The state Senate’s approval on Thursday of an expansion of Medicaid health benefits to about 50,000 Granite Staters is significant on a couple of levels.
First, is the level of bipartisanship. The New Hampshire Senate is Republican controlled. The fact that the Senate’s Republican and Democratic leadership could come to agreement on a Medicaid expansion compromise demonstrates that both parties can, if they want, work within the structure of the Affordable Care Act.
This may come as a surprise to most Republicans who, on a visceral level, abhor the Affordable Care Act, called Obamacare.
The law gives states the option of extending health care benefits, through Medicaid, to poor residents who cannot otherwise afford care,and, as a consequence, rely on the more expensive (and often unreimbursed) option of going to hospital emergency rooms for care.
In the state of New Hampshire, after failing once at a Medicaid expansion, political leaders figured out a way to satisfy both their political needs: Engaging the private marketplace, which the Republicans want, to pay for government-backed coverage for more people (which Democrats want).
Under the Senate bill - SB 413, approved 18-5 -- it would create a 2½-year pilot program using 100 percent federal funding to expand healthcare coverage. Anyone under 65 who earns up to 138 percent of federal poverty guidelines — about $15,856 a year for a single adult — could qualify. The program uses federal money to buy private insurance through the state’s health exchange for these individuals.
The expansion ends if federal funding drops below 100 percent and would end regardless at the end of 2016 if the Legislature doesn't re-authorize it.
The second level of importance has to do with the N.H. Democrats who are running for re-election to Congress: Jeanne Shaheen to the U.S. Senate, Carol Shea-Porter to the 1st Congressional District seat, and Anne Kuster to the 2nd Congressional District seat.
Their Republican opponents - both the candidates running against them and the conservative political action committees that want them gone -- will vilify them for supporting Obamacare. The attacks have already started under the heading of the Great Lie they perpetuated-- if you like your insurance plan you can keep your insurance plan.
But these Democrats can argue - thanks to New Hampshire’s GOP-led Senate -- that the ACA is a work in progress that can -- and should -- be adjusted and tweaked.
A sometimes tough - and at times contradictory -- campaign trail for Shaheen, Shea-Porter and Kuster is ahead..
Here’s how it’s contradictory.
A recent New England College poll shows that 65 percent of voters favor Medicaid expansion in New Hampshire while 25 percent do not, and 10 percent weren’t sure, according to a WMUR report.
Remember, Medicaid expansion is a provision of Obamacare.
But a WMUR Granite State Poll by the University of New Hampshire Survey Center in early February shows the ACA is unpopular among residents. Only 34 percent favor the legislation, 53 percent oppose it and 13 percent are neutral or don’t know enough about it to say.
Voters don’t like Obamacare but they like some of what Obamacare provides.
Here’s another tactic the incumbent Democrats can use. They can note that more than 5 million Americans across the country - and counting - have signed up for coverage under ACA, including more than 16,000 people in New Hampshire.
So their question to Republicans, who still insist on repealing the ACA, is this: “If I like my ACA health coverage, can I keep my ACA health coverage if it’s repealed?”
Paul Briand is an editor with the Live Free or Die Alliance, a non-partisan, non-profit organization that encourages the discussion and analysis of New Hampshire politics and policies.