|Governor Maggie Hassan spoke at a news conference in June in favor |
of expanding Medicaid in New Hampshire .
The first of two special sessions took place on November 7, the purpose of which was to establish the rules of the road for the final session scheduled for November 21. The 7th began with announcement by opponents that expanding Medicaid, to include New Hampshire’s low income and working poor, is a bad idea, must be stopped, and, in the words of former Speaker William O’Brien, is not an opportunity for members of New Hampshire’s families to gain access to life-saving healthcare, but is merely “an expansion of the welfare state.” This seems to fit within the view by some that we should dispense with the social contract, the social safety net that we have worked to create over the last 70 years, stand on our own two feet no matter the odds against us, meet adversity with personal responsibility, and recognize and accept that we are all born with equal opportunities (though some more equal than others), and that given our misfortune, we must accept the fate of being left behind.
Special session day, Thursday, November 21, began with opponents of expansion asserting that various sections of the bill were not within the scope of Governor’s Hassan’s authorization for the special session, and, therefore, not within the scope of legislative authority to act. So began a series of four such challenges to the rulings of Speaker Norelli whose conclusion was that the entirety of the bill’s sections were germane and within the authority of the House of Representatives to consider. The opinions of the speaker were upheld by the body by wide bi-partisan margins: 209 – 139; 215 – 137; 219 – 133; and 215 – 137.
Opponents of the expansion of healthcare coverage continued to halt debate through parliamentary process. A motion to indefinitely postpone was advanced at approximately 10:50 A.M. A motion to indefinitely postpone is defined as: “A motion made by a legislator from the floor that further action on a bill be deferred and thus that the bill be killed.” The motion was defeated on a bi-partisan, roll-call vote of 159 – 195.
Then a motion to adjourn was advanced at approximately 11:20 A.M. A motion to adjourn is defined as: “A verbal request by a legislator to discontinue proceedings; this motion has the highest precedence, is not debatable, cannot be offered during a vote or while a member is speaking, and requires a majority vote for approval.” The motion was defeated on a bi-partisan, roll-call vote of 144 – 211.
A motion was made requiring that the debate on the motion to indefinitely postpone be recorded in the permanent journal, which was even opposed by the mover of the motion to indefinitely postpone, as well as on a bi-partisan, roll-call vote of 115 – 240.
At last, a vote was taken on the House majority committee amendment on SSHB-1-FN-A. On a roll-call vote of 204 – 151, the majority committee amendment was adopted. Nine Republicans joined 195 Democrats in support of adoption; No Democrat joined with Republicans in voting to defeat.
Opponents then moved to divide the question on several occasions, intending that various portions of the bill be considered separately, somewhat akin to removing the engine, transmission, or drive shaft of an automobile in order to keep it from performing its intended purpose ... moving forward. SSHB-1 is a complete structure, each section dependent upon the other. Removal of any piece would jeopardize the whole. Such attempts to remove pieces were defeated on roll-call votes of 156 – 197, and 154 – 200. It was 12:00 noon, and we still had approximately 30 Republican amendments to consider before the clock ran out at 5:00 P.M., at which time the Republican majority senate president would dismiss his members for the holidays, and whatever we approved in the House would become moot since the senate, having adjourned, could not participate in further negotiation with the House.
Next: Amendment 2434h, and another motion to divide components of 2434h were made and defeated on a roll-call vote of 142 – 208. On a roll-call vote of 162 – 191, amendment 2434h was defeated.
Next: Amendment 2419h, which was defeated on a roll-call vote of 154 – 197.
Next: Amendment 2415h, which was also defeated on a roll-call vote of 146 – 195.
Next: Amendment 2528h, which was withdrawn by its sponsor.
Next: Amendment 2422h, which was also withdrawn by its sponsor.
Several representatives were gathered at the well. Some were entering the hall from the senate side gesturing thumbs down. It seemed to me the senate was not going to compromise, and that debate on further amendments was not necessary, that expansion of healthcare was going the way of the high-button shoe, at least for 2013.
But then amendment 2420h was moved, and on a roll-call vote of 142 – 200, was defeated.
