CONCORD — New Hampshire has been awarded a $5.3 million federal grant to help implement a health insurance exchange under the Affordable Care Act, but some members of a legislative oversight committee are balking at the state’s plan.
The Joint Health Care Reform Oversight Committee refused Tuesday to approve key provisions of the state and federal partnership until a Memorandum of Understanding between the state and federal government outlining their individual responsibilities comes before the committee next week.
The key sticking point is the state Insurance Department’s plan to help consumers navigate the new electronic exchange by using person-to-person assistance to help those new to health insurance access the program.
The department envisions using existing community-based providers like health clinics to provide outreach to the uninsured, said department counsel Jennifer Patterson.
Republicans on the committee said they believe there is too much overlap with the federally funded and hired navigators to help consumers find their way on the exchange.
Senate Majority Leader Jeb Bradley, R-Wolfeboro, said the department’s blue print indicates it will hire a project manager as well as numerous consultants.
“Given the responsibilities, I look at this and hear caching, caching,” Bradley said. “This going to be expensive and that concerns me.”
Committee member Sen. Andy Sanborn, R-Bedford, said the state would be usurping the role traditionally held by insurance brokers, but Patterson said the in-state helpers would not recommend the best policy for consumers.
“They are to help people gain access to the exchange, not help people who have existing policies,” she said.
She and Deputy Insurance Commissioner Alex Feldvebel said the state would control the in-person assistance program, while it would have only oversight of the federal navigator program in the state.
The committee did vote 4-2 to approve Insurance Department issued guidelines for insurers who want to participate in the health insurance exchange which begins Jan. 1, but has an Oct. 1 deadline to begin enrolling participants.
Republicans on the committee claimed last week that Gov. Maggie Hassan reneged on her promise to present the committee with a MOU when the committee approved her letter of intent to form the partnership with the federal government in February.
But Hassan’s legal counsel Lucy Hodder told the committee “We have learned that the federal government has dropped their mandated MOU and is willing to accept our goals and stipulations outlined in three documents.”
Those documents are Hassan’s letter of intent, the blueprint the state filed with the federal government outlining the Insurance Department’s intent to continue its traditional regulatory role and the federal grant application which outlines the state’s intended oversight over consumer assistance programs.
“In essence, in a MOU, the feds tell us what they will mandate us to do, and we tell them what we are willing to do,” Hodder told the committee. “We told the feds what we are willing to do in those three specific documents.”
Committee member Sen. Andy Sanborn, R-Bedford, said the committee had been promised a draft of the MOU and he did not share Hodder’s belief that the three documents represent a contract between the federal government and the state.
“The committee reserves the right to approve these types of documents,” Sanborn said.
Hodder acknowledged it may be helpful to review the three documents to ensure they reflect the understandings in the partnership.
The state’s intent is to retain as much control as possible without spending state money to implement the exchange, she said.
The co-chairs of the committee Reps. John Hunt, R-Rindge, and Ed Butler, D-Hart’s Location, will meet with the governor’s staff and Insurance Department officials to work on a MOU and report to the committee next week.
Committee members said they understand the department is under pressure to have enrollment on line by Oct. 1 and the exchange ready to begin operating Jan. 1.