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Senate approves Medicaid expansion 18-5

  • State Sen. Nancy Stiles, right, responds to a question from Sen. Andy Sanborn Thursday March 6, 2014, in Concord, N.H., on a medicaid expansion bill. After several hours of debate, the Republican-controlled Senate voted 18-5 to pass a bill that would use federal Medicaid money to buy private health insurance for thousands of New Hampshire's poor adults.(AP Photo/Jim Cole)

    State Sen. Nancy Stiles, right, responds to a question from Sen. Andy Sanborn Thursday March 6, 2014, in Concord, N.H., on a medicaid expansion bill. After several hours of debate, the Republican-controlled Senate voted 18-5 to pass a bill that would use federal Medicaid money to buy private health insurance for thousands of New Hampshire's poor adults.(AP Photo/Jim Cole)

  • State Sen. Andrew Hosmer, left, and Sen. Sylvia Larson smile during a Democratic caucus on the Senate floor, Thursday March 6, 2014, in Concord, N.H., before taking up a Medicaid expansion bill. After several hours of debate, the Republican-controlled Senate voted 18-5 to pass a bill that would use federal Medicaid money to buy private health insurance for thousands of New Hampshire's poor adults.(AP Photo/Jim Cole)

    State Sen. Andrew Hosmer, left, and Sen. Sylvia Larson smile during a Democratic caucus on the Senate floor, Thursday March 6, 2014, in Concord, N.H., before taking up a Medicaid expansion bill. After several hours of debate, the Republican-controlled Senate voted 18-5 to pass a bill that would use federal Medicaid money to buy private health insurance for thousands of New Hampshire's poor adults.(AP Photo/Jim Cole)

  • State Sen. Nancy Stiles, right, responds to a question from Sen. Andy Sanborn Thursday March 6, 2014, in Concord, N.H., on a medicaid expansion bill. After several hours of debate, the Republican-controlled Senate voted 18-5 to pass a bill that would use federal Medicaid money to buy private health insurance for thousands of New Hampshire's poor adults.(AP Photo/Jim Cole)
  • State Sen. Andrew Hosmer, left, and Sen. Sylvia Larson smile during a Democratic caucus on the Senate floor, Thursday March 6, 2014, in Concord, N.H., before taking up a Medicaid expansion bill. After several hours of debate, the Republican-controlled Senate voted 18-5 to pass a bill that would use federal Medicaid money to buy private health insurance for thousands of New Hampshire's poor adults.(AP Photo/Jim Cole)

Concord — After more than two hours of debate and three failed attempts by opponents to amend the bill, the New Hampshire Senate Thursday voted, 18-5, to expand the state Medicaid program.

Seven Republicans, including Senate President Chuck Morse of Salem, joined the entire Democratic Senate caucus in supporting the legislation.

Republican Sens. Sam Cataldo of Farmington, Sharon Carson of Londonderry, John Reagan of Deerfield, Andy Sanborn of Bedford and Russell Prescott of Kingston voted no. Republican Sen. Peter Bragdon of Milford abstained to avoid a conflict of interest with his employer, the former Local Government Center.

“This has been a long six months,” Morse said after the vote. “When we first started, we rejected this in the budget, I think rightfully so . . . to get to what I believe is a creative solution.”

The bill goes next to the House Finance Committee on Monday. The Democratic majority there is supportive of the bill, as is Gov. Maggie Hassan, who would have to sign it before the state can begin submitting necessary paperwork to federal agencies.

The proposal would use federal funding available through the Affordable Care Act to provide about 50,000 New Hampshire residents health insurance. About 12,000 will receive premium support to pay for insurance through their employers. Others will receive premium support to buy insurance on the state’s new exchange marketplace in January.

“This legislation will not expand government, it will not increase the number of residents on Medicaid rolls, and it will not increase spending,” said Sen. Nancy Stiles of Hampton, one of the bill’s prime sponsors.

“On the contrary, I am confident that once implemented, this bill will decrease what we spend each year on uncompensated care and Medicaid by helping more low-income residents access the private insurance market.”

Sanborn, the proposal’s most out-spoken opponent, said he still has doubts the program could save anyone money.

“My concern and my frustration continues to be that there is nothing in this legislation to reduce (the state’s payments for) uncompensated care, there is nothing in this legislation to eliminate uncompensated care. How much uncompensated care as a number are we going to eliminate with passage of this bill?”

“By placing people in private insurance, getting them to take ownership of their health and reducing usage of the emergency room will help. Can I give you a number? No,” Stiles said. “I am optimistic that . . . we will see a huge reduction if not total elimination.”

Sanborn later moved to amend the bill to cap enrollment to 50,000 people and spending at $300 million.

He also attempted to require that the state obtain all federal waivers before beginning any part of the program, and limit the program to residents who earn less than 100 percent of the federal poverty level, instead of the proposed 133 percent limit.

The lengthy process wore down at least one senator’s patience.

“I am getting a little tired about hearing what might happen in the future,” said Sen. Jim Rausch, a Derry Republican. “I take exception to senators saying I should vote against this bill because we’re not guaranteed 100 percent. What this bill does, is it does protect the New Hampshire taxpayer. . . . If we stand by in fear of what may happen, we will never accomplish anything.”

After the vote, Morse, who had refrained from commenting during the debate, said that yesterday’s debate would not be the last about this program.

It is designed to end Dec. 31, 2016, when federal funding will begin gradually decreasing from 100 percent to 90 percent.

“When this bill expires, you need to put the next plan in place,” Morse told the Senate. “Are you willing to add 10 percent? I’m not. I don’t think New Hampshire can afford it.”