In an effort to reach common ground and overcome differences between competing House and Senate bills to expand health coverage for tens of thousands of Granite Staters, Governor Maggie Hassan and Speaker of the House Terie Norelli today offered a compromise path forward that incorporates both Democratic and Republican ideas for increasing and preserving access to health insurance while promoting private coverage.
The compromise plan outlined by the Governor and Speaker would move health coverage forward and adopt the Senate proposal to shift the entire newly eligible population of individuals and families with incomes at 0-133 percent of federal poverty onto New Hampshire's health insurance exchange with premium assistance, but on a timeline that allows for workable, responsible and effective implementation, including increased competition to ensure cost-effectiveness on the exchange.
"While I believe that the bill offered by the House, which reflects the recommendations made by a bipartisan study commission, offers an effective path forward for New Hampshire to expand coverage to tens of thousands of working families while encouraging private insurance, we are open to the Senate's ideas," Governor Hassan said. "However, the bill as written by the Senate simply will not work and will result in families losing their new bridge health coverage just in time for Christmas of 2014."
The timeline in the Senate plan is unworkable for a number of reasons:
It would require the state to implement a significant new exchange-based health care program in a matter of months, with little to no resources. This would require federal approval that is unlikely to be granted in such a short time period. Under the Senate bill, an extensive waiver would need to be developed and submitted in just six months, with approval and implementation in just five months after that.
Arkansas, the only state in the country to pursue such a program, spent a full year developing its plan before it began negotiations with the federal government. In contrast, New Hampshire agencies have been essentially barred by law from doing much of the necessary groundwork to make the Senate exchange plan possible.
The accelerated Senate timelines do not allow time for additional competition to develop on the marketplace, which currently only offers the Anthem narrow-network plan. Without additional competition, the Senate plan would hurt our insurance markets, be more expensive to taxpayers, and is not likely to meet the cost-effectiveness test required by the federal government.
The Senate plan would undermine New Hampshire's efforts to manage the care provided to our low-income residents and would potentially violate the state's existing contracts with three private managed care companies.
Governor Hassan and Speaker Norelli also objected to the fact that the Senate bill does not include the necessary language to allow the state more control over the exchange, which would be necessary to ensure the increased competition required to making the Senate plan work. The Senate bill also includes provisions that give a few private entities - several with direct financial stakes - control over the program, even though New Hampshire taxpayers would be bearing the risk.
"We are willing to move toward the Senate's basic framework, but only if we have timelines and measures in place that are in the best interest of our people and families," Governor Hassan said. "We need to move forward quickly to maximize federal funds, and we should use the 100 percent federal match period to establish a New Hampshire plan that will work from day one and for the long-term. I thank Speaker Norelli and the House for their willingness to compromise, and I encourage Senate leadership to work with us to finalize a New Hampshire plan that can be implemented successful and responsibly."
"Through a long process the House has embraced new ideas and made compromises, and we continue to remain open to further innovation," Speaker Norelli said. "We must pass a plan that is designed for success from day one. It is important to deliver not just expanded access to needed care for tens of thousands of our neighbors, but also stability to all involved. The House plan provides security and improved health for those receiving coverage, and predictability for the providers, the private insurance carriers and the state."
"This compromise plan includes the ideas that were put forward in the Senate Republican plan, but makes them work for the people we are trying to cover," said Senate Democratic Leader Sylvia Larsen. "We can't support a plan that won't work in practice. The Senate Republican plan unfortunately threatens to pull the rug out from under tens of thousands of Granite Staters by imposing an unworkable timeline. At the end of the day, we want a bipartisan solution that delivers all of the economic, budgetary, and health benefits of expanded Medicaid. We believe this compromise can achieve that, and we look forward to working with Senate Republicans to pass it."
As proposed in both the House and Senate bills, the compromise path forward would expand the state's Health Insurance Premium Payment (HIPP) program, helping families and individuals with incomes at 0-133 percent of poverty to secure coverage through an employer if available.
For those without access to employer-provided insurance, the compromise offered today would make available a bridge plan operated by the state's Managed Care Organization partners for a period of time until New Hampshire's exchange has increased competition, additional state-level control, and plans with costs in line with the cost of providing coverage through the state's Managed Care program. Once those conditions are met, all newly eligible families and individuals without access to coverage through HIPP would then receive premium assistance to purchase private plans on the exchange.