Two sides battle over proposed health exchange ban

On one side are businesses, insurance companies, health care providers and the state Insurance Department. On the other are House leadership, conservative senators and a think tank. All of them mingled in a crowded House Commerce Committee meeting to testify on a bill that would bar the state from having anything to do with creating a health exchange under the federal health care reform law.Under House Bill 1297, “agencies, departments and subdivisions” as well as “any government in New Hampshire” would not be able to “plan, create, participate in or enable” a state or federal health exchange.State officials had been doing just that, working on Senate Bill 163, which would put into place a planning process to create an exchange if federal law is not overturned.The Senate bill’s sponsor, Sen. Ray White, R-Bedford, argued that — like it or not — the law is the law and the state ought to be prepared if it wants to maintain local control if health reform remains in place.Without it, he said, regional insurance agencies and local brokers (of which White is one) would be threatened.The Senate tabled White’s bill Wednesday, because it was too hot to handle.Indeed, Rep. Kevin Avard, R-Nashua, asked to have his name taken off White’s bill, and was there Thursday to testify for HB 1297, its antithesis.”I signed on [to SB 163] because I thought it would create local control,” he said. “but upon review, it does just the opposite.”Under the federal law, the state has to either set up an exchange to offer subsidized health insurance to those who cannot get private insurance, or the federal government will do it for the state — thus the concern about local control.The state has thus far rejected any federal funding for planning the exchange, voting down $666,000 of federal funds last year, and the Executive Council has nixed another $333,000.On the other hand, the Legislature has set up the Joint Health Care Reform Oversight Committee to oversee implementation of the federal law, jokingly referred to in testimony by Anthem Blue Cross Blue Shield of New Hampshire lobbyist Paula Rogers, as the “Mother may I?” committee.But Rep. Andrew Manuse, R-Derry, testified that “rejecting the funds to study the establishment of an exchange also means that we do not want one – for sure.”Manuse was followed by a string of elected officials, including House Speaker William O’Brien, who argued that the state would wind up paying for the exchange, and that by implementing a state exchange, “we accept the terms of the federal government that any exchange may not establish rules that conflict” with federal regulations.Other lawmakers were equally defiant.”Let the federal government take the blame,” said Sen. James Forsythe, R-Stafford, who said he was trying to convince other senators that the state could reject the exchange without any consequence”States have equal ability to judge what is constitutional as the [U.S.] Supreme Court does,” he added.The lawmakers were backed by Charlie Arlinghaus, president of the Josiah Bartlett Center for Public Policy think tank. “At the end of the day, do you want a puppet government or not?” asked Arlinghaus.But that’s all the backing the measure got, aside from other legislators.In written testimony, New Hampshire Insurance Commissioner Roger Sevigny said that by preventing any kind of interface, even with a federal exchange, “many areas of regulatory authority will be handed over to the federal government … and consumers and insurers will be forced to look to Washington, D.C., for guidance on health insurance.”The result would be “dual regulation,” added Jennifer Patterson, the Insurance Department’s legal counsel, at the hearing, which could “potentially cause great confusion.”If the intention was to keep the federal government out, she said, “ironically, should this bill pass, it will be the opposite of that.” Under the bill, she said, “we will have no control whatsoever.”Manuse said he found the department’s position “offensive,” since it has a “financial and self-preservation interest” in the matter.An exchange, he said, would “kill New Hampshire businesses with additional cost-spiking mandates and other regulations.”But the Business and industry Association of New Hampshire also opposed the House ban.Whether you are for or against ACA, testified BIA spokesperson Adrienne Rupp, “businesses support being prepared.”Concord-based dental insurer Northeast Delta Dental, worried that by refusing to cooperate with the federal government, the state could lose Medicaid money as well as “endanger New Hampshire and local and regional insurance carriers, and the jobs, quality products and community commitment that we embrace,” said Tom Raffio, CEO of the company.The bill, said Rogers, “pretty much ties our hands. An exchange will change the marketplace. The question is how you want to control the marketplace. We need some level of certainty, something you can plan.”The New Hampshire Hospital Association also opposed the bill, as did the Heart Association and the American Cancer Society.”The state wants to put its collective head in the sand and say, ‘Hey, federal government you do it all,'” said Mike Rollo, lobbyist for the cancer society. — BOB SANDERS/NEW HAMPSHIRE BUSINESS REVIEW