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New Hampshire's Medicaid expansion matters

A navigator helps a woman seeking health insurance at an enrollment fair in Portsmouth, NH, Nov. 9, 2013.
A navigator helps a woman seeking health insurance at an enrollment fair in Portsmouth, NH, Nov. 9, 2013.
It wasn't easy, but after some fits and starts, New Hampshire is now on its way to joining the half of the country that embraces Medicaid expansion under the Affordable Care Act.

After more than two hours of debate and three failed attempts by opponents to amend the bill, the New Hampshire Senate yesterday 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. [...] 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 legislative breakthrough comes on the heels of six months of debate, failed votes, and negotiations. Note, the state Senate has a Republican majority, which was not initially pleased with the idea.
The New Hampshire policy comes with a few caveats. For one thing, it relies on the so-called "private option," similar to the one embraced in Arkansas and Iowa, which uses Medicaid money to subsidize private coverage for those just above the poverty line.
Also of particular interest is the fact that the New Hampshire policy isn't necessarily permanent -- the measure approved by the state Senate yesterday would expire in 2016, when the federal government's contribution to Medicaid expansion dips below 100%. At that point, state officials would have to reauthorize the policy and decided whether to cut off coverage for those participating in the program.
Still, in the meantime, this policy is on track to bring coverage to about 58,000 low-income New Hampshirites, at least for the next few years, at which point the state will presumably find it difficult to start kicking struggling families to the curb.
While this is clearly a heartening development for proponents of health care access, there's also a political context to keep in mind.
Greg Sargent highlighted the efforts to derail the efforts and the political difficulties this poses for Republicans.

If it does become law, it will be a loss for the Tea Party group Americans for Prosperity, which lobbied against the expansion and is running campaigns against expansions in multiple other states. AFP is making a big stand against Obamacare in New Hampshire, pounding [vulnerable Dem Rep. Carol Shea-Porter] and another Dem with ads featuring alleged Obamacare victimswho turned out to be Republican activists. Shea-Porter, a top AFP target, hopes to use the expansion to muddy up the Obamacare issue. Former Rep. Frank Guinta and businessman Dan Innis are competing for the GOP nomination, and Porter hopes to use the expansion -- which is vociferously opposed by conservatives there -- to challenge her eventual opponent on whether he would take benefits away from tens of thousands.

Opposing health-care reform isn't quite as easy as some on the right make it out to be.