Unlike other New England states, New Hampshire has no game plan to access nor manage the explosion of healthcare costs. Over 20 years, the premiums for NH health insurance are consistently higher than the average for the US and other New England states. This puts considerable financial strain on the middle-income families who are already struggling to afford or find rentals and mortgages, and inflates our property taxes that fund health benefits for teachers and state employees. There is no controversy that the major reason for climbing premiums are ballooning hospital charges by large health systems to private insurance, driven by a larger medical-industrial system that rewards interventions rather than prevention or health maintenance. Such factors have also created the maternity desserts and a dearth of primary care we see across New Hampshire. 

Other states have implemented various strategies that bring stakeholders together to bring costs back under control. One such program, the All-Payer Total Cost of Care Model, coordinates negotiations between each hospital and insurers, utilizing yearly global budgets based on historical spending trends. A single set charge is equalized for all insurers at each hospital, although each hospital sets different rates based on hospital characteristics. Encouraging results include controlled hospital costs, protection of services and revenue for the rural hospitals that provide heavily for those on Medicaid and Medicare, reduction in unnecessary over-use of services, absent disincentive to accept Medicaid patients, and recent protection for hospitals from the financial effects of covid.

HB319 was written to propose a simple legislative study committee to assess an All-Payer system for NH. However, since NH has NO agency regulating or even monitoring the cost implications & consequences of health system mergers, private equity actions in purchasing health providers and numerous other current realities, this bill can be amended to have a broader field of study. The imperative is for the State House to designate a study committee to start to strategize how to “mind the store” of the costs of a health system that often seems to have run amuck.