A hearing for a long-shot bill to create a single payer health care system in New Hampshire drew throngs of supporters Friday, as doctors joined Democratic representatives in advocating for a state-led overhaul.
House Bill 1793 would prohibit all forms of private health insurance in the state and create a state-run system to provide “universal access” to health care. In a packed committee room Friday morning, legislators on the House Commerce heard from a range of advocates calling for the dramatic change.
“We believe in equal opportunity,” said Rep. Jerry Knirk, D-Freedom, who called it a founding principle of the country. “But if you are ill, without access to affordable healthcare, you do not have equal opportunity for success.
“...A single payer system is fundamentally fair as everyone contributes and everyone is covered,” he said.
The bill, named the “New Hampshire Single Cure Act,” would create a Health Services Trust Fund that would fund a vast range of services, including primary care, specialty care, inpatient and outpatient care, long term services, prescription drugs, vision care, chiropractic services and mental health and substance abuse services.
Sponsored by Rep. Peter Schmidt, D-Dover, the program would be open to all legal residents of New Hampshire, with no deductibles or co-pays.
To pay for it all, the trust fund would be non-lapsing, filled by a combination of state funding, existing federal funding for programs like Medicaid, and public and private grants.
The system would be vast in scope: In addition to basic services at all licensed health care practitioners, the fund would pay for medical equipment and capital expenditures for construction projects on health care facilities.
And its costs are unclear. Without more detailed information on how the program would be administered and how the funding would be calculated, the Department of Health and Human Services called the fiscal impact “indeterminable,” according to the bill’s fiscal note. The Insurance Department said the same, but added that the bill would substantially eliminate revenues from New Hampshire’s premium tax due to an elimination of private insurance.
But Schmidt argued that the price of the system would be worth the savings gained from the medical bills New Hampshire residents face now.
“Many people in New Hampshire are being ruined right now by health care costs, and we know it’s the chief cause of bankruptcy in this country right now,” he said.
As a potential back-up, a separate bill he’s sponsoring, HB 1241, would create a study commission to look at exploring the potential for single payer in New Hampshire.
Many who testified said they want a system now. Some legislators mentioned personal experiences. Rep. Kristina Schultz, D-Concord, brought up her three hospitalizations to treat a tumor while uninsured in 2004, which forced her to declare bankruptcy. Rep. Mindi Messmer, a candidate for Congressional District 1, brought up her background running a business, and the financial struggles she said came with not being able to afford health insurance to attract employees.
Several physicians voiced support as well. Kenneth Dolkart, a primary care physician, brought up relatively high cost of care in the U.S. versus other advanced nations, characterizing single payer as a system to bring the prices down.
Donald Kollisch, a family physician, added that a “global” funding source could allow care to be better distributed farflung areas like New Hampshire’s North Country, which suffers from a lack of interest by physicians.
But whatever the support, the bill faces long odds. Recent years’ efforts behind similar bills have floundered – in 2015, the Commerce Committee voted to recommend “inexpedient to legislate” for House Bill 686, with the majority declaring it financially unworkable.
And on Friday, Rep. Andrew Renzullo, R-Hudson hammered home the bill’s unlikely future, speaking on behalf of House Leadership and declaring the bill dead in the water.
“We’re not against any specific bill, but against the concept of a single payer health system,” he said, echoing comments made by House Majority Leader Dick Hinch, R-Merrimack, in October.
“It is our belief that this state and this nation was and is founded on capitalistic principles of competition and free market, which has given and will continue to give the best health care in the world,” Renzullo said.
Among his criticisms, Renzullo pointed to the likely cost. “The fiscal note may say 'indeterminable,' but I would simply say 'not affordable’,” he said.
Many opponents point to Vermont, which in 2014 abandoned long-running plans for a single payer system, citing an unacceptable cost burden. Schmidt has dismissed the example, claiming that New Hampshire’s larger population would weather it better against the pitfalls its neighbor faced.
But more broadly, it is unclear the breadth of support for a single payer option among the Democratic caucus. Speaking in October, House Democratic Leader Steve Shurtleff, D-Penacook, said he supported the concept, even if its passage is unlikely.
“It’s good to put it on the table because people are talking about it,” he said at the time. “When they’re talking about single-payer, they’re talking about health care.”
(Ethan DeWitt can be reached at edewitt@cmonitor.com, or on Twitter at @edewittNH.)