Next: Amendment 2430h, another motion to divide was moved and defeated on a division vote of 157 – 184.
Votes 20, 21, and 22 involved various motions to limit debate in an attempt to reach the final vote on the underlying bill as amended, SSHB-1 before 5:00, as it seemed a filibuster, of sorts, was in play. On the various debate limits, all but one were defeated on division votes of 83 – 260, 82 – 261, and 84 - 259. The original motion to limit debate was adopted on a bi-partisan, roll-call vote of 232 – 112. That limited debate to 10 minutes per side, including the time it took for members to ask questions of, and receive answers from, the amendment’s sponsors.
It was then announced that the balance of amendments proposed by Republicans were to be withdrawn.
Next: A motion to lay on the table the underlying bill was advanced. Lay on the table is defined as: A non-debatable motion to set aside a pending question until further action is desired, sometimes offered with the intent to kill the proposal; ranks second in precedence only to a motion to adjourn.” Once again, on a roll-call vote of 139 – 203, the motion failed.
Finally, on the motion of ought to pass with amendment (OTP-A) on the underlying bill and its amendment, on a roll-call vote of 198 – 146, the motion was adopted. Four Republicans joined 194 Democrats voting to adopt. One Democrat joined 145 Republicans voting to defeat.
The bottom line: With a significant spread of 42 votes, the New Hampshire House of Representatives voted to expand healthcare opportunities to the more than 50,000 inhabitants, in most cases the state’s working poor, who were left to their own devices when our “conservative” U.S. Supreme Court ruled that Medicaid expansion under the Affordable Care Act (ObamaCare) must be left to the decision of the states. That ruling meant that the fate of millions of Americans to attain financial and social security, as well as needed healthcare, would be the decision of individual legislators and collective legislatures. Put another way, elected officials in two dozen states are now inserting themselves between patients and their doctors, deciding who gets treatment for their ailments, and who doesn’t … and for how long hospitals must deal with uncompensated care, that is, treating the sick for free or well below the cost of treatment, and how those costs will be added to the premiums of those with insurance. Those add-ons are estimated to be in excess of $1000 per year to those of us who pay for our healthcare through insurance.
In addition to other flaws in the Senate bill, members of the Study Commission were advised by experts from the insurance industry, and others, that the requirements in the Senate’s bill could not be implemented within the timeframe set out in Senate language, and because of that, alone, the program would implode by October of next year.
Meanwhile, in the Senate: SSHB-1, expansion of healthcare to 50,000 Granite Staters was defeated on a straight party-line vote of 13 – 11, all Republicans voting to defeat, all Democrats voting to support.
At 4:45, the Senate, still in session, delivered its message of non-concurrence to the House-passed expansion of health coverage.
For those who oppose expanding Medicaid as a matter of abiding principle, no amount of spending or saving, nor the consequences or vulnerabilities imposed upon others matters. Reasons can always be found to vote against a bill. For them, the actions of the senate represent a victory. Because expanding Medicaid is also essential for the overall success of the Affordable Care Act, defeat in the senate represents a double victory. However, for those left out, few options remain: don’t get sick; refrain from seeking medical care at all; wait until health conditions are so dire that expensive hospitalization is required, for which treatment others will pay; or simply take the advice of former President Bush and seek treatment at any level of healthcare need at a hospital emergency room, for which others will pay.
My hunch is that no critic of expanded healthcare is personally without healthcare. It is likely those critics have adequate plans derived from union benefits, non-union benefits, a spouse, or, in some cases, the critic is financially secure and can seek good plans on the individual market. At the federal level, we know, for instance, that outspoken critic of the ACA, Sen. Ted Cruz (R-Tx), enjoys the benefits of a $40,000.00 super healthcare plan through Goldman Sachs. In too many cases, the hypocrisy is astounding, as is the disregard of the financial impact on the middle class, and the impact on health among the uninsured/under-insured.
The House did the right thing for New Hampshire’s inhabitants. Delay beyond January 1 will cost the state approximately one-half million dollars per day in federal funding not used for New Hampshire’s implementation of the ACA, and the thousands of jobs that would have been created upon its passage.
