How should New Hampshire handle national health care reform?
By: LFDA Editor
In March 2010, President Barack Obama signed into law the Patient Protection and Affordable Care Act, a federal statute that marks Congress's chief health care reform legislation. For the particulars of this act from the White House perspective, click here. Most of the Affordable Care Act (also known as "ObamaCare"), including the controversial individual mandate to purchase health care, was upheld by the U.S. Supreme Court in June 2012.
While there are many aspects of the Affordable Care Act, there are two major provisions that affect state government. First, each state must run an online health insurance marketplace (also called an "exchange"). Second, each state had to decide whether to expand eligibility for Medicaid.
Online Health Insurance Exchange
One of the primary requirements of Affordable Care Act was that every state establish an online health insurance exchange, often described as “one stop shopping” for consumers buying insurance. Each state had three options to establish the exchange: let the federal government create and operate the exchange, use federal funds to create and operate the exchange on the state level, or partner with the federal government on a limited basis.
HB 1297, passed by the New Hampshire legislature in 2012, forbid the state from using federal funds to create and operate the exchange on the state level. New Hampshire therefore had two choices: leave the exchange up to the federal government, or partner with the federal government on a limited basis.
In February 2013, New Hampshire agreed to partner with the federal government for the online health insurance exchange. Under the partnership the U.S. Department of Health and Human Service operates the exchange, while New Hampshire government regulates the insurance plans. New Hampshire is also responsible for consumer assistance for residents navigating the exchange.
In her February 2013 letter requesting a partnership, Gov. Maggie Hassan asserted that a partnership is the best way to ensure that the online exchange meets New Hampshire’s unique needs.
When the federal insurance exchange launched October 1, the website was plagued by problems. President Obama promised a fix by the end of November 2013.
The exchange was also criticized for only drawing one New Hampshire insurer, Anthem Blue Cross Blue Shield. Anthem was criticized in turn for offering a narrow network of health care providers. Anthem says the narrow network lowers costs and ensures quality. Opponents argue that the narrow network unfairly limits consumer choice.
A second insurer, Harvard Pilgrim Health Care, will join the exchange in 2015.
New Hampshire may withdraw from the partnership from the federal government if the state chooses. However, HB 1297 still forbids New Hampshire from creating an exchange at the state level, so unless state law changes, New Hampshire residents will have to use the federal exchange.
New Hampshire also decided to expand Medicaid eligibility under the Affordable Care Act.
Originally the Affordable Care Act required states to expand Medicaid eligibility starting in 2014, or the federal government would stop matching state contributions to Medicaid. However, the U.S. Supreme Court ruled that the federal government cannot deny matching funds if a state decides not to expand Medicaid.
As part of a budget compromise in June 2013, the New Hampshire legislature agreed to study a Medicaid expansion over the summer. On October 8, 2013 that study committee voted in favor of expanding Medicaid. After three weeks of negotiations, a bipartisan plan broke down and the Republican-controlled Senate killed the expansion.
On February 6, 2014 a bipartisan group of Senators announced a new Medicaid expansion deal that also has the backing of Gov. Hassan. The compromise relies on the use of private insurance. The program will end after three years if the federal government does not continue to provide 100% funding. This new Medicaid compromise, SB 413
, passed the House and Senate and was signed by Gov. Hassan March 27, 2014.
Ideally a Medicaid expansion will decrease the number of uninsured patients, which in turn would decrease the shift of costs from uninsured patients to the insured. “Anytime you put more people into the pool, you maximize your ability to create efficiencies and control costs,” explained Ned Helms, former health and human services commissioner and co-chairman of President Barack Obama’s 2008 campaign in New Hampshire. The federal government will also reimburse states for 100% of the cost of expanded Medicaid through 2016.
However, opponents of the Medicaid expansion argued that allowing government greater involvement in health care would undermine competition in the market, therefore raising costs for everyone. Opponents also pointed out that federal reimbursement will decrease slowly over time, capping out at 90% in 2020. According to the Nashua Telegraph, “Medicaid is the single largest item in the two-year New Hampshire budget… New Hampshire’s cost is about $1 billion a year.” Opponents argued that cash-strapped New Hampshire cannot afford a Medicaid expansion.
Several legislators hoped to change New Hampshire's implementation of the Affordable Care Act in 2014. Four bills are still alive in the legislature.
First, Rep. Sam Cataldo (R-Farmington) is sponsoring SB 340, a 2014 bill that would require the state Insurance Department to hold public hearings before approving any insurance plans to be offered on the exchange. The Senate passed that bill on March 13, 2014, and SB 340 now heads to the House.
Senate President Chuck Morse (R) is the primary sponsor of SB 413, which establishes the Medicaid expansion compromise described above. Gov. Maggie Hassan signed SB 413 into law March 27, 2014.
The legislature rejected eight other 2014 bills related to health care.
Sen. David Pierce (R-Etna) sponsored SB 380, a 2014 bill "requiring an insurer participating in the health exchange to include access to a hospital in each county of the state." The Senate killed that bill March 27, 2014.
Sen. Peggy Gilmour (D-Hollis) was the primary sponsor of SB 412, a bill that would have repealed the prohibition on a state-run exchange. SB 412 would have also requireed insurers on the health exchange to offer at least one broad network plan. The Senate killed SB 412 on March 6, 2014.
Rep. Neal Kurk (R-Weare) sponsored HB 1158, a 2014 bill that would require health insurers to give members a small monetary benefit if the individual chooses a less expensive health care provider. Kurk also sponsored HB 1612, a bill which "requires hospitals to charge self-pay patients no more than the Medicaid rate for medical services." The House sent both bills to interim study - effectively killing the bills - on March 12, 2014.
Rep. Bill Nelson
(R-Brookfield) sponsored HB 1294
, a 2014 bill which requires insurers selling plans on the federal health insurance website (such as Anthem Blue Cross and Blue Shield) to include any willing health care provider in the insurance network. The House killed that bill on March 5, 2014.
Rep. Emily Sandblade
(R-Manchester) sponsored HB 1328
, a 2014 bill that would have required insurance navigators to be licensed by the state, including a background check, license fee, etc. The House sent that bill to "interim study," a quiet death for a bill.
Former House Speaker Bill O'Brien
(R-Mont Vernon) sponsored HB 1541
, a 2014 bill which allows insurance companies to sell insurance policies that do not meet state and federal requirements, provided that the Insurance Commissioner approves the policies. The House killed that bill on March 13, 2014.
Rep. John Cloutier
(D-Claremont) sponsored HJR 12
, a 2014 resolution urging Anthem Blue Cross and Blue Shield, the only insurer offer New Hampshire plans on the federal health insurance website, to include at least one hospital in each county in its insurance network. The House killed that bill March 19, 2014.