2011 End of State Legislative Session
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End of State Legislative Session Update
This year has been particularly busy, between implementation of the Affordable Care Act at the state and federal level, and protection and education of the new health law at the same time. In addition, several state-based health policy priorities have continued to move forward.
We thank members of the NH Voices for Health network for your hard work over the past year on the many priorities that we jointly supported. Below, we have included a snapshot of some of the major accomplishments we have achieved together this year.
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Major Accomplishments on Voices Priorities
Passage of HB 601, Relative to Implementation of Federal Health Care Reform
House Bill 601 ensures that Granite Staters can continue to look to the NH Insurance Department for assistance and enforcement of the health insurance consumer protections contained in the new health law. The bill also provides for a legislative oversight committee that has already begun to work closely with the NH Insurance Department and NH Department of Health and Human Services to consider opportunities under the new health law. HB 601 became law in July 2011. Senate Bill 162, the Senate companion bill to HB 601, was tabled by the committee of conference concurrent with HB 601’s passage.
Unfortunately, during the final days of the committee of conference, language from various health policy bills were moved from one bill to the next, and the final version of HB 601 includes language requiring the state to return a large portion of the Exchange planning grant that the state was awarded from the federal government the previous fall. A health benefit Exchange is a health insurance supermarket that will give individuals and small businesses in New Hampshire increased choice of insurance plans and better transparency related to those products and their cost. The return of the funding means that New Hampshire will have to absorb most of the cost of the planning process, which would have been fully funded by the grant. If New Hampshire does not move forward with planning an Exchange, the state will cede local control of the Exchange to the federal government, who will plan and implement New Hampshire's Exchange.
On a brighter note, consideration and planning for a potential New Hampshire-based health benefit Exchange is continuing. (see Exchange Planning).
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Limiting Influence of HB 89 and SB 148, Relative to Legal Challenges to the New Health Law
NH Voices for Health opposed the initial House-passed version of SB 148, which required the Attorney General to join the lawsuit against the new health law, while also requiring the NH Insurance Department to return all federal grants under the new health law (including the Exchange planning grant) to the federal government for the stated purpose of deficit reduction. Similarly, NH Voices for Health opposed HB 89, an act requiring the Attorney General to join the lawsuit challenging the new health law.
Based on a request from the NH Senate, the NH Supreme Court issued an advisory opinion regarding whether the legislature can direct the Attorney General's activities. The advisory opinion stated that doing so would be a violation of the separation of powers. (Read more: Voices release on the advisory opinion.)
Based on the advisory opinion, the SB 148 Committee of Conference agreed to remove the language regarding the lawsuit. The portion about returning federal grants was also removed (but see above for HB 601). The committee did, however, pass symbolic language providing that a resident of New Hampshire shall not be required to obtain health insurance coverage.
In the meantime, HB 89 in its entirety was laid on the table by the NH Senate, effectively defeating the legislation.
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The Legislative Joint Fiscal Committee and the Executive Council Accepts Rate Review Grant and Consultant Contracts
The legislative Joint Fiscal Committee and the Executive Council approved acceptance of a health insurance premium rate review grant awarded to the New Hampshire Insurance Department. Subsequently, the Executive Council approved a package of six NH Insurance Department contracts related to the health insurance premium rate review grant.
The rate review grant was made available under the new health law and provides funding for New Hampshire to strengthen and make more transparent its health insurance rate review process.
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Medical-Loss Ratio Adjustment Decision
NH Voices for Health and partners helped ensure a sensible pro-consumer Medical Loss Ratio definition and standard for New Hampshire.
A MLR is the portion of premium dollars that insurance companies must spend on health care services and quality care improvement as opposed to administrative costs and profits (including executive salaries and marketing). The new health law requires insurance companies spend 80-85% of premium dollars on medical care and health care quality improvement, rather than administrative costs, starting this year. Companies that do not must provide a rebate to their customers.
The State of New Hampshire had filed for a Medical Loss Ratio (MLR) standard adjustment for NH's individual insurance market, which the new health law allows the Health and Human Services Secretary to permit for a state if it is determined that meeting the 80 percent Medical Loss Ratio standard may destabilize the individual market. The New Hampshire Insurance Department (NHID) had requested to adjust the MLR standard to a 70% MLR for 2011, 2012 and 2013.
Voices and several other organizations weighed in with concerns about this request. In response, the Federal HHS's Center for Consumer Information and Insurance Oversight (CCIIO) issued a determination denying NHID's full request, and instead granting a phased-up adjustment: companies will be required to meet at 72% MLR this year, 75% in 2012 and the full 80% standard starting in 2013. (Read more: HHS Determination on NH MLR Adjustment Request.)
This reasonable compromise moves companies more quickly to the full 80% standard while minimizing concerns about insurers leaving the market.
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Children's Health Insurance Study Commission Meeting
In 2011, Voices continued its work on children’s health insurance, providing expert information and staff support to the Children’s Health Insurance Study Commission created by 2010 Voices’ priority bill Senate Bill 436.
The federal CHIP Reauthorization bill - signed into law in February 2009 - provided states with a number of options and financial incentives for improving access to children's health care coverage. SB 436 established a study commission to allow policy makers and stakeholders to explore these new options and make appropriate recommendations for New Hampshire. NH Voices for Health Policy Director Lisa Kaplan Howe served on the commission and helped provide background and staffing support as the commission as a whole considered the options and the potential impact for strengthened children’s health coverage in New Hampshire.
In its final report, the SB 436 Study Commission included a review of the applicability of each of the CHIPRA expansion options and made such recommendations as encouraging the State of New Hampshire to apply for the CHIPRA Outreach and Enrollment Grant and similar opportunities to improve access to health care for pregnant women.
The full report is 28 pages long and can be found here: http://gencourt.state.nh.us/statstudcomm/reports/2046.pdf
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Update on Efforts Branching 2011-2012
SB 163 (Exchange Authorizing Legislation)
The new health law calls for the creation of health benefit exchanges, health insurance supermarkets that will give individuals and small business in NH more choice about what insurance plans they can buy and how much they pay for coverage. An exchange will provide individuals and small businesses with a “one-stop shop” to find and compare affordable, quality health insurance options; and bring new transparency to the market so that consumers will be able to compare plans based on price and quality. Exchanges will lower costs by increasing competition between insurance companies and allow individuals and small businesses to band together to purchase insurance. States have the choice of establishing their own exchange or opting to have the federal government establish an exchange for the state.
SB 163 created the framework for a NH-based health benefit exchange to assist individuals and small businesses with purchasing qualified health plans. Unfortunately, SB 163 was not voted on in the NH Senate the first week of February 2012, effectively killing the bill (which, as a re-referred 2011 bill needed to be voted on by a certain date). This means that NH's Exchange will now be created by the U.S. Department of Health and Human Services. Thanks to the efforts of NH Voices for Health and partners, the amendment to SB 163 adopted by the committee addressed the concerns that many of us raised, and we are hopeful that a federally-facilitated Exchange may be even better tailored to consumers’ needs. (Click here for more information on health exchange benefit related efforts in 2012.)
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Ongoing Work on Other Voices Priorities
Commission on Health Care Cost Containment Meeting
Voices continues to monitor the ongoing work of the state’s Commission on Health Care Cost Containment. This commission was established by 2010 Voices’ priority bill Senate Bill 505 to study hospital contracting and reimbursement practices with health insurance carriers, public payers and the uninsured, and to make payment system reform recommendations for containing costs and improving quality. More information can be found on the commission’s website.
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For up-to-date information and a timeline on state health policy and national health reform implementation, see the Voices Legislative Tracking Sheet.
