State Insurance Dept. wants flexibility in adapting to looming changes in health care

May 24--CONCORD -- The state Insurance Department will have broad authority to adapt to changes in federal policy on health care, with an eye toward stabilizing premiums in New Hampshire, if an amendment endorsed unanimously by a Senate committee on Tuesday becomes law.

If the Affordable Care Act (known as Obamacare) remains in place, the state will need to develop a strategy to retain insurance companies in the online marketplace and stabilize skyrocketing rates.

If the GOP-led Congress succeeds in passing an alternative, the state will need strategies to adapt to those changes, such as the possible end to mandatory coverage for pre-existing conditions.

Many of those changes could occur over the summer, when the Legislature is not in session, even though legislative approval is required for much of what the Insurance Department would need to do.

With those circumstances in mind, Insurance Commissioner Roger Sevigny worked with Gov. Chris Sununu and Senate Majority Leader Jeb Bradley to develop the contingency plan.

As approved by unanimous vote of the Senate Health and Human Services Committee chaired by Bradley, the amendment authorizes the commissioner to work with the board of directors of the N.H. Individual Health Plan Benefit Association to "develop a plan to support the affordability of health insurance in the state's individual market."

Sevigny and the association board will not have unilateral powers to act on the state's behalf. Any changes proposed by the board would have to be approved by the governor and the Legislature's Joint Health Care Reform Oversight Committee after a public hearing.

But after clearing those hurdles, the commissioner would be authorized to take any number of steps, which could include reopening the state's high-risk pool for individuals locked out of the insurance market because of pre-existing conditions.

Other options could include creating new reinsurance programs, in which insurance companies insure each other against excessive losses; or revival of risk adjustment programs that enable health plans to calculate payments based on the relative health of the at-risk populations.

Sevigny says it's too soon to say what steps will be taken, because the landscape is so uncertain. The authority granted in the amendment may not even be needed, he said.

"It would only be used if there appeared to be a need to provide market stability or to address some of the changes in health care as they come about, depending on congressional actions," he said. "It makes us more nimble."

The board of the Individual Health Plan Benefit Association, which would be the main group to consider and recommend changes, once presided over the state's high-risk pool. Since the passage of Obamacare has been used to help administer the expansion of Medicaid.

Of the 11 seats on the board, six are held by insurance carriers, and one each represents hospitals, insurance agents, consumers, small employers, and the Insurance Commission.

Greg Moore, state director with the conservative policy group Americans for Prosperity, testified that putting policy changes in the hands of a group comprised almost entirely of insurance carriers is akin to putting the fox in the hen house.

Sevigny testified that the Insurance Department is representing consumer interests.

"Our biggest concern is that in the individual market, we need to make sure as representatives of the consumers that we do everything to provide consumer protections, and that we have a market as stable as it can be," he said.

Although most New Hampshire residents get their insurance through their employer, about 100,000 are insured through the individual marketplace on the Obamacare online exchange or through expanded Medicaid, which is administered through the exchange.

Major changes in how the exchanges operate, or if they continue to operate at all, could have a dramatic effect across the market.

"We better be in a position to act quickly if we need to act," said Sevigny. "The goal is to mitigate any potential rate increases and preserve the individual market."

He said no decisions have been made about what changes may be sought or what kind of waivers the state might seek from federal mandates.

Sununu reinforced that message in his written testimony urging support for the amendment.

"The amendment does not authorize and it is not my intent to seek a waiver of the Affordable Care Act's pre-existing condition coverage requirement," he said. "The amendment does not commit New Hampshire to any type of waiver. Its purpose is to give the state the authority to act in a timely fashion to stabilize the market."

Sununu said that action could include some form of waiver, "but the exact nature would depend on what is available and found to be beneficial."

The amendment to an unrelated bill, HB469, must now be approved by the full Senate and House, before heading to the governor's desk.

The authority granted to the Insurance Department under the amendment would expire on July 1, 2019, unless it's reauthorized by the Legislature.

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