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In an attempt to reach a compromise with reluctant House Republicans, the Senate Finance Committee Tuesday added a seven-year sunset clause to the proposed reauthorization of Medicaid Expansion.

“From where I sit, seven years is pretty darn good,” said Senate President Jeb Bradley (R-Wolfeboro).

The committee added the seven-year sunset as it moved SB263 to become part of the biennial budget and a major part of the GOP majority’s Family First platform.

“We have allocated resources to support key areas such as education, our economy, health care, infrastructure, and public safety, all while delivering more financial support to our communities. Further, the Senate Finance Committee accomplished all this while reducing spending by three-quarters of a billion dollars less than the budget was brought to us,” Bradley said.

The budget includes $169 million for education, $30 million for the Housing Champions program, an additional $10 million for local homelessness programs, and a $134 million increase to the Medicaid reimbursement rate. Senate Finance Chair Sen. James Gray (R-Rochester) said that was all being done without adding to the tax burden.

“Throughout the budget process, we have remained mindful of the diverse needs of our state, listening to the concerns of our constituents and working diligently to address them. This budget reflects our efforts to serve New Hampshire families without harming the financial stability of our Granite State,” Gray said.

Bradley is the main GOP driver behind SB263, the bill to continue New Hampshire’s Granite Advantage Medicaid program. It provides medical insurance for about 60,000 low-income residents and is scheduled to end next year without another reauthorization.

The bipartisan bill, already passed by the Senate, would have created a permanent Medicaid program as part of the Affordable Care Act. Though it is supported by New Hampshire’s medical and business communities, the bill ran into opposition from the slim GOP majority in the House.

House leadership under Speaker Sherman Packard (R-Londonderry) tried to limit the expansion to five or six years when SB263 went to the chamber earlier this month.

With the measure now heading to the House Finance Committee later this week, pressure was on to reach a compromise that could get to Gov. Chris Sununu’s desk. Sen. Cindy Rosenwald (D-Nashua) agreed to Bradley’s amendment limiting the expansion to seven years, saying it could always be changed next year.

“If the House retains the bill, we can override the seven-year sunset next year,” Rosenwald said.

Bradley said the seven-year extension allows the state to seek the best deal with managed care companies to administer the insurance. Any shorter time frame could add about 10 to 15 percent to the costs, he said. The bill also includes a clause to revive a commission that will investigate the future of the expanded Medicaid program.

“The seven-year sunset, I believe, is an acceptable compromise,” Bradley said.

Sen. Regina Birdsell (R-Hampstead) said the budget protects families while strengthening the state’s economy.

“By extending our innovative Granite Advantage Health Care Program for seven years and increasing Medicaid reimbursement rates by $134 million, this budget will not only safeguard the health and well-being of New Hampshire’s most vulnerable populations but also provide financial stability to our state’s health care sector,” Birdsell said.

Steve Ahnen, president of the New Hampshire Hospital Association, praised the compromise.

“We are pleased with the agreement on reauthorization of Medicaid expansion for the next seven years as part of the state budget for fiscal years 2024 and 2025 currently in Senate Finance,” Ahnen said. “This agreement will provide much-needed stability for the program that will serve our patients, providers, and the state well. The Granite Advantage Health Care Program has successfully helped to ensure our patients are able to receive the right care, at the right time, in the right place, and this compromise agreement will continue to help people access the care they need, when and where they need it. We appreciate the bipartisan leadership in both the Senate and House in reaching this important compromise.”

Under the Affordable Care Act, 90 percent of Granite Advantage is paid for by the federal government, with the remaining 10 percent getting funded by an insurance premium tax and other sources. In 2022, Granite Advantage cost a total of $558 million, but the federal government covered $502 million.

Expanding Medicaid to low-income residents has created savings for hospitals and led to more people being healthier and able to enter the workforce. It is also driving the costs of private insurance down by cutting the amount of money hospitals lose providing uncompensated care.

According to the New Hampshire Hospital Association, Granite Advantage has led to a 63 percent decrease in the number of uninsured people going to emergency rooms. There has also been a 57 percent drop in uninsured people being admitted to hospitals and another 41 percent reduction in the number of outpatient visits by uninsured people.

In 2014, hospitals reported $174 million in uncompensated care costs before Granite Advantage went into effect. In 2021, that figure dropped to $69 million, according to the NHHA.

