House Finance Committee recommends passage for health coverage expansion compromise
CONCORD – The compromise plan to use Medicaid funding to provide private health insurance to an estimated 50,000 working, low-income New Hampshire adults cleared another hurdle Tuesday toward likely enactment.
The House Finance Committee voted 15-10 to recommend that the so-called “Medicaid Expansion” bill, Senate Bill 413, ought to pass when the full House takes it up, most likely next Tuesday, March 25.
Although the plan was dubbed a bipartisan compromise by leaders in the state Senate, where it passed 18-5 with seven GOP votes, there was a much more partisan divide on the powerful House panel Tuesday. Only one Republican, Rep. Robert Elliott of Salem, voted in favor of the plan, joining 14 Democrats.
The bill Senate Bill 413 establishes a two-year pilot program that would end if the state does not receive federal approval for program provisions or if the federal government does not pay 100 percent of the costs.
After the vote, Rep. Sharon Nordgren, D-Hanover, vice chairman of the committee, said the bill “reflects the significant work of the House, Senate and governor over the past 15 months, including the Commission to Study Expansion of Medicaid Eligibility.
“SB 413 is a broadly supported compromise plan to provide access to privately delivered health care for 50,000 working men and women across the state,” she said. “By taking action now, the state will be able to begin enrollments in early May and start providing coverage in July.”
The finance committee rejected by 14-11 votes, strictly along party lines, two amendments brought up by a veteran Republican committee member Rep. Neal Kurk of Weare. He said the amendments were aimed at limiting taxpayer exposure to potential costs.
Kurk’s initial amendment called for deferring implementation of the program until all waivers required from the federal Center for Medicare and Medicaid Services (CMS) are approved.
After that was rejected, Kurk moved an amendment that would terminate the program if participation exceeded 60,000 participants or total annual expenditures exceeded $400 million, which was also killed.
On his initial amendment, Kurk said it would be wise for the state to wait until the CMS waivers are approved before embarking on the program.
He said his amendment would eliminate the bridge program because “it goes into effect immediately while we’re waiting for waivers required by CMS.” He said the move would increase the likelihood that the state receives the waivers it requires.
Kurk said it would continue the Health Insurance Premium Payment Program (HIPP) program.
Kurk said that if the program begins immediately and then waivers are declined, “all of these people would have their insurance eliminated, or, he said, it would force the to continue on Medicaid “on a pure Medicaid expansion basis.”
“It’s not the way to do business,” he said.
“It’s a policy question,” said Kurk, “if you want to start the program for people having insurance for a while and then risk having it removed, or do you want to wait until such time as CMS approves the waiver, which I believe is more likely.”
But Rep. Tom Sherman, D-Rye, one of the bill’s cosponsors, said that “by delaying the availability of the bridge program, we are delaying care to 58,000 or at least 30,000 residents.”
“Not only are we delaying care but we are also saying that even one year delay is not appropriate. We can do a lot in a year from a physical, health standpoint and I believe that most of those people would feel a year of benefits is better than none at all.”
Sherman said that to “pull back at this point would be undermining some of the essential portions of the agreements we have with the managed care organizations of this state.”
And, Sherman said, “to use patients and health care as a negotiating tool with CMS is not appropriate for how we treat our residents and how we treat out constituents. We would be saying we will not provide care to 30,000 to 60,000 New Hampshire residents and use it as a leverage to be sure we get a waiver.”
Rep. John Cebrowski, R-Bedford, said he backs expanded access to health care coverage, “but the process, without getting the waivers approved up front, is deeply flawed and a bad fiscal decision.”
Kurk said it is better policy to defer services for a “short period of time” in return for a long-term commitment.
But Sherman said the bridge program is federally funded at 100 percent, and that if the waiver is not approved, “the program would be stopped.” As a result, he said, Kurk’s amendment was unnecessary.
Kurk’s said his second amendment would have protected taxpayers if the number of those participating or the cost exceed estimates produced last year by a state-hired consultant.
“If the estimates turn out to be too low and the costs increase dramatically, what do we do?” asked Kurk. “This takes the numbers given to us by the Lewin Group and goes beyond that.”
“I’d ask the committee to protect the taxpayers of New Hampshire, who will eventually be paying 10 percent of the costs. This says to go ahead but do it in a fiscally prudent and responsible way.
Rep. Stephen Spratt, D-Greenville, said the committee had been told that the CMS would not grant a waiver if the program contained limitations on participants or expenditure. Kurk disagreed.
Sherman added, “I don’t believe this amendment is necessary. We are already guaranteed 100 percent of the coverage (by the federal government), whatever that is in those three initial years.”
Salem Republican Elliott said that while he backed the two GOP amendments, he also supported the overall bill because “I get the impression that the public believes this is a Democratic bill and a Democratic measure. The message that should come from the committee and the House of Representatives is that this is not a partisan bill.
“This isn’t about Democrats and it’s not about Republican,” Elliott said. “This is about people being able to buy managed care insurance. I’m going to send a message to my constituents that we Republicans say we are united with the Democrats that there should be health care coverage for the poor.”
But Rep. Marilinda Garcia, a Republican congressional candidate also from Salem, said, the program is “inflexible and will be increasingly so.
“We need to achieve better health care for more people at lower costs,” she said. “Medicaid does not provide high-quality, innovative care to people. It’s just another way to say, ‘Let’s expand what we already have.’ It’s as though the federal government is offering us money and we have to take it.’”
Cebrowski said he would “love to support the bill,” but he said it is “grossly irresponsible for the long term.”
“It reflects poor management on the part of the state and I believe there will be long term negative consequences,” he said.
Kurk said the program “is not good public policy. We know the public in general does not like Obamacare, and why we would extend that to even more people is a mystery.”
Kurk suggested expanding the Earned Income Tax Credit so low-income people “can buy the type of health care that they know they need and not what Congress or we think they need.
“This goes in the wrong direction and is contrary to traditional American values,” Kurk said.