The New Hampshire House voted this week to make health care more accessible. The Lower chamber of the state legislature passed HB223, which would exempt certain facilities from restriction in existing state law.
In the Granite State, a “medical facility” within 15 miles of a critical care hospital needs the permission of that hospital to open and operate. This allows hospital networks to prevent competition, while urgent care clinics end up as satellites of those hospitals.
It is part of a war on affordable care in the Granite State, which was started by then-State Senator Jeann Shaheen in 1994.
During the 1994 legislative session, Democrat Jeanne Shaheen, then a state senator, responded to BCBS by sponsoring SB 711, which passed and went into effect January 1, 1995. Among other provisions affecting the state’s insurance industry, the measure:
Required insurance companies to guarantee issue individual health insurance policies. Companies were prohibited from denying coverage to any person or eligible dependent;
Imposed price controls, in the form of modified community rating, on individual health insurance premiums. Premiums could be modified or adjusted only for age, not health status; and
Prohibited insurers from increasing premiums by more than 25 percent until January 2000. …
While health insurance coverage was little affected by Shaheen’s reforms, consumer choice was badly damaged. By 1997, the number of commercial health insurers serving New Hampshire dwindled to five from a previous high of 12. Those remaining in the market reduced their insurance offerings to cover only high-deductible, catastrophic-type health insurance plans.
The cost of care rose as access declined. The State’s Certificate of Need Board, run by hospital interests, limited the construction of new health facilities until it was disbanded by statute in 2016, but in 2017, the State amended its licensing rules to require “a written determination by the commissioner of health and human services, after inquiry to the critical access hospital, that the proposed new facility will not have a material adverse impact on the essential health care services provided in the service area of the critical access hospital.“
House Bill 223 exempts “ambulatory surgical centers, emergency medical care centers, birthing centers, drop-in or walk-in care centers, dialysis centers, and special health care services from the critical access hospital exclusionary zone restrictions.” This change would permit licensed healthcare professionals to operate outside the hospital system, free from Hospital rules, pricing, and overhead.
New Hampshire has the 11th highest per capita health care costs in the US, according to the World Population Review (Health Care Costs by State 2024).
| New York | $14,007 | 35% | $13,012 |
|---|---|---|---|
| Alaska | $13,642 | 35.8% | $13,188 |
| Massachusetts | $13,319 | 18.2% | $12,754 |
| Delaware | $12,899 | 28.1% | $12,294 |
| West Virginia | $12,769 | 39.5% | $12,019 |
| Vermont | $12,756 | 35.5% | $12,237 |
| South Dakota | $12,495 | 47.1% | $11,736 |
| Connecticut | $12,489 | 21.3% | $11,899 |
| Maine | $12,077 | 37.4% | $11,505 |
| New Jersey | $11,868 | 31.1% | $11,266 |
| New Hampshire | $11,793 | 51.7% | $11,359 |
| Rhode Island | $11,694 | 54% | $11,049 |
| Pennsylvania | $11,603 | 32.8% | $11,229 |
| North Dakota | $11,301 | 47.1% | $10,741 |
| Wyoming | $10,989 | 64.7% | $10,296 |
In advancing the measure for a floor vote, the Majority of the House Committee on Health and Human Services and Elderly Affairs concluded that,
[T]his bill will address the decline in medical access and the high cost of medical care in New Hampshire. It achieves this by exempting ambulatory surgical centers, emergency medical care centers, birthing centers, drop-in or walk-in care centers, dialysis centers, and special health care services from the critical access hospital exclusionary zone restrictions. This will facilitate better synergy between hospitals and future medica centers located nearby, while still maintaining protection against new hospital competition.
State Rep Judy Aron, who writes regularly for GraniteGrok on state legislative matters, reported that,
House Democrats … were wringing their hands that hospitals will (gasp) have competition and suffer from a myriad of horrible detrimental effects by allowing more healthcare facilities to be made available within 15 miles of an existing hospital. They believe hospitals will go out of business and people will suffer and die in the streets from having more choices, removing bureaucratic barriers, and having easier and more abundant access to healthcare.
HB223 moves to the NH State Senate, which some observers suggest might be a challenging to impossible hurdle, despite a Republican super-majority. Health systems like Dartmouth Hitchcock, Big Pharma, and others regularly donate large sums to state Senate campaigns for Democrats and Republicans. The lobby has a good deal of influence there, flexing those relationships to block past efforts at reform. Getting the upper chamber to kill any change to RSA 151:4-a will be a priority.
It is also unclear if Governor Ayotte would sign the legislation were it to advance to her desk and a veto would not survive in the NH House where the Republican majority is slimmer than the State Senate. But the NH House has moved the legislation forward and that is the first step.