Granite Advantage has also helped close to 30,000 people have been able to access mental health care. Another 9,000 have been able to seek treatment for substance use disorders.

After the New Hampshire Senate passed its version of a state budget last week, it was expected the House would request a Committee of Conference, so it could ultimately have a say in the final budget negotiations. House conservatives, who led the charge to defeat the budget in April, were hopeful that Republican leadership would finally cooperate with their list of demands. Yet, representatives of a conservative caucus were disappointed Tuesday after House Speaker Shawn Jasper appointed none of its members to the conference committee, putting the fate of the state budget in jeopardy.

Acting under a recess rule, the House non-concurred Tuesday with the Senate version of the biennium budget and Jasper, R-Hudson, appointed members to a conference committee.

He named to the committee himself, House Majority Leader Richard Hinch, House Finance Committee Chairman Neal Kurk, Rep. Lynne Ober (R-Hudson), Rep. Karen Umberger (R-Kearsarge), and Rep. Mary Jane Wallner (D-Concord).

The conservative House Freedom Caucus criticized the conference committee because its members are “the same House leadership that led the House budget to fail in April.”

“With less than two weeks to go to the final House session, it is critical that the House leadership find a way to work with all of their members. However, the message that the House is sending in these negotiations when they put forth leaders who were so utterly clueless about the budget in April is they are only interested in more of the same. This is short sighted at best,” said Rep. JR Hoell, R-Dunbarton.

For the first time since at least 1969, the House failed to pass a budget on to the Senate. The Senate Finance Committee used Gov. Chris Sununu’s budget proposal as a starting point, but it also took into consideration some of the House Finance Committee’s spending plan. In last week’s Senate marathon budget debate, a trailer bill accompanied the budget to specifically incorporate the failed House budget “for purposes of committees of conference.”

During a conference committee, a selection of House and Senate members work to compromise on the specifics of a bill. A conference committee report would be sent to the House and Senate for final approvals. That’s where it can get dicey, especially in the House.

The House Freedom Caucus was instrumental in the demise of the budget in April. The group didn’t like that spending increased over former Democratic Gov. Maggie Hassan’s budget and that the House GOP leadership’s budget lacked tax cuts. If the Freedom Caucus can convince other conservatives or on-the-fence Republicans to jump ship, the budget could die in the House.

“The definition of insanity is doing the same thing over and over again and expecting different results,” said Rep. Anne Copp, R-Danbury, and a member of the House Freedom Caucus.

“By putting the same leadership on the committee of conference that led to a budget that failed by over 85 votes, the state is being set up for having no budget that can pass the House later this month,” she added. “We need a fresh start to begin the processing of a truly fiscally responsible budget, not the same group that offered a reckless spending increase.”

Jasper has not publicly responded yet to the criticisms from the House Freedom Caucus. Last week, Jasper sent an email to caucus members asking to sit down and discuss the budget with them on Tuesday and Wednesday this week.

“It is important at this point in the process that we hear your concerns and find areas where we share common ground,” he wrote. “Ultimately, we hope to be able to reach agreement on the major issues, which would be extremely helpful prior to the state of the budget committee of conference.”

Jasper told WMUR in an earlier story that a conference committee was needed to make passing a budget easier.

“The reason was simply that if the Senate hadn’t agreed to do that [a conference committee], we would have been amending our positions on the budget and…onto Senate bills everywhere possible in order to be able to preserve those positions,” he said. “The Senate realized that to have done it in that way would have made the committee of conference process very, very difficult.”

Yet, conservatives say its unfair to have the failed House budget included in conference committee discussions.

“How can the Senate or Governor even begin to approach a committee of conference knowing that there isn’t much chance that the House conferees can pull together a majority of the body?,” said Rep. James McConnell, R-North Swanzey. “This is a recipe for disaster and is something that we can all see coming.”

If either chamber fails to approve the budget, a continuing resolution to maintain spending at its current levels would likely occur, at least until a full budget is passed. Republicans only hold a slim majority in the House and even a small number of “nay” votes could spell doom for the budget if Democrats also oppose it.

Only one Democrat has been appointed by the House to sit on the conference committee. Democrats in the House and Senate have been critical of the GOP budget, but when it comes time to vote, some could change positions and vote in favor of a budget out of fear that the chamber would come up short again. They could also band together against the budget and watch the Republicans’ infighting, hoping that helps them in next year’s elections.

Senate President Chuck Morse is expected to announce his budget conference committee members on Wednesday.

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