to a report from a commission that studied palliative care and quality of life this summer and fall.
"The best method for changing current medical practices is to educate the patient to ask their medical provider for the service," said commission member Mary Scott, APRN.
A statewide registry is needed for advance directives such as do not resuscitate orders that can be accessed in a medical emergency, the commission found.
Two members of the commission, Reps. Suzanne Smith, D-Hebron, and Frank Kowtowski, R-Hooksett, will sponsor legislation for a privately funded education center for palliative care.
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