As is often the case each legislative session, many of the bills that are brought forward are ones we have seen before (and frequently that we have seen more than one time before).

One of these old chestnuts fell off the tree yesterday, when the House HHS Committee held a hearing on HB 389, which deals with Certificate Of Need (CON) in health care. As you will recall, the CON process governs the ability of health care facilities to open up or expand here in NH. Over the last few years (and at other times even before that) there have been moves to eliminate CON in New Hampshire.  Most recently, during the 2010-2012 session, the Legislature put into place a prospective repeal of CON that is slated to take effect on June 30, 2016. Last year, there was an unsuccessful attempt to speed that date up to June 30, 2015.

The same folks who tried to move up the date last year have now filed HB 389, which on its face just applies to a speeded-up implementation date for elimination of the existing CON moratorium regarding nursing home and rehab beds. As many expected, however, most of the testimony that came from the backers of HB 389 yesterday was aimed once more at putting into effect a 2015 repeal date applicable to all health care providers.

CON is one of those complicated but important issues. The Chamber has long opposed the plan for CON repeal because it would have a hugely negative impact on the businesses that provide health care (and therefore on the businesses that utilize health care). Advocates of eliminating CON argue that free-market principles should be applied in the delivery of health care. That seems like a simple enough proposition, and at first blush it is tempting to agree with it. But the reality of the situation on the ground tells a different story. It seems clear to us that it is impossible to establish a free market delivery system in health care unless a similar situation exists on the revenue side. For instance, about two thirds of the beds in nursing homes are Medicaid beds, which means that the precise amounts that the facilities can charge for the care of these people is dictated by the New Hampshire Department of Health and Human Services, and in turn by the overall amount that the Legislature has appropriated for those purposes. So this is not exactly the sort of situation that you would describe as fertile ground for the operation of open and competitive markets.

Rather than passing HB 389 (or worse, expanding HB 389), we hope the House HHS Committee will recommend that the bill simply be killed and that the House will instead proceed to extend out or eliminate next year's repeal of CON.

Those of you who have been readers of The Advocate over the last several years will also be highly familiar with this issue, which makes its appearance one more time in 2015. HB 365 looks to generally bar employers from using credit checks of employees in connection with any employment decisions.

The Chamber has always been opposed to this measure because we think that it should be left to the discretion of the employer whether a credit history is important in making an employment decision. Obtaining credit histories costs money, and it is highly unlikely that an employer will go to the trouble of using a credit history unless the employer genuinely believes that such a check is necessary. Although this bill does include some language which allows the use of credit checks when the use of a credit history is "substantially related" to the job, that definition is a limited one and in any event it seems destined to be the source of litigation after an employer has decided to use a credit history and an employee disagrees with that decision.

Rep. Laurie Sanborn, the Chair of the House Business Caucus, was one of the people who registered her opposition to the bill. She pointed out that Forbes Magazine has ranked New Hampshire 46th among the states in terms of regulatory environment for businesses. A bill like this obviously would be yet one more contributor to that environment.

We agree with Rep. Sanborn. In order for us to bring back a favorable regulatory environment to New Hampshire, we need to have in effect a burden of proof that rests with people who want to introduce new business regulations. Unless it can be conclusively shown that a new regulation is needed to address some crisis, that proposal should be rejected out of hand (and in any event all the remaining proposed regulations should be put to a balancing of the costs and the benefits). Let's remember what we heard at our legislative symposium two weeks ago: since the recession, job growth in Texas has been over 11%. Job growth in New Hampshire has been .44%. Either we do business a new way, or we don't do business at all.

There may be an interesting storm brewing in the State House this week. Last Friday morning, DHHS  Commissioner Nick Toumpas appeared before the Joint Legislative  Fiscal Committee to inform the Committee that he intends to use $7 million of the money earmarked by the legislature in the state budget for nursing home funding to be used instead to fill a part of the $58 million hole that has cropped up in other parts of the DHHS budget. Several members of the Fiscal Committee were vocal in their displeasure with what the Commissioner was proposing, since the budget passed by the legislature contains an express directive that says that all the appropriated funds must be spent on nursing homes.

Immediately following the Committee meeting, the Governor issued a statement supporting the Commissioner's plan and shortly after that the Senate leadership issued its own press release blasting the plan. Then yesterday Senate Finance Committee Chair Jeanie Forrester announced that she had just filed a bill intended to put a stop to the Commissioner's proposal.

The upshot of all this? A $7 million issue (a big amount to the nursing homes but just a small number to the State in the context of the overall budget) has set off a heated dispute between the Governor and leaders in the legislature (and what is more difficult for the Governor, it is a fight that involves the Senate President and also the chair of the Senate Finance Committee, the last legislative Committee that will get a crack at the budget that the Governor is going to be submitting  in just a couple of weeks.) Never underestimate the potential for seemingly isolated State House disputes to have far-reaching impacts.