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N.H. lawmakers shorten PPACA implementation bill

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CONCORD, N.H. (AP) — New Hampshire House and Senate lawmakers moved close to agreement Wednesday on a severely scaled-back version of a bill intended to align state insurance rules with the Patient Protection and Affordable Care Act (PPACA).

The state insurance commissioner had argued that a wide range of changes were necessary to preserve the state’s traditional role in regulating insurance plans. But opponents of the bill cast the original version as an attempt to move New Hampshire toward a state-operated marketplace, something specifically prohibited by state law. In the end, House and Senate negotiators drafted a three-paragraph bill to replace the 15-page original and planned to vote on it Thursday morning after consulting with their peers.

“This is about finding the least intrusive solution, if there needs to be one,” said Sen. Andy Sanborn, R-Bedford.

Under PPACAlaw, new “exchanges,” or health insurance marketplaces, will offer individuals and their families a choice of private health plans resembling what workers at major companies already get. The government will help many middle-class households pay their premiums, while low-income people will be referred to safety net programs they might qualify for. Enrollment starts Oct. 1 with coverage taking effect Jan. 1. After that, virtually everyone in the country will be required by law to have health insurance or face fines.

While the last Legislature passed a law prohibiting the state from setting up its own markets, or exchanges, Democratic Gov. Maggie Hassan decided in February to have the state partner with the federal government to manage the health plans offered through the markets and to provide consumer assistance. The decision by the first-term Democrat didn’t sit well with Republicans, who have blocked or slowed several efforts to implement the federal law.

“I get that politically, there’s a question and disagreement about moving forward, but this (bill) is specific, it was well thought out,” said Rep. Donna Schlachman, D-Exeter. “I’m struggling with the layer of difficulty you all are having with something I think our carriers, and our markets, are asking us to do so they can go forward.”

The state insurance commissioner has argued that without the original bill, the federal government would regulate all individual and small group insurance products in the state, not just those related to the health overhaul. He and other supporters say that will create confusion for insurance companies and businesses trying to plan their coverage.

Sen. David Pierce, D-Etna, said the federal law gives the state some discretion when it comes to factors that can be used to vary insurance premiums, including age, geographic location and tobacco use. He argued the original bill simply amounts to “taking that discretion and telling the federal government that we’re going to run things our own way to the extent we’re permitted.”

Sen. Jeb Bradley, R-Wolfeboro, disagreed, saying that the original bill would mean accepting the federal rules “lock, stock and barrel.”

“It says we’re going to align our laws with the federal law. That is the antithesis of preserving and protecting our regulatory oversight,” said Bradley, who accused the insurance department of manufacturing a crisis. “All we would get out of that is the ability for our department of insurance to push paperwork for federal bureaucrats.”

At Bradley’s insistence, the new language drafted Wednesday includes a provision specifying that nothing in the bill should be interpreted as expanding the insurance department’s authority to adopt rules. He said he didn’t trust that the department wouldn’t try to circumvent the Legislature by using an emergency rule-making process to circumvent the Legislature and enact parts of the bill that were cast aside.

“We’re not trying to do anything sneaky,” countered Insurance Commissioner Roger Sevigny.

The proposed compromise states that insurance companies will follow the federal law in terms of rating factors, with the specification that New Hampshire will continue to be considered one geographic rating area. But it does not include provisions from the original bill related to differences in how the state and federal government count employees and define “small employer.”

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