I attended Governor Hassan's presentation last week. Below are discussions concerning Medicaid Expansion, NH State Health Marketplace aka "The Exchange", a few highlights from Governor Hassan's budget proposal, and our current budget deficit.
As everyone knows last week the Governor presented her biennium budget for fiscal years 2013/14. The budget restores many of the cuts made by last session’s legislature particularly for health care. The budget summary is on line and is easy reading.
Medicaid Expansion - The Governor has notified the Federal Government that NH will participate in expanding Medicaid resulting in health care coverage for 58,000 additional adults that otherwise would not be covered. Not only does this significantly reduce the costs for emergency room visits; it also brings in $2.5B to the state over 7 years with an outlay of up to $18.7M from general funds. This represents over 13,000% return on the state’s investment. For the Governor’s biennium budget beginning July 1, 2013 there are zero dollars of general funds spent for $447M (almost a half a billion dollars!) in Federal assistance during that same period. Also according to the Lewin Report an additional 700 jobs per year will be created.
Bill O’Brien, former speaker of the House, had proposed a bill to make it illegal for NH to expand Medicaid. The House HHS committee voted 13 to 6 recommending the bill as Inexpedient To Legislate (ITL). Two Republican committee members voted with the majority including the ranking Republican on the committee. The bill now goes to the full House for a vote most likely on February 27.
Some of Obama’s harshest critics have agreed to Medicaid Expansion - even Arizona’s Governor Janice Brewer knows a good thing when she sees it and will be accepting the money for Medicaid expansion. This week Gov. Rick Scott of Florida, a leading critic of President Obama's health care law, said he now backed a three-year expansion of coverage for poor people.
Health Exchange Marketplace - The Governor notified the Federal HHS Dep’t that NH will participate in a joint partnership with the federal government for operating NH’s Health Exchange Marketplace. This followed a 4-2 vote in support of the Governor by the Joint Health Care Reform Oversight Committee. Senators Bradley and Sanborn voted against. It really was moot because the Governor’s lawyers had concluded that the joint oversight committee had no legal standing in this matter, but it was helpful that they supported the Governor’s decision. Senator Sanborn spent most of the time at the Joint Oversight Committee meeting arguing that he (the committee) had the authority to make the decision about NH participating in a joint partnership and never did engage in the merits of the question.
The three objections I heard to the items above were: 1. we can’t trust the Feds; 2. we want nothing to do with “Obamacare”; and 3 - a small minority of representatives said that beneficiaries of Medicaid Expansion would become “addicted” and would stay dependent on government healthcare.
Some observations:
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- The budget includes $38M for a new women’s prison which is desperately needed - lawsuit time if NH does not address the horrific conditions at the Goffstown prison.
- Mental health services receive much needed new funding
- Restores state funding for family planning
- Fully funds the wait list for services for people with brain disorders and developmental disabilities
- Restores funding for Children in Need of Services (CHINS)
- Not only restores the $.10/pack cigarette tax, but increases it by another $.20/pack
- Repeals the education tax credit for private and religious schools
- ...and the big addition is one “highly regulated casino” with $80M projected revenue from a single license! I think this is the weakest part of the plan and in my opinion will determine if Governor Hassan is reelected in two years. I have lots of problems with casinos and it will be a very close vote in the House which has historically voted down casinos. I am not in favor and do not have a clue where she can find $80M in cuts to her budget without hurting health care and education. While much of the Governor's budget presentation received enthusiastic applause there was only a smattering of applause when she spoke about the casino. The Senate will pass it, but will distribute the monies differently than Governor Hassan is proposing.
An immediate issue is balancing the current budget. The previous legislative session cut so much revenue sources from its budget that NH has a projected deficit and this Governor has to fix it before July 1. Not a pleasant task given she cannot add any revenue - it has to come from cuts or raiding the rainy day fund.
Live view of the State House sessions are on line; click on the link and then click on “Live video house sessions” in red type under General Court news and hot links. Next Wednesday will be interesting so if you cannot attend in Concord then you can watch the proceedings live.
