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State Medicaid expansion bill sent to Senate for vote

BISMARCK -- Lawmakers on two Senate committees recommended passing the proposed Medicaid expansion program that would provide insurance coverage to an estimated 20,000 North Dakotans who are currently living without.

The final recommendation by the Senate Appropriations Committee on Wednesday sends House Bill 1362 to the full Senate for a final vote. If approved, the measure will be sent to Gov. Jack Dalrymple for his signature.

The measure passed the House in February by a 57-36 vote and was recommended by the Senate Human Services Committee last week.

Rep. Al Carlson, R-Fargo, proposed the bill, pulling the language out of the Department of Human Services budget bill to allow for more discussion on the individual topic.

He said Wednesday that the expansion program "is a dangerous road for us to go down," and is urging lawmakers to wait and review it in two years.

"We're $16.5 trillion in debt, sequestering as we speak, and we're expecting the same federal government to pay for Medicaid expansion," he said. "I don't think it's realistic, I think they're broke."

The expansion program is part of the Patient Protection and Affordable Care Act, often called Obamacare, passed by Congress in 2010. 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.

The Department of Human Services estimates that 20,547 people could be eligible for the program while the Kaiser Commission on Medicaid and the Uninsured, a nonprofit, private operating foundation focused on health care, estimates that as many as 32,000 would be eligible.

Dan Ulmer, with Blue Cross Blue Shield North Dakota, told lawmakers to do the math and realize the state would miss out on millions of federal dollars through the program, which provides 100 percent federal funding until 2017.

"We're going to pay the taxes under Obamacare whether you like it or not," he said. "The question is whether you will get any benefit from it or not."

Those living under 138 percent of the federal poverty level in North Dakota include an individual earning $1,285 a month, according to the Department of Human Services.

If passed, the expansion will become effective Jan. 1, 2014, and end July 31, 2017, when federal match payments drop from 100 percent to 95 percent.

The state expects between $154 million and $171 million in federal funds to come in during the next biennium to pay for the program.

The state's share to cover the expansion for the current biennium will be about $248,789 from the general fund and about $2.8 million to $3.1 million for the 2015-17 biennium. The costs are associated with an increase in administrative oversight.