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.