Support building to create state-run health exchange [The New Hampshire Union Leader, Manchester]

Sep. 24—Bipartisan support is building in the state Senate for a possible state-run exchange to manage health insurance bought on the individual insurance market.

Supporters maintain the state could save $3 million a year from what it pays the federal government to manage the exchange for New Hampshire.

State spending to manage this exchange would attract up to 3-to-1 federal grant support, which could be used to lower health insurance premiums for those buying insurance individually as well as those in the small business market, said Senate Majority Leader Jeb Bradley, R-Wolfeboro.

The Legislature in 2012 passed a law in response to the Affordable Care Act. It prevents the state from planning — much less creating — a state-based health exchange.

Advocates said Thursday that since then, private companies now help a dozen states manage their own exchanges for "40% to 50%" less than they would pay the federal government.

"We thought at the time in 2012 that the state didn't have the resources to have these exchanges," said lobbyist Peter Bragdon, who was Senate president when the Legislature passed that law.

Bragdon now represents GetInsured, a private company that runs exchanges for seven states, from New Jersey to California.

"There are a lot of advantages to it. We are seeing red and blue states creating these exchanges," Bragdon said.

All five members of the Senate Health Care Committee said Thursday they support the concept of the bill (SB 121), left over from the 2021 legislative session.

Sen. Cindy Rosenwald, D-Nashua, said that her bill doesn't create a state exchange. Rather, it permits the Insurance Department to study the feasibility of one and report to lawmakers next year.

Two approvals required

If passed as written, however, this bill could lead to a state-run exchange without a follow-up vote of the entire Legislature.

Once the Insurance Department issues a report, any recommendation would then require the approval of the Legislative Fiscal Committee and the Health and Human Services Oversight Committee.

Bradley said the fiscal panel would analyze the finances of the move, while the oversight committee would consider the policy implications.

Any contract to hire a private vendor to manage a state-run exchange would require approval of the Executive Council.

"This is a pretty big change if we are going to do it," said state Sen. Tom Sherman, D-Rye, a co-sponsor of the measure. "This really requires the department to do the homework about whether it makes sense."

Deputy Insurance Commissioner D.J. Bettencourt said his agency is neutral on the legislation.

Since 2017, the agency and Sununu administration have taken steps to make individual insurance policies more affordable.

In 2019, the Trump administration approved an insurance waiver that made New Hampshire and other states eligible for advanced tax credits. These were used to lower individual insurance rates by up to 15%.

Enrollment up

A special open enrollment period during the COVID-19 pandemic was extended until last Aug. 15. During that time, more than 9,000 individuals signed up to buy insurance, twice the number of new customers in either 2019 or 2020.

The American Rescue Plan passed by Congress last spring further increased these tax credits, which lowered the average premium that new customers were paying by 30%, according to Insurance Commissioner Christopher Nicolopoulos.

About 48,000 New Hampshire residents get individual insurance through the federally run Health Insurance Marketplace.

State officials also note at the end of 2021, the individual market pool could further grow after about 30,000 people on Medicaid lose the eligibility the federal government extended to them in response to COVID-19.

"It is remarkable how New Hampshire's individual market has improved over the course of the last four years," Bettencourt said.

State insurance officials have stressed that the agency lacks the staff and budget to manage a state exchange on its own. They also point out this change would entirely shift liability for the coverage from Washington to the state government.

A week ago, the Biden administration's Centers for Medicare and Medicaid Services made the state-run exchange option even more attractive.

They raised the fee that states must pay the federal government to manage these exchanges from 2.25% of total premiums to 2.75%.

The Senate panel is expected to meet Oct. 26 to vote on the measure, which then would go to the full Senate for action early in the 2022 session.

If the Senate approves it, the legislation goes to the House of Representatives, where some GOP conservatives may be loath to embrace a state-run health insurance exchange that enshrines Obamacare.

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