Health mandates show staying power in House hearing

One of the Republican mantras during the last election was to get rid of all mandates that were said to be driving up the cost of group health insurance for small businesses.On Tuesday, in both the House and Senate’s commerce committees, it became clear that doing so was easier said than done, as three bills aimed at mandates were still stuck in the political muck.As the day wore on, it became clear that state mandates were not going away in a hurry. Indeed, it looks as if they might remain until replaced by the Patient Protection and Affordable Care Act, which looms over any state effort to tinker with health care.In the Senate, an attempt to allow companies to buy insurance from other states that don’t have such mandates turned into a clash between the insurance industry and small business, personified by Sen. Ray White, R-Bedford, Commerce Committee vice chair and an insurance agent, and committee member Sen. Andy Sanborn, who owns a bar and restaurant.The two differed, joked White to Sanborn, “because you don’t understand insurance.” To which Sanborn retorted, “You don’t know anything about running a small business.”After that warm-up act, Sanborn argued that businesses should be able to shop nationally — just like it can for auto insurance — to increase competition and choice because currently there are only “2.5 companies, which are mandated by law to pay the same rate.”But White said that these out-of-state insurers will pick out the young and healthy, leaving such an undesirable pool of sick and old workers that the state runs the risk of losing the insurers that it has. Besides, if you want to get rid of mandates, White said, why not repeal them.Instead, White pushed for House Bill 627, which would prevent the state from adding any extra mandates that are not required under the health reform law.”I don’t want to pay one nickel beyond the essential benefits package,” White said.But the federal essential benefits package won’t be out until February, and other committee members didn’t want to get rid of state mandates when they weren’t even sure of which ones they’d be getting rid of.”We might still want to cover autism,” said Sen. Matthew Houde, D-Plainfield.”I’m not going to vote for something when I don’t know what it is,” added Sen. Tom De Blois, R-Manchester.
“I don’t like to pass mandates,” White said. “I’m sick of hearing about Susie’s law and Freddy’s law. The cost curve is out of control. I’m trying to draw the line in a cold matter.”Over on the House side, the direct assault on mandates was faring no better. HB 309 would have wiped out seven mandates passed when the Legislature was under Democratic control — certified midwives, cost of testing for bone marrow donation, continuation of group health insurance in the event of divorce or legal separation, children’s early intervention therapy service, stomach staple surgery, autism and hearing aids.HB 309 was retained last year, mainly because of opposition from groups that would have been affected that packed the hearing room. And at Tuesday’s House Commerce subcommittee work session. enough people showed up to force the committee to double the size of the hearing room.While the bill had some supporters, almost all of the mandates had a defender, either in the hearing room or among the committee members — and not just Democratic members.Supporters of the hearing aid mandate argued that the committee shouldn’t even be talking about it without interpreters.”I don’t understand what you are talking about because I’m deaf,” shouted Susan Wolf-Downs, executive director of Northeast Deaf and Hard of Hearing Services.Hunt agreed to hold off discussion on that one until an interpreter could be provided, though the subject did come up after the deaf members of the audience left, and Hunt said a “little birdie” told him that elimination of the hearing aid mandate would remain in the bill.The autism treatment mandate’s greatest Republican defender was Rep. Chris Nevins, R-Hampton, who also wanted to keep the mandate for early intervention.Vice Chair Jennifer Coffey, a pro-business Republican, backed the mandate for insurance companies to cover surgery to remove excess fat from very obese people, noting that it saves money in the treatment of a number of obesity-related illnesses, from diabetes to heart disease.She also noted that insurance companies have come to agree with that position, and have begun offering such coverage in the self-insured market (which the aforementioned mandates do not apply to.) And Democrats argued that midwives are cheaper than doctors, so how does that drive up rates?In the end, Hunt agreed to drop his opposition to the mandate to cover the divorced spouses of employees — since few lives are affected — and was willing to look at utilization review to control costs on some others. But on the whole, he still wanted to forge ahead with most of the bill, changing the word “shall” to “may” in most of the mandates.Whether that will pass the committee, the House, the Senate and win the governor’s support remains to be seen. – BOB SANDERS/NEW HAMPSHIRE BUSINESS REVIEW