Legislative Update 
February 18, 2003

Governor Benson Unveils State Budget

The Governor unveiled his “Kitchen Table Budget” in which he announced an across-the-board 5% cut in Medicaid provider payments.  In addition, Governor Benson proposes elimination of Medicaid benefits for “optional” services for adults, $1 million per year reduction in community mental health funding, and a cap on NH Healthy Kids program at current enrollment.  In addition, another $12 million is cut from the Department of HHS each year.  Specific details are not yet available.  The devil’s in the details, as the House Finance Committee pores through the Governor’s proposals.  However, his budget message reiterated his support for malpractice reform.  A proposed $2 million for nursing education would be set aside for those graduates who agree to work in New Hampshire.

Medical and Hospital Liability Insurance

The House Judiciary Committee will hear testimony next Wednesday, February 19^th on HB 290, “Relative to the burden of proof in medical injury cases”.   NHHA opposes this bill, which inserts the Loss of Opportunity doctrine into statute.  If passed, this bill could cost providers as much as a 34% increase in their liability insurance premiums. Under this doctrine, patients can sue health care providers if their medical care could have resulted in a substantially better outcome – not just if the care provided resulted in injury.  Worse yet, there's no objective measurement of degree of loss.  Any medical expert could testify that proper medical care would have allowed for a "better" recovery.  As we have already seen, the Loss of Opportunity doctrine makes medical lawsuits more inviting.

The bill we support, SB 119, “Relative to medical and hospital liability insurance,” would specifically remove the Loss of Opportunity doctrine.  Without this change in the law, the increasing costs of liability insurance premiums will eventually be passed on to health insurance companies, leaving them little choice but to raise their premiums. 

Tax Exemption for Not-for-Profit Hospitals

The House passed HB 172, “Extending the committee to study the exemption from property taxes for not-for-profit hospitals, and including a study of the community benefits law.”  The bill’s sponsor convinced legislators that last year’s study brought to their attention additional areas of inquiry.  If passed by the Senate, the study committee’s scope of inquiry will be expanded to include payment of business taxes by physician practices owned by not-for-profit healthcare organizations, as well as consideration of changes to the state’s Community Benefits statute

Medical Students and Community Benefits

A bill that would increase the number of reserved seats at Dartmouth Medical School also proposes to allow the pooling of hospital community benefits to assist in physicians’ medical school loan repayments. HB 677, “increasing the number of reserved student slots in medical programs, and establishing a loan forgiveness program for physicians who practice in underserved areas, was heard this week and received support from the bill’s many co-sponsors.  NHHA testified in support of additional seats to achieve the intended purpose of keeping New Hampshire residents in the State.  However, we expressed grave concerns about the bill’s language to allow the pooling of healthcare charitable trusts’ community benefits to match state funds for loan repayment programs.  New Hampshire’s hospitals already provide substantial assistance to physicians in an effort to recruit and retain them in our communities.  Moreover, the community benefits statute specifically emphasizes the “community” focus and requires that the community benefits of the health care charitable trust “be directed toward addressing the issues and concerns of that community.”  Therefore, NHHA is concerned about the pressure to apply community benefits on a statewide basis, which clearly runs counter to the intent of the Legislature when it passed SB 69 in 1999.

Access

NHHA signed up in opposition to HB 382, “relative to state-funded health insurance”, which would prevent coverage expansions of the NH Healthy Kids program, including the privately purchased health insurance product available through NHHK.  It specifically prevents the program from pursuing independent private activities.

Workforce

NHHA signed up in opposition to SB 93, “relative to wrongful discharge from employment”, which would significantly alter the at-will employment doctrine in New Hampshire, thereby placing significant new burdens on employers.

Coming up…Next week, NHHA will weigh in:

Against HB 290, “relative to the burden of proof in medical injury cases”

Against HB 788, “repealing the Certificate of Need law”

Against SB 78, “establishing the New Hampshire Health Care Information Council

For HB 760, “establishing the NH healthy families trust fund, increasing the tobacco  tax, and making an appropriation therefore”