When it comes to the fight in Concord over Medicaid expansion, what you see isn’t what you’re going to get.
The state Senate unanimously passed a bill reauthorizing the state’s Granite Advantage program without requiring future legislatures to reauthorize the program for it to continue.
The House of Representatives has amendments on its calendar requiring reauthorization after just two years, which supporters of Medicaid expansion find unacceptable. Director of Medicaid Services Henry Lipman said it could increase the program’s cost by 10 percent rather than a longer reauthorization which would increase competition and stability in the managed care organization (MCO) contracting process.
Tensions reached a new high Friday when Senate President Jeb Bradley (R-Wolfeboro) took the mic during the Senate Finance Committee meeting to deliver a message to the House GOP: Don’t push us.
During Friday’s session to talk about Medicaid expansion, he was speaking to the Senate, but his words were for his fellow Republicans in the House.
“Despite my best efforts to be accommodating,” Bradley said, the House was moving forward with “the amendment for two years and two years only.”
“I would rather that we negotiate in good faith than anything else. But when I see the amendments posted in the calendar for the debate on [Medicaid expansion] next week, which is a two-year authorization, I’m not sure where the good faith is.”
“So, I guess the point I’m trying to make is, we’re kind of getting forced into a corner, and I think we’re going to have to respond.”
But is anyone in this debate really “cornered?” House Majority Leader Jason Osborne doesn’t think so.
“House Republicans have been trying to make this easy on everyone from the beginning by not putting up a fight about it,” Osborne said, “We’ve agreed to reauthorize expanded Medicaid with a sunset provision, just as we have done a few times already. It is incomprehensible why anyone wants to create a controversy where one need not exist.”
Rep. Wayne MacDonald (R-Londonderry), the Health and Human Services Committee chairman, isn’t too worried, either.
“I do know that negotiations are ongoing,” he told NHJournal. “I don’t think it’s about pushing anyone into a corner or about posturing. It’s about an honest difference of opinion on how to handle this issue.”
Sources on both sides of the debate tell NHJournal everyone knows their current positions won’t be the final resolution. Despite the 24-0 vote to make Medicaid expansion permanent, that is not going to happen. And though some hardcore holdouts in the House GOP won’t support more than two years, the House can pass a compromise somewhere around eight years.
“The Senate wants Medicaid expansion in the form of SB 263, which is a stand-alone bill with no sunset provision,” MacDonald said. “The House wants Medicaid expansion to be in the budget (HB 2) with a sunset of some kind. House Republicans on Health and Human Services voted to put the HB 2 language in SB 263 last Wednesday without success. Hence the bill came out of committee 10 to 10 without any recommendation. The first motion to consider will be Ought to Pass on Thursday when the full House considers the bill.”
Under the popular Granite Advantage program, the state’s version of Medicaid expansion, families up to 138 percent of the poverty line are eligible for Medicaid coverage. The state only pays 10 percent of the bill, while the federal government pays 90 percent.
When COVID lockdowns drove unemployment up, the number of Granite Staters on the expanded coverage shot up to around 90,000. But as employment has recovered, the numbers have fallen closer to the average of around 55,000 or so.
Supporters of making the program permanent say taking coverage away from those families is bad politics. Why not just put it into place once and for all? They note that if federal support drops below 90 percent, New Hampshire law requires the program to end, putting the blame on Washington, D. C.
So, what’s the holdup? One concern is the House’s narrow — and shrinking — majority. With the majority down to a handful of votes and entirely dependent on attendance, every plan the Republican leadership makes is at risk.
And supporters of Medicaid expansion want a stand-alone bill rather than making it part of the budget because they don’t want it to become a bargaining chip for other issues — for example, the push to legalize recreational marijuana.
“If there was an amendment from House leadership next week to make it eight years, I believe we would agree,” said Sen. Tim Lang (R-Sanbornton). “But the House could screw this all up by attaching HB639 [pot legalization] to it. If they do — all bets are off. I’d imagine the Senate will not concur, and we’ll wind up in a committee of conference.”
And, Lang adds, there’s no reason for the House to have this fight. “One legislature can’t bind another legislature to future policy. If it says ‘permanent expansion’ this term, a future legislature can put in a sunset clause. We’re always less than two years away from a policy change. So it’s sort of ridiculous.”
On Monday, Bradley told WFEA radio’s Drew Cline that he sees daylight ahead.
“I spoke to the speaker [Rep. Sherm Packard] on Friday, and I presented some opportunities for us not to be at loggerheads. Sherm and I are good friends and will be, I hope, able to get there.”