NH Senate to explore state-run health insurance exchange as session starts

(Dana Wormald/ New Hampshire Bulletin)

Will New Hampshire take over the Affordable Care Act health insurance exchange? Will it start reimbursing child care providers differently? Will it stop charging interest on non-fraudulent overpayments for unemployment?

When the New Hampshire Senate meets Wednesday, it may provide answers to those questions, when it considers leftover bills from the 2021 session.

Insurance exchange

The Legislature has always had a shaky relationship with the Affordable Care Act. It expanded Medicaid to insure more people but backed off establishing its own insurance exchange because that would have been seen as too much of an endorsement of the ACA. Instead, New Hampshire went along with the federal exchanges, preferring to see the new program sink or swim on its own.

But the ACA is now more than a decade-old and fixture on the health care and political landscape, and Senate leaders of both parties are having second thoughts about leaving operation of the exchange to the federal government as evidence of a unanimous recommendation by its Health and Human Services Committee Senate Bill 121, which requires the state Insurance Department to start looking into setting up a state-based exchange.

The department would be tasked with looking at the possible benefits of such a switch, including strengthening the state’s control over health insurance reform, economic benefits to the group and individual management, and improved access to data for health policy decisions and reliability, including integration with Medicaid. If the Insurance Department thinks it’s good to go, the decision would be up to the governor, with final approval up to the Executive Council, not the Legislature.

Child care centers

Under SB 144, the state would explore ways that child care providers, who have been especially vulnerable during the pandemic, are compensated. The measure would compensate them based on enrollment, rather than attendance, which would address the need for children to isolate after being exposed to Covid, or the center itself closing because of exposure.

This would cost the state more money, but a lot more federal money is available at present, thanks to the American Rescue Act, and possibly more, if some version of Build Back Better passes. The feds have been doing something like this in other states during the pandemic, and now the state Senate is on the brink of trying it out as indicated by another unanimous vote by the Health and Human Services Committee.

Unemployment overpayments

In the rush to get unemployment out the door at the start of the pandemic – when unemployment was up to 16 percent – and Congress and the federal Department of Labor was changing the eligibility rules with frightening speed as well – some workers were overpaid. Now the Department of Employment Security wants that money back, with interest.

SB 161, however, would require that the agency at least drop that interest, “unless the person willfully made a false statement or representation or knowingly failed to disclose a material fact to obtain or increase any benefit or.”

It’s unclear whether this will pass, since the Executive Departments and Administration Committee voted to recommend passage on a 3-2 vote.