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Concord, NH: Opinion: Ambulance importance

4 Jun 2024 9:26 AM | Matt Zavadsky (Administrator)

Interesting perspective by a former insurance regulator. 


Opinion: Ambulance importance




Brendan Williams is the president and CEO of the New Hampshire Health Care Association.

It is a story often told: A bipartisan New Hampshire Senate bill, in this case co-sponsored by over half the Senate, passes the Senate and is eviscerated in the House.

This particular story involves Senate Bill 407, which addresses what insurers pay for ambulance services.

As it passed the Senate, it would require insurers to pay rates that are fair, as part of a genuine negotiation between an insurer and an ambulance company. In the absence of an agreement between the insurer and the provider, the Senate would require that the insurer pay rates set by the local government or contracted entity subject to a public process, or rates tied to what Medicare pays, or the billed charges, whichever is the least expensive amount.

Sound reasonable? It certainly would be great for Granite Staters who too often today can find that ambulance services are hard to access, particularly in rural areas, because of the costs of inflation, including wages.

A report issued last year by New Hampshire Ambulance Association surveyed 150 emergency medical service leaders, and 98% of them said the system was in urgent need of attention. One ambulance company alone had 50 job openings it couldn’t fill because reimbursement was not high enough to compete in the job market. Other companies were going out of business.

In contrast, health insurance companies seem to be doing okay. For example, even after nearly bringing down the U.S. healthcare system due to one of its myriad subsidiaries, which handles insurance billing, experiencing a cyberattack that could have been avoided with simple cybersecurity, UnitedHealth Group has a market cap of $455.93 billion as I write this. That’s thirty times bigger than the size of the state of New Hampshire’s current two-year budget.

As a former state insurance regulator, I can attest to the fact that for providers and patients alike to be chiseled by health insurers is as American as apple pie. I paid $9,100 out-of-pocket last year even though I was “insured” — an experience too many can relate to. Health insurers are even buying up medical practices so that they can steer those they insure to themselves, cleverly bypassing the already generous Affordable Care Act limits on how much they can pocket. One major New Hampshire insurer was reimbursing less for ambulance services than it did a decade ago. Why? Because it can get away with it.

As it passed the Senate, SB 407 would apply a very small leveling to this uneven playing field and benefit all Granite Staters who need an emergency response or transportation to a health care provider. The current crisis has, for example, burdened hospitals when an ambulance is not available to transport a patient ready for discharge into a long-term care setting. Yet in the House, this good bill got turned into a study.

It is a classic legislative move: When you don’t want to do something you just study it. I cannot count how many study committees I have been a part of that have completely failed to accomplish anything substantive. And then sometime later another study committee studies the same thing.

The Senate has refused to concur in the House approach and there is now a conference committee between the two legislative chambers.

The House should yield to the Senate position. Especially in a state as rural as ours, the well-being of Granite Staters, including some of our most vulnerable citizens, depends on having a viable ambulance sector.

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