Abortion, circumcision, workforce among focus areas in new round of health care legislation


New Hampshire Bulletin

Published: 01-28-2024 10:00 PM

Among the nearly 1,030 bills New Hampshire lawmakers are expected to take up this year, dozens relate to health policy and practices, from workforce growth and insurance coverage to abortion. Some bills, such as one that would ban abortions at 15 days, could see a committee vote Thursday, a first step before it goes before the full House.

Other bills will get their first public hearings this week, including those seeking to expand coverage for breast exams and infertility treatment. Many are in their earliest stages, such as two that would put restrictions on circumcision procedures and insurance coverage. 

The Legislature’s website, gencourt.state.nh.us, is the place to go for details about the bills, including public hearing dates and how to weigh in with lawmakers.

A $32 million effort to add more health care workers

One of the session’s most expensive health care bills seeks to spend just over $32 million, some with unused federal COVID-19 money if possible, to bring more workers into the state, a critical need, its sponsor, Sen. Cindy Rosenwald of Nashua, told a Senate committee last week. She said the more than $305 million in state and federal Medicaid lawmakers passed last year has helped but not solved the state’s critical workforce shortage. 

“It’s still very difficult to get a doctor’s appointment, which I can personally attest to, or get a hospital or a nursing home bed, get home care, mental health care, or substance use disorder treatment,” Rosenwald said. “So lack of adequate workforce has not only led to increased costs in this system as providers have had to pay enormous temporary staffing costs, but they’re also worrying implications that the quality of our fantastic health care system in New Hampshire is at risk.”

The legislation includes $12 million to expand the student loan repayment program, which employers say is a key recruiting tool. The next biggest expenditure would put $10 million into building a workforce pipeline, in part by engaging middle and high school students as well as under-represented populations in the health care field. 

Kristine Stoddard, senior director for New Hampshire public policy at the Bi-State Primary Care Association, said in an interview that New Hampshire is one of a few states that does not invest state money into this type of workforce development. 

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The bill proposes spending $2 million on a certification program for community health workers, who provide direct care but also connect people with necessities, such as transportation and child care so they can go to health care appointments. Creating a certification would allow agencies to bill insurance for their services. Currently, they primarily use grant money, which can be unreliable, Stoddard said 

Nearly 50 health care organizations, including Stoddard’s, are backing the bill. Its biggest challenge will be its price tag. Senate President Jeb Bradley made that clear at last week’s hearing.

“So this is where I am going to get in trouble and people aren’t going to like this,” he said. “But there’s a reality factor here, folks.” Bradley noted that lawmakers may face the possibility of increased spending this year on education and settlements for individuals abused while at the former Youth Detention Center. 

“What I would ask the sponsors and the department to do is to take this bill and strip it down to what can be done now that has minimal costs,” Bradley said. “And then … work through the budget process next year to come back with some of this as it is able to get funded.”

Expanded insurance benefits

There are several bills that would require insurance companies to expand their coverage.

House Bill 1296 would prohibit certain insurers from charging co-pays, deductibles, or other cost-sharing for diagnostic and supplemental breast examinations, which can cost hundreds of dollars.

Basic screenings, such as mammograms, are free under most health plans.

Unless a child required circumcision for medical reasons, Medicaid could no longer cover it under House Bill 1683. A separate bill would require providers to show parents the tools used in a circumcision and get their written permission before performing the procedure.

In fiscal year 2023, the state’s Medicaid plan, half of which is funded by the federal government, paid $213,160 for circumcision procedures, according to the Department of Health and Human Services. Of that, about $90,500 was for “elective” circumcisions that would no longer be covered under the bill.

Nearly 20 states have passed similar legislation, according to the Journal of Urology. Medical experts disagree over whether the potential risks, such as surgical complications, outweigh the potential benefits, such as a reduced risk of urinary tract infections.

The second piece of legislation, House Bill 1706, would prohibit providers from performing a circumcision until parents have signed a form that warns them of health complications.

With Senate Bill 558, Senate and House Democrats are seeking to expand coverage for infertility treatment to include in-vitro fertilization and to drop the requirement infertility must be due to medical reasons to be covered. 

The New Hampshire Insurance Department said the change would allow more people to receive infertility coverage and increase some insurance premiums by $9.50 to almost $100 each month. 

The bill would also prohibit employers from requiring that employees use their accrued paid time off before receiving parental leave benefits, a chance that could also increase premium costs, the department said.

Abortion restrictions and protections

Of the eight abortion bills headed to lawmakers next year, one already looks certain to fail and another will face a tough fight given that House Republicans and Gov. Chris Sununu said last year that they would not support restrictions beyond the existing law.

Current law bans abortion after 24 weeks except when the mother’s health is in danger or a fatal fetal anomaly is present.

House Bill 1248 from Franklin Rep. David Testerman, a Republican, would replace the state’s 24-week abortion limit with a ban on abortions after 15 days – before most know they are pregnant. 

House Speaker Sherman Packard predicted the bill won’t make it out of the House, and even Cornerstone Action, a faith-based nonprofit that vehemently opposes abortion, objected to the bill, saying it will fight to protect the state’s existing law. 

One of its co-sponsors, Rep. Kristine Perez, a Londonderry Republican, backed out and apologized to constituents, saying she thought the bill prohibited abortion after 15 weeks, not 15 days. 

Testerman, Perez, and Rep. John Sellers, a Bristol Republican, are sponsoring a second bill that faces an equally tough challenge. House Bill 1541 would ban abortion at 15 weeks and require the presence of a second physician for any done before that. Some abortions would also have to be done in a hospital with premature birth intensive care units.

The remaining bills would protect existing abortion rights or expand them. If they clear the House, where the number of Republicans and Democrats is near even, they will face a challenge in the Senate, where Republicans outnumber Democrats, 14-10. 

Rep. Amanda Toll, a Keene Democrat, is sponsoring a constitutional amendment, CACR 23, that would ask voters to protect abortion up to 24 weeks and allow abortions beyond that when a physician believes they are necessary.

Two bills seek to protect access to the abortion drug mifepristone, which is used with a second drug to terminate pregnancies up to 11 weeks in most clinics. A challenge to mifepristoneone is pending before the U.S. Supreme Court. 

Toll is asking the House and Senate to pass a “concurrent resolution,” which has no legal power, to condemn restrictions on medication abortion.

Senate Bill 567, from Sen. Becky Whitley, a Hopkinton Democrat, would require the Department of Health and Human Services to identify ways to protect and expand access to reproductive health care, including medication abortions.

The department noted in its response to the bill that it is prohibited from using state or federal money for abortion-related activities. It said it can only identify ways to increase outreach and education about contraception and access to preventative health care services.

With Senate Bill 575, Sen. Debra Altschiller, a Portsmouth Democrat, is seeking to prohibit New Hampshire public officials from cooperating with efforts from outside the state to limit the state’s existing abortion access and access to contraception.

She has also sponsored a constitutional amendment, CACR 24, that would protect the right to “personal reproductive autonomy.”