N.D. House embraces Medicaid expansion

BISMARCK — More than 20,000 more North Dakotans may have health insurance after members of the House voted to expand Medicaid coverage to align with the federal requirement under the Affordable Care Act.

The House approved and sent the expansion to the Senate in House Bill 1362 by a 57 to 36 vote.

The bill came to the floor with a do pass recommendation by the House Human Services Committee, which added an amendment to implement the program Jan. 1, 2014, and sunset, or end it, Aug. 1, 2017.

The bill would allow the Department of Human Services to use private insurance carriers or the federal health insurance exchange to administer the program. It also would require the state to study the effects the expansion may have on North Dakota residents and providers.

Rep. Rick Becker, R-Bismarck, was the first to offer his opposition to the expansion program and wanted the House body to strike down the actual program, but carry out the study.

“There’s no need to rush here because of the federal timeline,” he said. “I think we can be wise in our decision and be very thoughtful and not be compelled to rush into something that will last for many years.”

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

Human Service Committee Chairman Rep. Robin Weisz, R-Hurdsfield, said he disagreed with Obamacare and the expansion program, but had to vote for it.

He said Obamacare has at least 18 new taxes that go into effect to pay for the Medicaid expansion.

“Whether we go forward or not, the state citizens will pay those taxes, that’s a given,” he said.

“I don’t think it’s fair for me to ask the individuals in my district to pay for all of this and not get a single penny out of it,” he said.

The act would provide insurance for individuals 19 to 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.

The Department of Human Services estimates 20,547 persons 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 as many as 32,000 would be eligible.

The costs to the state 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 Human Services.

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.

Rep. Todd Porter. R-Mandan, said the bill is an attempt to help the most vulnerable citizens in the state. “We are the safety net before they hit bottom, and this is part of that safety net,” he said.

Becker said the state hasn’t had the safety net to help the uninsured, and doesn’t think expanding Medicaid is the right option to start using now.

“We’re asking to consider what type of safety net we want for the small doughnut hole that remains,” he said about those that stand to benefit from the expansion.

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