caring for health care

President Obama isn’t the only one with health care on his mind these days. About a week after his Health Care Summit at the White House on March 5, several bills that could render big changes to health insurance in New Hampshire will come before the House Commerce and Consumer Affairs Committee. Two of them with very different approaches will get their public hearings on Tuesday, March 17.

nationalized healthcare

First up is endorsement of the National Health Care Act, which would provide free medical care to all U.S. residents on the assumption that health care is a human right. N.H. Rep. Paul McEachern (D-Portsmouth) has sponsored House Concurrent Resolution 2, asking both the state House and Senate to officially urge the U.S. Congress to enact the law. A similar resolution passed the N.H. House last session but failed in the Senate.

As a non-binding resolution, the U.S. Congress would not be obligated to respond in any way. But it would carry an important message, according to Dr. Marcosa Santiago, chair of Granite State Physicians for a National Health Plan. “Mounting endorsements for single payer reform can no longer be ignored by Congress,” she says. 

The U.S. Census estimates that 137,000 New Hampshire residents (about 10 percent) had no health insurance coverage in 2007. And according to HCR 2, almost half of all personal bankruptcies stem from medical expenses. The state resolution calls for a nationalized plan in response to “a growing crisis in health care.”

Dr. Marcosa points out that HCR 2 would cost New Hampshire nothing, and that if the national plan passes, “our state’s health care expenditure problems will be addressed, as well.”

As introduced by U.S. Rep. John Conyers Jr. (D-Michigan), the national plan would essentially expand the existing Medicare program and make it available to all Americans. No co-pays or deductibles would be required for any medical necessities, and patients could take their pick of health care providers, as long as they are from either public or nonprofit institutions.

Insurance companies would not be allowed to sell competing policies. They would still be in business, however, for coverage of elective medical care, such as cosmetic surgery.

“The ‘elite’ always have a way of using their money,” says Dr. Marcosa. “Those elite don’t have to worry.  It’s the majority of American people that don’t want to have this health care misery.” She offered the example of someone who, after a lifetime of working, cannot afford long-term care. “So they have to divest themselves of all the things they worked for so they can qualify for social safety nets,” she says.  “That doesn’t make sense.” 

Public funding for the plan would come from government money already tagged for healthcare, increased personal income taxes on the top 5 percent of earners, a progressive excise tax on payroll and self-employment income, and a tax on stock and bond transactions.

unmandating coverage

While the National Health Care Act would do away with a large portion of the insurance industry by establishing a single-payer, government system, House Bills 109 and 434 would work with insurance companies in the state to create more affordable plans. The results would look something like an à la carte menu—an option not currently available in New Hampshire due to various state-mandated insurance requirements. 

The bills are sponsored by state Reps. Thomas Buco (D-Conway, HB 109) and Joel Winters (D-Nashua, HB 434).  To explain how they’d work, Winters gives the example of bariatric surgery for morbid obesity.  A law passed in New Hampshire last year requiring insurance companies to cover this procedure, but Winters doesn’t think that people at low risk of obesity should have to pay for its coverage. 

Especially people who can’t afford health care to begin with. And here lies the difference between the two proposals. 
HB 109 would allow companies to sell accident and health insurance policies that don’t include state-mandated coverage, and anyone could buy them. Plans created under HB 434, called Cover New Hampshire, would only be available to people who don’t already have insurance.

Winters figures that people who don’t have insurance go without because they can’t afford it. If companies could offer policies more specific to their customers, he says, then costs would come down since the coverage wouldn’t be so comprehensive. 

Some people, Winters acknowledges, would still fall through the cracks. But he believes that HB 434 would at least help some new people become insured. 

Florida passed similar legislation last year, and Winters largely copied HB 434 from that plan. But he’s not hopeful for the fate of his bill. The Commerce and Consumer Affairs committee already voted down HB 109 last week. Winters thinks HB 434 is bound for the same road. 

“The committee is going to vote on it and make a recommendation 48 hours later, which to me is a pretty clear sign that it will be killed,” Winters says. “I guess they believe that mandates are there for a reason and they don’t think it’s fair to allow people to opt out of them …. But I believe it’s better for people to have health insurance than not,” he says. 

Front Door Politics is a weekly legislative update for everyone affected by New Hampshire laws. An online learning center, additional reporting, and a blog subscription are available at www.frontdoorpolitics.com .