Senate came together 
on ‘NH specific’ solution

Last modified: Wednesday, February 19, 2014
There has been much talk in the news this past week about a compromise reached in the Senate to expand health coverage to NH low income adults using federal dollars. The process to reach this compromise has been intense, but an example of NH legislators working across party lines to reach a solution that will work for New Hampshire.

The Affordable Care Act, aka Obamacare, offers federal dollars to insure low income working adults health insurance under the Medicaid program. Income levels are below $16,000 annually. The federal government will pick up 100 percent of the cost for the first three years, then gradually reduce the contribution to 90 percent of the cost of the program. The additional 10 percent will be the responsibility of the state.

The Commission that met over the summer recommended that the state move ahead with this program, but in an “NH specific” way. The recommendations were: to supplement the cost of insurance for anyone meeting the low income guidelines who has access to employer based insurance; enroll eligible adults without employer insurance in the privatized Medicaid managed care program while awaiting a waiver from the federal government to use the dollars for “premium assistance”, i.e. a voucher, for individuals to purchase private health insurance through the Marketplace Exchange.

Unfortunately, during the special legislative session that met in November to take up these recommendations ended in a failure to pass legislation and move forward. Republicans and Democrats disagreed mainly on the timing of moving people into the private marketplace. Democrats believed it would take two years to have a robust Marketplace with competition and access to a broad network of hospitals, thus we should cover people with managed care while waiting. Republicans wanted faster movement to the private marketplace or no deal.

Most agreed that the advantages of covering more people with health insurance far outweighed the disadvantages. To refuse to participate, 50,000 NH citizens would remain uninsured, and suffer the health and economic impacts being uninsured brings; hospitals, doctors, health clinics and mental health centers would continue to care for those uninsured without any compensation; all those with health insurance would continue to pay for the uninsured through “cost shifting” to their own insurance premiums; NH would continue to forgo the return of our own tax dollars and lose millions of dollars that could pay our providers, create jobs, benefit our economy. So…if we agreed on the benefits, how could we make it happen?

A bi-partisan group of six senators, three Republicans and three Democrats began meeting after Thanksgiving. We rolled up our sleeves and committed to finding a solution. We got technical consultation from insurance and health department experts on enrollment facts, timing issues, federal requirements. We debated process, and each side “gave up” on issues so we could continue to move the process along. And, Senate staff worked hard capturing language all could agree upon.

The result is a bill, SB 413, The New Hampshire Health Protection Program, that will be voted on in the Senate the first week of March. The bill is sponsored by the three Republicans and three Democrats that met through the holidays and beyond to “figure this out.”

There are many protections for NH in the proposal. If federal dollars fall below 100 percent, the program ends. If timely waivers are not received that will move people to the private market, the program ends. And, the program sunsets at the end of 2017 and cannot continue without legislative reauthorization.

Understand, there continue to be hurdles. Political pressure on some senators not to support this is intense. The far right believes any acknowledgement of participation in using federal dollars to expand coverage is bad. The far left believes the timelines to sunset the program are too short. And, to be successful, both the House and the governor must agree with the approach the Senate has taken.

They say (whoever they are!) that we do not want to watch making sausage or making legislation. The process can be messy indeed! However, there can be an end product that is good. In this case, good for 50,000 of our NH neighbors, good for our hospitals and doctors, good for our economy, and good for New Hampshire. Let’s make it happen.

Peggy Gilmour represents NH Senate District 12, which includes Mason, Greenville, New Ipswich and Rindge, as well as other towns and cities.