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Garry Rayno's State House Dome: 'Medicaid expansion' ... sweet by any other name?

State House Bureau

March 01. 2014 10:56PM

Medicaid expansion will be on the minds of many in Concord in the next month, but you will not hear the words "Medicaid expansion'' spoken.

Instead, you will hear about the New Hampshire Health Protection Program and the premium assistance program, mandatory and voluntary.

Whatever it is called, federal Medicaid dollars will pay 100 percent of the cost, or New Hampshire's "assistance program" will end.

The compromise worked out between key Republican and Democratic state senators with the support of Gov. Maggie Hassan uses private health insurers to cover the between 50,000 and 60,000 state residents who will qualify for Medicaid services when eligibility is expanded to 138 percent of the federal poverty level under the Affordable Care Act.

Some conservative Republicans, libertarians and various activists groups - even some not funded by the Koch brothers - are not buying the rebranding and have promised to hold Republican senators who vote for the health protection act accountable, saying they will face a primary battle in September.

Several Republican county organizations, Rockingham and Strafford, as well as local committees, including Manchester, Bedford, Merrimack and Epping, are lining up in opposition to the plan sponsored by Senate President Chuck Morse, D-Salem, Senate Majority Leader Jeb Bradley, R-Wolfeboro, Sen. Bob Odell, R-Lempster, Senate Minority Leader Sylvia Larsen, D-Concord, Sen. Lou D'Allesandro, D-Manchester, and Sen. Peggy Gilmour, D-Hollis.

The opposition among rank-and-file Republicans has been growing despite the work of Morse and Bradley behind the scenes and at party gatherings.

Last week, Morse said the unrest over his bill is "how New Hampshire works" and that he expected the debate to continue. But he did not waver, saying that private insurance was the New Hampshire solution.

The restlessness has begun drawing national attention.

Late last week, the Breitbrat News had an article with the headline "New Hampshire Republicans Caving on Obamacare Medicaid Expansion," not something you want to see if you are a Republican senator.

Last year, the 13 Republicans in the Senate stood together to block expansion bills supported by the House and Hassan, but it was an uneasy alliance as several senators believed they needed some form of coverage to satisfy their constituents.

Morse and Bradley worked to make that happen while trying to keep at bay the vocal naysayers in the caucus. The plan is more to Republicans' liking than most believed Hassan and House Speaker Terri Norelli, D-Portsmouth, would agree to, but they have.

But the opposition to SB 413 may be a little too late coalescing.

The plan was revealed 2½ weeks ago. A public hearing was held the next week, and two days later, the Senate Health, Education and Human Services voted, 4-1, for the bill.

The full Senate is set to vote on SB 413 Thursday. One scenario has the bill moving to the front of the calendar so the Senate can act before noon, the deadline for the House to schedule a public hearing and have it printed in the calendar for the next week.

Norelli reportedly does not want the bill coming before the House the last week of March, which is "crossover," or when all the approved House bills have to be sent to the Senate and vice versa.

Consequently, the House vote on SB 413 will be held either during the third week in March or the first week in April, with Hassan's signature soon after unless some of the more adamant House members decide to try for a little more of what they want in Medicaid expansion, but that is unlikely to succeed.

Quick action is needed to meet some of the deadlines for waivers to be submitted to the federal Center for Medicaid Services and for the July 1 start date for the program. Quick action will also take Medicaid expansion out of the headlines by the end of March and give voters a little more time to forget which Republicans voted for expansion.

How many people remember the first bill the House approved this session was a Medicaid expansion plan similar to the one proposed by the Medicaid Expansion study commission last fall?

You didn't? Well, that's the idea.

The compromise plan may not be Medicaid as we know it because it uses private insurance plans either through the state's health insurance exchange, the state's Managed Care Medicaid program or private employers who offer health care coverage, but Medicaid money will pay the premiums, as is the case in Arkansas and Iowa, which have federal waivers for similar plans.

You can call it what you want, but if the plan passes, New Hampshire will be added to the rolls of states that expanded Medicaid eligibility under the ACA.

