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HealthBeat

Bills target insurance, health care

Two would force expansion of N.H. provider networks

Two bills due to go before the Legislature next session would require federal marketplace insurers to expand the number of providers included in their networks.

Sen. David Pierce, an Etna Democrat, seeks to require that the plans include one hospital in each county, while Rep. Bill Nelson, a Brookfield Republican, wants all hospitals to be allowed to participate.

Anthem Blue Cross Blue Shield of New Hampshire, the only insurer in the state offering plans in the marketplace, excludes 10 of the state’s 26 hospitals from its network of providers.

“It’s basically unfair, it’s discriminatory, it’s every other thing you want to call it,” Nelson said.

The marketplace is an exchange where people can shop for insurance and use tax credits and subsidies to defray some or all of the cost, one of the major components of the Affordable Care Act, also known as Obamacare.

Nelson, who also represents Effingham, Ossipee and Wakefield, has heard from constituents worried about losing their ability to go to Frisbee Memorial Hospital in Rochester.

Concord Hospital also is excluded from the Anthem marketplace network.

Anthem officials have said that including all hospitals and doctors in the network would drive up the cost of insurance plans. Nelson said he doesn’t believe them, and because Anthem is the only company selling plans on the marketplace, the free market can’t be counted on to fix the situation.

Harvard Pilgrim has announced it will begin selling plans on the marketplace in New Hampshire in 2015.

“But what if they do the same thing?” Nelson asked.

Pierce represents several towns in Sullivan County, where the only hospital, Valley Regional in Claremont, is not included in Anthem’s marketplace provider network.

He couldn’t be reached for comment last week.

Several other bills having to do with health care and health insurance also are in the works.

Rep. Emily Sandblade, a Manchester Republican, has filed a bill related to the exchange. Her legislation seeks to require licenses and background checks for people working as federally funded navigators – those who help people apply for insurance and tax credits.

“The idea is, of course, to safeguard people’s information,” Sandblade said.

There is no federal requirement for background checks for navigators, however, Arkansas, Florida, Georgia, Indiana and Ohio have implemented them.

In New Hampshire, Bi-State Primary Care Association and Planned Parenthood of Northern New England received federal grant funds to train and employ navigators.

Planned Parenthood’s navigators undergo background checks as a condition of employment, and Bi-State Primary Care performs monthly audits that compare staff to a list of individuals not allowed to work for federal grant recipients, according to officials from the organizations.

Rep. Tom Sherman, a Democrat from Rye, has proposed legislation to fix a problem he said was brought to his attention by a constituent who recently moved his business to New Hampshire from Massachusetts.

The business owner wanted to switch the company’s insurance from one company to another, but he found he could have ended up paying his share of the policies twice, Sherman said.

The insurance contract renewed in June, but the company’s share of the premium costs were due in January.

If the company switched carriers in June when the contract expired, the owner would have had to pay for new premiums after having just paid them six months earlier, Sherman said.

Sherman’s legislation would require insurers to align their cost-sharing years with their coverage years.

“It’s a glitch in the system, that’s the sense that I get,” he said. “In a state that is trying to be business-friendly, it seems like a matter of common sense, and it’s a matter of fairness.”

Rep. Laurie Harding, a Democrat and registered nurse from Lebanon, has proposed legislation clarifying the state law on surrogate health care decision making.

As of 2009, 44 states had a surrogacy law, which outlines a process for making decisions, according to the American Bar Association. It prioritizes people who should have authority to make decisions when a patient is unable to make them and has not written an advance directive for care.

An annual survey of patients in New Hampshire hospitals on a random day showed that two out of three patients did not have an advance directive codifying their wishes if they were to become unable to make decisions.

“Sometimes people are left in situations that you wouldn’t want your loved one left in because there is no plan and no one to make one,” Harding said.

The law would standardize the prioritization of who can make decisions, which is currently up to the policies of individual hospitals, said Shawn LaFrance, executive director of the Foundation for Healthy Communities.

Harding has also filed legislation presenting guidelines for county mental health courts.

The bill would give judges the ability to remove a misdemeanor from someone’s record once the individual has met the criteria of the mental health court, if the judge thinks that is appropriate, she said.

“This is purely enabling legislation. . . . There is a nationally recognized set of best practices for mental health courts, as more and more people realize that we need to change the focus of our corrections system,” she said. “People really believe that we shouldn’t be putting people who are mentally ill behind bars but giving them a sentence for treatment that is appropriate.”

Lawmakers have until Nov. 15 to file requests for legislation or to decide to move forward with the bills they have already filed. Official text of proposed bills will be available at the start of the next legislative session in January.

(Sarah Palermo can be reached at 369-3322 or spalermo@cmonitor.com or on Twitter @SPalermoNews.)

This article has been edited to reflect Shawn LaFrance’s correct job title and organization.

Legacy Comments2

As long as health insurance is left to the for-profit marketplace, this is what we will get. If the insurance company cannot make a profit (however small) by working with a particular provider, they will exclude that provider from the network. Remember, their primary responsibility is to stockholders, not customers. That's the case with every corporation. I have supported the ACA as "better than what we had," but the real goal ought to be single-payer insurance. Without a profit motive on the part of the insurer, far more providers could be included in the network. Go look up HR 676, the so called Medicare for All Act for an idea of how it would work.

Rep. Bill Nelson, a Brookfield Republican, wants all hospitals to be allowed to participate. Are the Republicans now heading toward Socialism. This Rep. wants to side step Capitalism and go to forcing no competition, no agreements for lowing pricing, force every company to charge the same price. An insurance company makes a deal to give "all" their business to certain hospitals for a lower rate (supply and demand) and he wants a law against it. Companies and the state make these deals with Ins. companies every day - why does the Local Government Center exist in Concord. Sounds like he wants to take over the insurance and hospital business.

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