House panel weighs health exchange ban

The insurance subdivision of the House Commerce Committee appeared split Wednesday over whether to prohibit state employees from even considering setting up a state health exchange under the federal Affordable Care Act, even after a national expert from the Cato Institute urged them to do so.The expert, Michael F. Cannon, the Cato Institute’s director of health policy studies in Washington D.C., literally had one of the absent lawmaker’s seat at the table during the subcommittee’s work session, unlike the local lobbyists who stood and sat at the back of the room.Cannon was introduced by bill sponsor Rep. Andrew Manuse, R-Derry, who presented an amended version of House Bill 1297, which he thought would satisfy the concerns of some senators who do want to move forward on the health exchange.The new version of Manuse’s bill would still allow state officials to work with a federal exchange if the state doesn’t create its own. Under the existing federal law, if the state doesn’t set one up, a federal exchange would be imposed. Some raised the concern that the federal government would cut off Medicaid money under such a ban.Still, on Monday, a coalition of business organizations came out favoring Senate Bill 163 — now on the table in the Senate — which would establish a state-run exchange.”New Hampshire would be able to shape and control, to a greater degree, the structure and function of a state-based exchange than it would a federally-imposed one. Business leaders have a real and vested stake in what a health insurance exchange would look like in New Hampshire since they may consider shopping in an exchange or sending their employees to an exchange to buy health insurance,” according to a statement released by the Business and Industry Association of New Hampshire. The BIA was supported by three chambers of commerce, various insurers, health providers, and such groups as Ski NH and the New Hampshire Auto Dealers Association.But Manuse argued there is no difference between a state and federal exchange. The only “pleasure of a state exchange is the pleasure to pay for it,” he told the panel. Any state exchange, he said, would be a “puppet exchange. Really the federal government is controlling it.””The idea that New Hampshire will have more control is a mirage,” echoed Cannon. “The federal takeover has already happened. Are you going to lend manpower to the takeover or refuse and force Congress to open the law to give the states more control?”Because of the uncertainty surrounding the health reform law — it is being challenged in the courts and by conservatives at the state level — the state risks “creating a new government bureaucracy to create a law that could be overturned tomorrow,” Cannon argued.He noted that a loophole in the law would make it difficult to mandate that employers either provide insurance for their employees or pay into a fund that would cover them under federal exchange.However, Paula Rogers, a lobbyist with Anthem Blue Cross Blue Shield New Hampshire (which signed the letter in support of SB 163), the uncertainty is the very reason to allow officials to find out more information about whether a local exchange would make sense for the Granite State.”There will be some major changes in the marketplace in the next two years, and there will be some large changes because of (health reform) and we agree with many of them,” said Rogers. “Yes, there is a cost, but there are going to be arguments in March, so why cut it off in February? We should be realistic and plan to have all the tools at our disposal.”Committee Chairman John Hunt finally cut short the debate to take a straw poll.While Rep. Don Flanders, R-Laconia, said, “We need some planning. If we completely shut everything off I can’t support it.”But most of the other lawmakers seemed as uncertain about the bill as about the future of health care reform itself. Hunt put off any decision for another day. — BOB SANDERS/NEW HAMPSHIRE BUSINESS REVIEW