House panel endorses naturopath mandate

Republican members of the House Commerce Committee bucked their leadership Thursday and voted 15-5 to endorse a health insurance mandate requiring insurance companies to cover people who use naturopathic practitioners as primary care physicians.If the bill is approved, the insurance companies of patients of some 60 practices throughout the state will have to reimburse the visits.”Patients have been begging us to push for this legislation,” said Dr. Jaclyn Chasse, president of the New Hampshire Association of Naturopathic Doctors. “We couldn’t be happier.”But the vote on House Bill 351 certainly did not please Rep. John Hunt, R-Rindge, chair of the committee, who urged members to reject the measure as another mandate.Two days earlier, Hunt was pushing a bill that that would have eliminated all health insurance mandates enacted over the past three years in an effort to keep down the cost of health premiums. And while that bill is mired in political controversy, no one expected the committee to put its stamp of approval on a new one.Indeed, Rep. Andrew Manuse, R-Derry, one of the leaders of the committee’s conservative wing, said on Tuesday that Hunt wasn’t going far enough and wanted to roll back all mandates.So when Rep. Donald Flanders, R-Laconia — who chairs the committee’s insurance subcommittee — added an amendment to gut the bill by changing the word “shall” to “may,” observers thought it would be shoe-in.But on Thursday, Manuse and other conservative committee members were persuaded by the argument of Rep. Donna Schlachman, D-Exeter — that the naturopath measure is a question of parity, not mandates.”It would allow consumers to choose to use a naturopathic doctor. It is not going to add to insurance costs. They are not paying anything they aren’t paying out now. They already pay for primary care physicians, so they will be paying this instead,” she argued.Indeed, chimed in Rep. Kenneth Gidge, D-Nashua, insurers would probably pay less, since naturopathic doctors would be less likely to prescribe expensive drugs and recommend high-tech medical intervention.Democrats on the panel who supported the measure even found unexpected allies from the most conservative Republicans on the panel.”When you treat people under the law, you should do it equally,” said Manuse.”It will mean more competition,” added Rep Fred Rice, R-Hampton. “Competition is what keeps prices down. Let the free market rule.”Anything that has a “shall” in it, is a mandate, argued Hunt, and it will cost money. “People going to naturopaths pay out of pocket. If we pass this mandate, insurance companies will have to pay them.”The reason insurance companies want to use primary care physicians is that they are part of a network that includes specialists and hospitals. A primary care doctor is supposed to be a gatekeepers to keep costs down, he said.By forcing insurance companies to use naturopathic doctors, “you are taking the managed care system and turning it upside down,” said Hunt.But advocates on the committee and in the audience said say that naturopathic doctors do make referrals to other medical professionals when needed, and they have as much training as many other primary care gatekeepers, and more than some, like nurse practitioners.In the end, even the committee’s vice chair, Rep. Jenn Coffey, R-Andover, voted for the mandate, and Manuse volunteered to write the “blurb” in the House calendar to explain the position to the House as a whole.All this left Hunt a bit baffled.Later, Manuse endorsed another bill backed by Schlachman to study the idea of a state bank to help out small businesses. Manuse wanted to look at a gold-based bank, in case U.S. currency collapsed — certainly not what Schlachman had in mind, though she was glad to get his support.Hunt, bemused at this unusual alliance, put his arms in a circle, so the tips of his fingers touched. “This is what happens when the extreme left meets the extreme right,” he said.In the end, the study bill on the state bank lost on an 11-3 vote. — BOB SANDERS/NEW HAMPSHIRE BUSINESS REVIEW