Decisions about certain provisions of health care reform are proving nettlesome for New Hampshire lawmakers.
There are two aspects of the Affordable Care Act that are on the table at the State House in Concord.
One is the optional expansion of Medicaid. The other is state participation in the creation of health care exchanges.
The U.S. Supreme Court during the summer, while holding up the provision of Barack Obama’s signature health care law that requires everyone to participate or pay a tax penalty, gave states the option of whether to expand its Medicaid rolls, as provided by the law.
HB 271, filed by Republican Rep. William O’Brien of Mont Vernon, the former House speaker, would specifically prohibit the state from expanding Medicare eligibility.
The Affordable Care Act calls on states to extend Medicaid up to 138 percent of the federal poverty level or just under $30,000 a year for a family of four.
Currently in the Granite State, adults earning up to $18,000 a year can be eligible for Medicaid though children can be covered in families that earn up to 185 percent of federal poverty.
The federal government will pick up 100 percent of the cost of benefits for the expanded population from 2014-16 and 90 percent from 2017-20.
Opponents of the expansion, including O’Brien, generally oppose any government intervention in health care (they believe it should be market driven), particularly if it means adding to the nation’s deficit.
Proponents say Medicaid will be less expensive for the state in the long run because people who are otherwise eligible will be able to get regular doctor’s care and stop using the expensive services of a hospital emergency room every time they get sick.
Whether, as a voter, you oppose or support the expansion, will likely fall on your view of the role of government.
The principle of the health care exchanges is the same: How much of a role should government play in a person’s health.
The exchanges are meant to help consumers and businesses find more affordable health insurance than they might currently have.
States have until Feb. 15 to notify the federal government if they will participate in the exchanges. If they choose not to participate, the government will create the exchanges without the state’s input or participation.
A Joint Legislative Committee on Health Care Reform of three Democrats and three Republicans has been named to figure out the exchange issue.
Right now, according to a Nashua Telegraph report, GOP committee members are hung up on whether the committee has final say on committing the state to the exchanges or whether that authority rests ultimately with Gov. Maggie Hassan.
“Though the governor has full authority to communicate with the federal government about the approach the state would like to pursue for our marketplace, Gov. Hassan is always open to collaboration with legislators from both parties,’’ said Marc Goldberg, the governor’s communication director told the Telegraph..
It entirely likely that Hassan will tell the feds “we’re in” by the deadline. The joint committee will take a vote that will result in a 3-3 tie (three Democrats supporting the exchange, three Republicans opposing the exchange), so the issue of authority becomes a bit moot.