The Granite State’s foray into healthcare reform started with United States Sen. Jeanne Shaheen (D-NH), who burnished her progressive healthcare pedigree long before she became known in New Hampshire as ‘the deciding vote for Obamacare.’
Twenty years ago, inspired by then First Lady Hillary Clinton’s failed reform effort, State Sen. Shaheen introduced state Senate bill 711.
To grassroots activists battling Obamacare, these ideas may sound familiar. Senate Bill 711 inserted a community rating system into the state insurance marketplace. It also prohibited insurers from denying coverage for certain pre-existing conditions and changed the fee formulas for premiums on higher-risk subscribers, shifting the cost burden from the old and sick to the young and healthy.
Within eight years of passage, the number of insurers in New Hampshire decreased from 26 to five: SB711 drove 21 health insurance providers out of the state.
The primary beneficiary of Shaheen’s 1994 legislation was Blue Cross Blue Shield (BCBS).
Conrad F. Meier, writing at Heartland.org in 2004, quoted a competitor of BCBS who summed up the results of Shaheen’s meddling.
“In 1994, Golden Rule had a thriving business in New Hampshire. We insured a lot of people and paid millions of dollars of claims expeditiously and accurately. But Blue Cross complained that carriers like Golden Rule were doing great harm in New Hampshire. In fact, the only entity suffering harm was Blue Cross.
“Jeanne Shaheen’s 1994 reforms ended up freeing Blue Cross of its money-losing business and handed it a virtual monopoly in the individual market,” Tooman continued. “Blue Cross returned to the individual market, able itself now to ‘cherry pick.’ But it still has the provider discounts no one else can touch.
Efforts to undo the damage were hit and miss, but the health coverage coup de gras that would come to be known as Obamacare has energized state Republicans to pursue a more open insurance market for New Hampshire.
In the 2010 legislative session, House Bill 1585 was introduced to allow “health insurance policies without mandates to be sold to New Hampshire residents” and across state lines. It failed.
Between 2010 and 2014, other legislative efforts followed. HB 237 tried to build up consumer protections by forbidding the federal government from mandating coverage it did not pay for in total. HB 619 sought to allow the state “to opt out of the requirement that individuals buy health insurance contained in the Patient Protection and Affordable Care Act.” Senate Bill 150 was another effort to allow individuals and businesses to buy health insurance across state lines.
Additional legislation would have allowed the purchase of policies without federal mandates and added exceptions for religious objection. While none of these ever became law, it wasn’t a total wash.
Two pieces of legislation made it into state statute. SB148 provided that “no resident of this state (shall be) liable for any penalty, assessment, fee, or fine as a result of his or her failure to procure or obtain health insurance coverage,” while HB 1297 prohibited the state of New Hampshire “from planning, creating, or participating in a state health care exchange. “
As we enter the 2015 session, the pursuit of open markets continues. Each chamber has a bill authorizing individuals and certain businesses to purchase health insurance from out-of-state companies; HB 128 in the House, and SB 131 in the Senate.
HB 128 had its first hearing on Jan. 14, and the song remained the same. Lobbyists argue uncertainties and special interests warn that consumer protections will be compromised. But there may be a new wrinkle to encourage support.
At least one legislator suggested to me that refusing to open the marketplace is a disincentive for business owners from outside the state to move to New Hampshire. The law as written may make it illegal for them to keep existing plans or coverage should they relocate within our borders.
Democratic Gov. Maggie Hassan would typically veto any such legislation were it to make it to her desk. But if that analysis proves out, either HB 128 of SB 131 may have a chance at becoming law.
Hassan is expected to challenge Sen. Kelly Ayotte in 2016. Protecting Senator Shaheen’s BCBS cartel—they are the only approved provider of coverage in New Hampshire under the Affordable Care Act—could become politically contentious if doing so is perceived as anti-business or anti-jobs.
This article was originally posted Jan 21st at Watchdod Arena, the Franklin Center’s network of writers, bloggers, and citizen journalists.