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CASINO VOTE: Having held a public hearing and three or four work sessions, the House Ways and Means Committee will vote Tuesday on the bill developed by the Gaming Regulatory Oversight Authority.

House Bill 1633 would establish one casino in the state with up to 5,000 video slot machines and 150 table games, although consultants hired by the authority estimate the more realistic initial offering would be about 2,000 video slots and 75 table games. More would then be added over time.

The bill would establish a gaming commission to regulate all gambling activity in the state: a commercial casino, the state lottery, charitable gaming and horse and dog racing.

Gov. Maggie Hassan is backing the bill, which has drawn all the gaming attention this year, and not the Senate-passed bill allowing for two casinos.

The bill faces a significant hurdle in the Ways and Means Committee because Chairman Susan Almy, D-Lebanon, and Vice Chairman Patricia Lovejoy, D-Stratham, are both opponents of casino gambling.

If you're a betting person, put your money on the committee recommending the bill be killed.

The recommendation, however, will have little to do with the House vote by the end of the month.

Unlike in years past, potential casino operators are not out front on this, and that may put the bill in a more favorable light. But is that enough?

The bill certainly has led to a more reasoned discussion about gaming in the House, and that doesn't hurt the causes of either side of the issue.

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Gas Tax: The third big issue lawmakers will face this session, increasing the gas tax, will also face a committee vote Tuesday.

The Senate Ways and Means Committee will vote on Senate Bill 367, which would raise the gas tax about 4.2 cents to raise $30 million a year in additional highway fund revenue.

The bill's prime sponsor, Sen. Jim Rausch, R-Derry, will ask the committee to remove a provision that uses the consumer price index to adjust the gas tax every four years to account for inflation. The automatic increase was the more controversial aspect of the bill for many, including the Business and Industry Association, which backed the increase but opposes the indexing formula.

Morse, who is on Ways and Means, is adamantly opposed to increasing the gas tax and instead wants casino revenue to provide additional money for roads and bridges.

Other members of the committee, including Rausch, have a slightly softer stance on the gas tax, so it may well make it out of committee with a positive vote.

But like the gambling bill in the House, how the committee votes will have little bearing on the full Senate vote later this month.

Last year, some Democrats joined with Republicans to kill a bill to increase the gas tax by 12 cents.

If a few Democrats oppose the increase, it is dead. At the end of last week, only three Republicans were on board, including Rausch.

Even if the bill ultimately becomes law, the additional $30 million falls far short of what Department of Transportation Commissioner Chris Clement says is needed to fix the roads and bridges and finish the Interstate 93 expansion project from Salem to Manchester.

Passing the bill takes any additional increase in the gas tax off the table for at least four years, and that may do more harm than good.

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Modern Age: The executive councilors have joined the 21st century.

State troopers will no longer be delivering to councilors boxes of background material used to inform them about issues coming up for a vote. The deliveries were made two Fridays a month.

The councilors have received new iPads, which will allow the information to be delivered electronically, saving both the troopers' time and travel expenses and the cost of all that paper and printing.

District 5 Executive Councilor Debora Pignatelli, D-Nashua, called the new arrangement a big step forward for the council.

"This is a big accomplishment," she said. "This will save us a lot of money and save a lot of trees."

The councilors had their first tutorial on the new iPads after Friday's council meeting.

Council District 1 Race: The money is flowing into the District 1 Executive Council race to replace the late Raymond Burton, who died last year.

Democrat Michael Cryans of Hanover continues to hold a commanding monetary lead over Republican Joseph Kenney of Wakefield, according to reports filed with the Secretary of State's Office last week.

Cryans has raised $38,747 since the primary election, for a total of $108,900. He spent $18,772 during the period and a total of $28,973, leaving him with a war chest of $79,727 going into the final two weeks of the campaign.

Kenney has raised $13,256 since the three-way primary he won, for a total of $68,971, although he loaned his campaign $40,000 of the total.

Kenney's campaign spent $3,206 since the primary, for total spending of $24,946, leaving him with a war chest of $44,025 leading up to the March 11 general election on Town Meeting Day.

District 1, which had been represented by Burton for almost 40 years, stretches from the Canadian border to just north of Concord.

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