HB 1297, relative to health care exchanges. MAJORITY: OUGHT TO PASS WITH AMENDMENT. MINORITY: INEXPEDIENT TO LEGISLATE.
Rep. Andrew J Manuse for the Majority of Commerce and Consumer Affairs: A recent New York Times article said “the success of [the president's] health care overhaul … depends on the creation of … health insurance exchanges,” which are new state or federal bureaucracies set up to administer the rules and regulations regarding health insurance under the so-called “Patient Protection and Affordable Care Act of 2010” and its follow-up legislation. HB 1297 with the amendment recommended by the committee would be the state's most reasonable and measured response to the president's federal act because it would prohibit the creation of a state health insurance exchange and contribute to a nationwide effort by a majority of states to force the repeal and replacement of this bad public health care policy. While passing HB 1297 would contribute to the potential success of 28 other states' lawsuit in the U.S. Supreme Court challenging the federal act's constitutionality, the most significant reason to pass this bill is that it would encourage the ultimate amendment, repeal or replacement of the federal act regardless of the outcome of the federal lawsuit. In other words, passing this bill in New Hampshire and other states is the most effective way to ensure better and more affordable market-based health care reform is advanced in Congress. At the very least, because of a legal fault in the federal law that provides subsidies to insurance companies only in states with a state exchange, and not in states defaulting to a federal exchange, Congress will have to reopen the federal law to address this issue or face the monumental and apparent costs of the law's implementation and the increased public opposition that will come with it. Regardless of the outcome of the next election, this practical reality will force Congress to change the federal law, which is a good reason for this Legislature to prohibit the voluntary implementation of a state exchange, one of the law's key components, at this time. Only 17 states are studying the implementation of a state exchange, and the other 33 states have already done what we're proposing with this bill or they are considering the idea. It's also important to note that not even the handful of states actively pursuing a state exchange are likely to meet a federal deadline to create one, and the federal HHS Department has already indicated it won't meet many of its own deadlines, so fears about the looming deadline's approach are unfounded. To be clear: the federal act gives states the option to create a state health insurance exchange and pay for the operation of the state exchange starting in 2015, or to default to a federal health insurance exchange and let the federal government pay for its operation. The idea of a state exchange option was installed into the federal act using “local control” rhetoric to encourage states to voluntarily pursue the idea. Perhaps the plan was to get states to figure out how to implement the federal law for the federal government? This rhetoric worked for a time, but now even early leaders on the idea of adopting a state exchange have backtracked after further study. Contrary to those arguing that a state exchange would help New Hampshire maintain control over its insurance regulations, the federal law itself says exchanges can be established “only as prescribed by the HHS Secretary.” States may adopt only those exchange laws and regulations that “the secretary determines implements the standards within the state.” The federal secretary may change the rules without additional approval at any stage in the game, and the state exchange must comply. In summary, while a state exchange would be entirely controlled by federal regulators, just like a federal exchange would, the state of New Hampshire would have to pay anywhere from $10 million to $30 million a year to operate a state exchange starting in 2015. Massachusetts' example, which may not even comply with developing federal rules, costs that state about $29 million a year to operate. By creating a state exchange, we gain nothing and we lose millions that we simply can't afford to lose. HB 1297 will install roadblocks to this colossal financial mistake while recognizing that the next State Legislature will be able to reverse this action if changes to the federal law make the idea of a state exchange more appealing. The committee amendment removes a provision that would have prohibited the state's involvement with the creation of a federal exchange, which would have cost the state Medicaid money. With the amendment language, this bill will not cost the state Medicaid money because it only prohibits the planning, creating or participating in a state health insurance exchange and not a federal exchange. However, due to the flaw in federal law and lack of funding on the federal level, it's possible that a federal exchange may never be imposed on us. Repealing, replacing or amending the president's federal health care reform is favored by a supermajority of likely voters in both parties, and only 37 percent of the population actually supports the provisions in the federal law. Clearly, prohibiting the planning, creation or participation of a state exchange is the right thing to do at this time, and since we have no power to bind any future N.H. Legislature, it is also the measured and appropriate thing to do to make sure that we are only implementing the federal act in New Hampshire if there is no other way to resist. It is reasonable for us to put this blockade in place to ensure our departments are not spinning their wheels and spending the people's money for no reason while everything is worked out in Washington and our way forward becomes clearer. It will be much easier to take appropriate action when we know the details, and much harder to roll back the implementation of the federal act if we don't pass this bill now. Vote 10-6.
Rep. Donna L Schlachman for the Minority of Commerce and Consumer Affairs: The bipartisan minority believes that the changes this bill, as amended, makes to our state’s 2010 Federal Health Care Reform statute (which took effect in July 2011) is poor public policy. The current law was put in place to prevent NH from defaulting into federal oversight and implementation and specifically preserves our flexibility in responding to the Patient Protection and Affordable Care Act. This bill, as amended, prohibits our agencies and departments from engaging in planning for any state exchange for health insurance or in enacting any parts of the Federal Patient Protection and Affordable Care Act without legislative action. This guarantees that New Hampshire will default to a federally designed health care exchange at the same time it prohibits the implementation by the insurance commissioner of the exchange. Barring all planning for even a minimalist exchange would undercut the long established state mechanisms for regulating health insurance in NH. Prohibiting our state agencies from any involvement in planning could eventually harm both NH businesses and consumers. As stated in committee by the majority, this bill is a political solution to what the legislature was unable to achieve in an earlier attempt to have New Hampshire’s Attorney General join the lawsuit against the Federal Patient Protection and Affordable Care Act. No one can predict what the outcome of the Supreme Court decision on the ACA will be. Wishing for something is not the same as being prepared for what may occur. The bipartisan minority, including those who are not fans of the Patient Protection and Affordable Care Act, understand that it is not good public policy to prohibit “the state and all of its agencies, departments, and subdivisions” from planning for the future. The only testimony in favor of this bill came from local politicians and their political “think tanks.” Those intimately involved in NH’s healthcare planning and delivery, and members of New Hampshire’s business community (e.g., the Department of Health and Human Services, NH Voices for Health, the NH Insurance Department, Anthem, National Federation of Independent Business, NH Delta Dental, the Business and Industry Association, the American Cancer Society, the American Heart Association, the NH Hospital Association, Professional Insurance Agents of NH) as well as private citizens all spoke against this bill. As amended, this bill prohibits our own knowledgeable and experienced departments from planning for the future. They have specifically asked us not to tie their hands. Planning is paramount for whatever health care system that will greet us down the road. The minority believes it is irresponsible to put any changes to our health care delivery system on hold.
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