Nonprofit leaders across New Hampshire will want to keep abreast of two state legislative items that are relevant to the critical issue of affordable health care coverage.

• Senate Bill 540, scheduled for a public hearing before the New Hampshire Senate Commerce Committee on March 10, authorizes the creation of a comprehensive and affordable, wellness-focused health insurance benefit for small businesses (nonprofits included) and their employees.
• House Bill 461, already passed by the New Hampshire House and not yet scheduled for a public hearing in the Senate, allows business groups that form qualified purchasing alliances to take advantage of value-based/wellness-focused health coverage savings.
  

Senate Bill 540 (“NH HealthFirst”):
An innovative and bipartisan initiative proposed by Governor Lynch, with Senator Kathy Sgambati as the lead sponsor, SB 540 (“NH HealthFirst”) establishes an alternative health coverage plan for employers in the small group market (up to 50 employees), which includes more than 65% of the nonprofits in New Hampshire.

Modeled on a successful initiative in Rhode Island, and recognizing the increasing burden of rising health care costs on small businesses and their employees, NH HealthFirst is designed to lower costs for business as a way to help stabilize the small group market and support employer efforts to maintain coverage.

The NH HealthFirst coverage plan will have five key components/incentives that are expressly designed to address health care cost-drivers and lower premium cost overall: promotion of patient wellness, primary care, and the establishment of a medical home; coordination of care for persons with chronic or acute illness; the use of effective, least cost care; and the employment of best practice, evidenced-based, patient-centered care.

SB 540 does not require state funding, and small business purchase of and participation in the coverage plan will be entirely voluntary. The bill does require all health insurance carriers with over 1,000 covered lives in New Hampshire to offer the NH HealthFirst coverage plan for small businesses.

As in Rhode Island, SB 540 requires the Insurance Commissioner to form a standing advisory committee, made up of small business employer and employee representatives, to make final recommendations on the design requirements for the coverage plan.

If approved, it is projected that small businesses taking advantage of the NH HealthFirst plan (and their employees) would experience a cost savings of at least 15% on their health insurance premiums, based on current data. The equivalent plan in Rhode Island has resulted in a 17% reduction in small employer premium cost.
HealthFirst plan Q & A

House Bill 461:
HB 461 is a complementary and bipartisan initiative that would revise New Hampshire’s law related to health insurance purchasing alliances in order to strengthen the ability of qualified purchasing alliances to access health coverage cost savings. 
The evidence-based model proposed by the bill allows and encourages business organizations/associations that form qualified purchasing alliances to create health coverage plans that seek and achieve “value” at the health care service level.

HB 461 allows a purchasing alliance with 3,000 covered lives to be certified as a “qualified purchasing alliance” by demonstrating that its coverage plan will promote more cost-effective health care by better aligning financial incentives with health care quality and efficiency. Having said that, a purchasing alliance may not “cherry-pick” its members based on health status and, in order to be certified as a qualified purchasing alliance, must demonstrate that its membership criteria is not based on health risk selection.

A “qualified purchasing alliance” will have the same rights, under law, as a qualified association trust. That is, it will not be a risk-bearing entity, and will be subject to the small group health insurance rating rules. But its base premium rate will be determined by the evaluated claims experience of its members, rather than the experience of the entire small group market – providing the express opportunity to achieve value-based savings.

HB 461 creates a structure that allows a business group/association to develop and implement a health coverage plan that lowers cost by integrating incentives for quality of care and wellness, improving the use of primary and preventive health services, disease prevention, health promotion, and chronic disease management.

Under HB 461, existing organizations such as New Hampshire’s Chambers of Commerce, the New Hampshire Center for Nonprofits, the New Hampshire Bar Association, the Business and Industry Association of New Hampshire, and other such trade associations can form qualified health insurance purchasing alliances for the exclusive benefit of their members and to help achieve health coverage savings. 

The New Hampshire Center for Nonprofits will continue to track each of these two legislative items, and to keep nonprofit leaders informed of upcoming action. To find out about more health coverage-related bills, initiatives, and task forces on the legislative calendar, please feel welcome to review the NH Voices for Health Tracking Sheet, on the NHCN website, at www.nhnonprofits.org.