Committee's role unclear in NH health reform plans

CONCORD, N.H. (AP) -- A legislative committee created to oversee how New Hampshire implements President Barack Obama's health care overhaul law may have little say in the next key decision.

Gov. Maggie Hassan has until Feb. 15 to declare whether the state will partner with the federal government to operate the new insurance markets required under the law. According to her spokesman, she doesn't like the idea of leaving everything to the federal government and doesn't need to include lawmakers in her decision. But he stopped short of saying she would act without them.

"Leaving control of New Hampshire's exchange solely to the federal government is not in the best interest of our people and businesses," spokesman Marc Goldberg said. "Though the governor has full authority to communicate with the federal government about the approach the state would like to pursue for our marketplace, Gov. Hassan is always open to collaboration with legislators from both parties."

A major component of the health overhaul law requires the creation of exchanges, which are marketplaces that will offer individuals and their families a choice of private health plans resembling what workers at major companies already get. States can establish and operate their own exchanges, create regional exchanges with other states, run an exchange in partnership with the federal government or let the federal government operate the exchange for the state.

The first option is off the table because New Hampshire lawmakers passed a law last session prohibiting the state from establishing its own exchange. They also created an oversight committee to approve policy changes related to the health overhaul law, and that committee met Monday for the first time this session.

During that meeting, the state insurance and health commissioners described the recommendations they've made to Hassan — that New Hampshire enter two types of partnerships that would make the state responsible for both regulating insurance companies and the plans they offer under the exchanges and helping consumers access the exchange. But much of the discussion focused on whether the state could move forward without the committee's approval.

Insurance Commissioner Roger Sevigny said he couldn't speak for the governor, but from his perspective, a state law passed last year requires his department to retain as much regulatory authority as possible over the insurance markets or exchanges, which could only happen with a partnership model. He said the partnerships would be a step toward preserving states' rights.

But committee members pointed to another section of the law that puts the committee in charge of determining all policies regarding implementation of the federal law.

"To me, the legislative intent was very clear that any steps going forward in implementing the Affordable Care Act were going to come before this committee," said Rep. John Hunt, R-Rindge.

He and the other Republican members of the committee said they have great concerns about the regulatory burden and sustainability of a partnership and urged Hassan, a Democrat, to delay making a declaration that would start the process of creating one.

Democrats on the committee said they agreed with Hassan that the state shouldn't leave everything up to the federal government. And they accused Republicans of playing political games with their request that Hassan delay action, pointing out that the Republican-controlled Senate caused a delay by waiting until Friday to appoint its committee members.

Under a plan management partnership, the state would regulate and resolve complaints about the insurance plans offered through the exchange and the insurance companies offering them.

Under a consumer assistance partnership, the state would help individuals and businesses learn about and access the exchange. State agencies would regulate organizations receiving federal grants to assist consumers or could set up their own short-term outreach programs using federal funds.

Department of Health and Human Services Commissioner Nicholas Toumpas said while he respects lawmakers' concerns about whether a partnership model could prove costly to the state, the consumer assistance partnership would help make sure people can get face-to-face help in making insurance decisions rather than rely only on the federal government website or hotline.

"Whatever we can do in order to provide them the type of information they need to make an informed choice for themselves I think is the right thing to do," he said.

Some committee members questioned whether the state could send a letter reserving the right to enter partnerships without fully committing to it. But insurance department lawyer Jennifer Patterson said federal funding would only be available next year.

"As a practical matter, if we don't do this now, it's unlikely we'd have an opportunity to do so again," she said.