2020 New Hampshire Revised Statutes
Title XXXVII - Insurance
Title 404-J - Commission on the Status of Health Coverage Markets for Individuals and Small Employers
Section 404-J:1 - Commission Established.

[RSA 404-J:1 effective 60 days after certification by the insurance commissioner that 29 C.F.R. section 2510.3-5(b) is valid and that issues raised in State of New York v. United States Department of Labor have been resolved, but not later than December 1, 2021. Repealed by 2019, 346:422, I effective December 1, 2024.]     404-J:1 Commission Established. –
I. There is hereby established a commission on the status of health coverage markets for individuals and small employers.
(a) The members of the commission shall be as follows:
(1) Three members of the senate, one of whom shall be a member of the minority party, appointed by the president of the senate.
(2) Three members of the house of representatives, one of whom shall be a member of the minority party, appointed by the speaker of the house of representatives.
(3) The insurance commissioner, or designee.
(4) Three persons representing health carriers, appointed by the insurance commissioner, as follows:
(A) One person representing a health carrier with a significant presence in the individual market;
(B) One person representing a health carrier with a significant presence in the small employer market; and
(C) One person representing a health carrier with an interest in providing or administering health coverage in the pathway II association market.
(5) Two producers, appointed by the insurance commissioner, one of whom shall be a producer with a significant clientele in the individual market and the other a producer with a significant clientele in the small employer market.
(6) A public member from an academic institution or charitable foundation who has health care and health insurance expertise, appointed by the senate president.
(7) A public member who shall represent the interests of persons who obtain their coverage through that market, appointed by the speaker of the house of representatives.
(8) A public member who shall represent the interests of persons who obtain their coverage through the individual market, appointed by the president of the senate.
(9) Two public members from organizations that represent the interests of the medically underserved, persons with pre-existing conditions, or persons with chronic health conditions, including mental health or substance use disorders, appointed by the governor.
(10) A public member who shall represent the interests of small employers sponsoring health coverage for their employees, appointed by the governor.
(11) A public member from the Business and Industry Association of New Hampshire or a New Hampshire chamber of commerce, appointed by the governor.
(12) A public member from a national organization with a New Hampshire chapter that is interested in qualifying as a bone fide pathway II association, as defined in RSA 415-E:1, III, appointed by the governor.
(b) Of the commission members listed under subparagraph (a), only the 6 legislative members shall be voting members. All other members shall serve in an advisory capacity only.
(c) Legislative members of the commission shall receive mileage at the legislative rate when attending to the duties of the commission.
(d) The commission shall be a public body subject to RSA 91-A, and its meetings shall be considered public proceedings.
II. (a) The commission shall evaluate the status of health coverage markets for individuals and small employers. This shall include the individual market, the small employer market, and alternative sources of coverage that may be available to individuals and small employers, including pathway II association coverage, transitional coverage, and short-term limited duration coverage. These markets shall be evaluated in terms of their performance in making available to individuals and small employers affordable coverage that provides access to medically necessary care on affordable terms. Consideration shall be given to market competitiveness, price, choice of plans, market size, market segmentation, the risk profile of the covered population in each market, adverse selection against specific markets, migration between markets, the rate of growth or diminution in the overall number of covered lives, and other similar factors that may affect the coverage available to individuals and small employers. Specifically, the commission shall evaluate markets and make recommendations on the following:
(1) The performance and effectiveness of the small group market in itself and in conjunction with other markets that may be available to small employers and their employees, including, if applicable, pathway II association coverage. This shall include consideration of coverage for pre-existing conditions and essential health benefits, premium rates and product offerings, impact on premiums, the availability and choice of plans, the number of covered lives, and the overall impact on the availability and affordability of coverage for higher risk individuals and small employer groups. Based on this evaluation, the commission shall make recommendations in its annual report for future program or legislative modifications, including, if applicable, modifications to the risk adjustment program authorized under RSA 420-K, as well as a final recommendation as to whether the general court should allow the continuation or should phase out the market for pathway II association coverage.
(2) The performance and effectiveness of the individual market in itself and in conjunction with other markets that may be available to individuals and sole proprietors, including, if applicable, pathway II association coverage. This shall include consideration of the migration of sole proprietors to the pathway II market and the effectiveness of screening procedures in validating sole proprietorship status, the price and availability of coverage for individuals who do not qualify for an advanced premium tax credit or cost sharing reduction assistance through the marketplace exchange, and the design and effectiveness of the risk sharing mechanism and 1332 waiver for the individual market authorized under RSA 420-N:6-a. Based on this evaluation, the commission shall make recommendations concerning the individual market risk sharing mechanism under the 1332 waiver, any changes that are needed to screening and monitoring procedures for compliance with the hourly work standard to qualify as a sole proprietor under pathway II association coverage, and any other legislative or regulatory measures that would promote market stability and growth in the individual market.
(b) The commission shall not make any recommendation that includes the use of new general funds.
(c) The commission shall solicit information from any person or entity the commission deems relevant to its study.
III. The insurance commissioner shall provide information and reports to the commission on a biannual basis concerning the status of the individual, small employer and, if applicable, pathway II association markets as necessary to allow the commission to carry out its duties. The commission shall have the authority, at any time, upon a finding that pathway II association coverage is having an adverse impact on the availability and choice of coverage in the individual or small employer markets or is causing average premiums for individuals or small groups to increase at a rate that is significantly higher than the trend in claims costs, to recommend that the commissioner limit pathway II associations to the writing of existing business only or adjust the risk score differential amount in RSA 420-K:4, I(d), and the commissioner shall have authority to implement this recommendation by order pursuant to RSA 400-A:14 and this paragraph.
IV. The members of the commission shall elect a chairperson from among the members. The first meeting of the commission shall be called by the first-named senate member. The first meeting of the commission shall be held within 45 days of the effective date of this section. Four of the 6 voting members of the commission shall constitute a quorum.
V. The commission shall submit an annual report on or before November 1 of each year with its findings and any recommendations for proposed legislation, and a final report on December 1, 2024 to the president of the senate, the speaker of the house of representatives, the senate clerk, the house clerk, the governor, and the state library. If applicable, the commission's reports shall contain the commission's recommendation regarding whether the market for pathway II association coverage should continue or be phased out.

Source. 2019, 346:419.