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House panel passes Medicaid expansion under federal act

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BISMARCK -- A House committee recommends passing a bill that would expand North Dakota's Medicaid coverage under the federal Affordable Care Act, but with a few strings attached.

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The House Human Services Committee voted 12 to 1 Monday for a do-pass recommendation on House Bill 1362. The bill received three amendments, one of the allowing the expansion program go into effect beginning Jan. 1, 2014, and sunset, or end, Aug. 1, 2017.

Other amendments would allow the Department of Human Services to bid out the administration of the program through private insurance carriers or the federal health insurance exchange and would require the state to study the effects the expansion has on North Dakota residents and providers.

The expansion program is part of the Patient Protection and Affordable Care Act passed by Congress in 2010, otherwise known as Obamacare. The act would provide insurance for individuals under 65, who are not disabled, don't have insurance and have an income less than 138 percent of the federal poverty level.

An income at 138 percent of the federal poverty level for a household of one is $1,285 and 100 percent of the poverty level is $931.

Human Services estimates 20,547 persons could be eligible for the program while the Kaiser Commission on Medicaid and the Uninsured, non-profit, private operating foundation focused on health care, estimates as many as 32,000 would be eligible.

The costs associated with implementing Medicaid Expansion for the 2013-2015 biennium are estimated to be between $102 million and $158 million with the state only having to pay between $273,172 and $337,960 from the general fund for administrative costs, according to the DHS.

The program is projected to cost the state between $2.5 million and $3.8 million in 2015-2017, with anywhere from $152 million to $237 million in federal funds.

Committee Chair Rep. Robin Weisz, R-Hurdsfield, said he added the sunset clause so the Legislature can look at the program in 2017 and see if it wants to continue with the program when the federal funding goes from 100 percent funded to 95 and eventually down to 90 percent by 2017.

"It clarifies this portion of expansion is not an entitlement and could disappear if federal funding disappears," he said in committee.

The second amendment, from Rep. Alan Fehr, R-Dickinson, would possibly save the state money by allowing the Department of Human Services to hire a private carrier or by utilizing the federal health insurance exchange.

The amendment could save the state from paying out the $273,000, Weisz said.

The final amendment, from Rep. Todd Porter, R-Mandan, calls for the legislative management to study any alternatives to the program and provisions to make health care more affordable to citizens. The study would examine access, cost to provide service, Medicaid payment system and Medicaid penalties to North Dakota providers.

He said it is imperative to add a section to the bill to study those effects during the next interim. "One consideration we have to have is the ill effects the act has on the providers of North Dakota," Porter said.

Rep. Chuck Damshen, R-Hampden, was the sole "no" vote on the committee, despite approving the three amendments and anticipating the state will pass the legislation and take the federal money.

"It's the type of thing you can't back out of," he said after the vote.

He said he is fundamentally opposed to the way Congress enacted Obamacare and believes there are several provisions in the federal law, that many are unaware of, that could cause other consequences to the state or individuals.

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