CONCORD — Although the effort to expand Medicaid ran aground in the New Hampshire Senate on Thursday, the two senators from the Lakes Region — Democrat Andrew Hosmer of Laconia and Republican Jeanie Forrester of Meredith — believe that a compromise will be reached and the program will go forward.
"It was the timing we got stuck on," Hosmer said yesterday. "We've got minor issues holding up major health care reform. My disappointment is that we had an opportunity to do something," he continued. "But many of us, on both sides of the aisle, remain optimistic."
"We were almost there," remarked Forrester. "It didn't work, but I believe we can make it work."
Republicans and Democrats agreed on a plan that would use federal funds to enable some 50,000 residents to enrolled in Medicaid managed care plans to purchase health insurance from private carriers through the exchange established by the Affordable Care Act. Both acknowledged that the plan would require waivers from federal regulations. However, the Republicans insisted that the transition from Medicaid managed care to private health insurance begin in 2015 while Governor Maggie Hassan and the Democrats favored delaying the transition until the federal waivers and funding are in place and the exchange, which counts but one insurance company, becomes more competitive.
Republicans are concerned that the longer the transition from Medicaid managed care to the health insurance exchange is delayed, the greater the risk the state will be exposed to the cost of a growing Medicaid program.
Noting that others states, notably Arkansas and Iowa, have been granted waivers similar to those sought by New Hampshire, Forrester doubted warnings from the Insurance Department and Health and Human Services Department that the process could take one or two years. "We have to get these waivers and the departments must get it done," she said. She said that with some adjustments to their programming the Medicaid managed care providers could qualify to offer health insurance plans on the exchange.
Acknowledging the fiscal risk to the state, Hosmer agreed on the need for benchmarks and timelines as well as "performances matrices and cost efficiencies to ensure that funds are well spent." At the same time, he stressed that the importance of "allowing ample time for more insurers to enter the market." Likewise, he said that Arkansas and Iowa spent nearly two years designing their programs and drafting waiver requests while New Hampshire has just begun the process. Nevertheless, he described the differences between the parties as "minor issues" that he is confident can be overcome.
While some have charged that the Senate Republican leadership has sought to scuttle the expansion of Medicaid from the outset, Hosmer said "there are cores on both sides of the aisle who want this to happen and are willing to keep working. It's too big an issue that affects too many people. Failure cannot be an option."
Forrester said that "right after the session adjourned we began talking about how we could this done," indicating that the conversation included senators from both parties. "I think people want to get this done," she continued, "for the people who the health care." She pointed out that shortly after the Senate reached stalemate, the Josiah Bartlett Center, a conservative think tank, honored Chuck Morse, the Republican senate president from Salem, who told his conservative audience that he believed agreement was within reach and he intended to pursue it.