The renewal of the Medicaid expansion in New Hampshire is one step closer to reality after a bill to reshape and extend it for five years advanced in the state House of Representatives.
The legislation, which already passed in the state Senate in March, marks a significant departure from the previous two-year installments that the state had enacted. It moves to a managed-care model, which is expected to dramatically lower the state’s costs, and introduces work requirements and a Granite Workforce pilot program designed to help those without work find jobs.
The provisions of the bill were based on the findings of a bipartisan commission established to put New Hampshire’s health-care system on better footing in the face of rising premiums and the uncertain future of the Affordable Care Act. Three state senators and three state representatives served on the commission, along with eight other members from various health and insurance-related entities.
The bill is supported by Republican Gov. Chris Sununu, who lauded its passage in the Senate as a “fiscally responsible plan.”
During floor debate April 5, Rep. William Marsh, R-Wolfeboro, explained why the House’s Health, Human Services and Elderly Affairs Committee had given the bill its unanimous support.
“At any given point in time, approximately 50,000 low-income people rely upon Medicaid expansion to provide their health care,” Marsh said. “And despite assertions to the contrary, we know this is not a handout but a hand up, for approximately 130,000 citizens have passed through this program, which means that over 60 percent of them no longer need it.”
Marsh said that by switching to the managed-care model, Medicaid expansion would cost the state $10 million a year instead of $22.7 million under the previous program. He also insisted that ending Medicaid expansion outright would actually increase costs for New Hampshire as certain mandated expenses currently paid with federal dollars would have to be funded with state money. He cited numbers that showed the state would have to assume expenses of $4 million for state employees on Medicaid, $3 million for inmates on Medicaid and $17.3 million for people in behavioral health programs.
“And yet these are not the only costs,” he said. “If we fail to reauthorize Medicaid expansion, the municipal welfare departments of our cities and towns would again incur costs assisting low-income residents with their health care. They can’t afford this either.”
Rep. Jess Edwards, R-Auburn, criticized the expansion as a giveaway that unfairly wastes the efforts of taxpayers who work to pay for their own health insurance.
“I think that we need to do a much better job of tightening up the eligibility around this bill, making sure that we have better fraud protection in this bill, because as it stands I think this bill makes a mockery of every W-2 employee in this state,” he said. “They’re paying $1,000 to $2,000 a month to pay for their family’s health insurance, and we’re going to create a program that’s going to be open and just paid for free health insurance.”
The bill was seen as unnecessarily speculative by state Rep. Laurie Sanborn, R-Bedford, given the uncertainty surrounding the future of government-sponsored health care in the U.S.
“The future of Obamacare is highly uncertain, and this bill reauthorizes Medicaid expansion under Obamacare,” she said. “This bill reauthorizes Medicaid expansion for a period of five years, and we should not extend anything beyond two years or the next budget.”
The bill advanced on a 222-125 vote. As had been seen in the Senate, House Democrats were unanimous in support of the legislation, with all 156 present voting in favor. Republicans were largely against the bill, 124-66, and the lone Libertarian vote was against it.
Senate Bill 313 will now go to the House Committee on Finance for consideration before it can return to the full House for final passage. Among Finance Committee members who were present for the April 5 vote, they were split 13-12 in favor, making it difficult to predict if the 26-member committee will recommend adoption.