House majority and minority committee reports appear below:
THURSDAY, NOVEMBER 21
SSHB1-FN-A, relative to access to health insurance coverage. MAJORITY: OUGHT TO PASS WITH AMENDMENT. MINORITY: ITL Rep. Sharon Nordgren for the Majority. This legislation as amended reflects the bipartisan supported recommendations of the Commission to Study the Expansion of Medicaid Eligibility, further compromises, and technical corrections and improvements in a fully privatized system to expand healthcare access to approximately 58,000 low income New Hampshire working men, women and families.
This compromise plan would provide expanded access to Medicaid services provided through our privatized Managed Care system initially with the goal of moving the entire newly eligible population to a competitive marketplace including at least one managed care option by 2017. This plan would enhance state control of our healthcare system and maximize federal dollars received while improving the health and security of our citizens and providing increased stability and predictability to our providers, private insurance carriers and the state. A key component of the significant savings achieved through this plan comes from expansion of the Health Insurance Premium Payment (HIPP) program, which allows low income workers to utilize employer offered insurance coverage. Additional savings come from a significant reduction in uncompensated care, honoring existing Managed Care contracts which include significant savings, and promoting increased competition in our state insurance market. Vote 15-10.
Rep. Neal M. Kurk for the Minority. The minority believes it important that low-income New Hampshire adults have health insurance but in a way that is affordable to New Hampshire taxpayers. The majority would provide this coverage by accepting expanded Medicaid under the Affordable Care Act (aka ObamaCare) but without thoughtful and reasonable financial safeguards. Its plan continues in effect regardless of whether the federal government grants the necessary waivers or not. Its plan continues in effect no matter how high its costs - the lowest estimate is around $40-45 million in general funds for the 2022/23 budget. The majority’s plan only ends if the federal government reduces its promised cost share. In essence, the majority proposes to expand an out-of-control Medicaid entitlement program. This is not the New Hampshire way.
The minority would have preferred a plan that is more in keeping with New Hampshire traditions. It would be a time-limited, three-year program fully paid for with federal funds disbursed through a separate health protection trust. If the program were effective and efficient in provide health care to low-income adults, and if its future costs were affordable, it could be continued or modified. If not, it would terminate.
The minority would have required income-eligible adults with employer-sponsored insurance to keep those policies, where cost effective, and pay the premiums, co-pays, deductibles and other cost-sharing provisions with federal funds. This is the so-called HIPP program. For those who do not have employer-sponsored insurance, coverage could be provided through exchange-based, private qualified health plans only. The use of private insurance would result in higher health provider re-imbursement rates, reduce provider uncompensated care costs and improve our state’s insurance markets and consumer choices.
The minority would not have begun coverage until the necessary federal approvals (waivers) were received. The HIPP program waiver could be received in early January 2014. The private insurance waiver would take somewhat longer; likely in January 2015. These delays in the implementation would be necessary to maximize the state’s leverage in negotiations with federal authorities. The minority believes these delays would be a small price to pay for getting it right from the start.
Finally, unlike the majority’s proposal, the minority would have required an important personal responsibility measure: unemployed participants would be referred to the Department of Employment Security to receive help in finding work.
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The December 2, 2013 segment of Politics Nation with Al Sharpton, emphasized, among other things, that the federal website www.healthcare.gov, is now capable of handling 50,000 visits simultaneously; that there is a substantial public demand for access to affordable healthcare; and that the critics of the Affordable Care Act continue to promote its demise, offering no plan of their own to help the American people.
In a previous post to this site, I emphasized the hope that New Hampshire would pass expansion of healthcare access and remove it from the map of states refusing to expand. It is very unfortunate, as you will see in the video below, that New Hampshire remains on that map.
NH State Representative
Strafford County District #3
Strafford and New Durham
House and Senate Voting Record
November 21 Video recofrding of the House Special Session
Politics Nation with Al Sharpton (December 2, 2013)
N.H. lawmakers taking up Medicaid expansion question in The Boston Globe
The NH Medicaid Expansion Waltz on Susan the Bruce