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Proposed allowance for 'direct-pay' medical facilities stirs debate over access and nursing-home finances
Summary
Representative Mark McLean told the committee House Bill 548 would let membership'or direct'payment health facilities operate without the current all'payer requirement, a change supporters said could offer lower up'front prices to uninsured or high'deductible patients.
Representative Mark McLean introduced House Bill 548 to allow certain health facilities operating on membership or direct'pay models to be excluded from statutory requirements that otherwise require facilities to accept all payers. McLean said the change is intended to allow new practice models to develop that can offer upfront prices and lower out'of'pocket options for people who are uninsured, self'insured, or have high deductibles.
The bill prompted a broad panel. Supporters said limited, direct'pay or membership'based models have increased access and lowered prices in other states and in outpatient sectors, and could create additional options for people priced out of traditional care. Greg Moore of Americans for Prosperity urged the committee to consider the third'party payment problem and highlighted evidence that administrative costs drive health care prices upward. Several speakers with experience running ambulatory surgical and imaging centers described real examples where lower cost, patient'facing providers reduced the price of routine diagnostics and elective procedures.
Opponents included the New Hampshire Hospital Association, county officials, the New Hampshire Healthcare Association and nursing'home advocates. They argued the bill would create a parallel, unregulated tier of facilities that could "cherry'pick" well'insured or privately paying patients, leaving hospitals and nursing homes with a worse payer mix and higher uncompensated care. County and nursing'home representatives noted that Medicaid already pays less than the cost of long'term care and said the moratorium on new nursing'home beds and other statutory protections are intended to preserve broad access; they warned that unregulated private-pay facilities could increase county taxpayer burdens.
Several witnesses described the mechanics of New Hampshire'specific policy that affects rural hospitals: the critical'access hospital designation and the 15'mile exclusion zones. Opponents said the bill would not change the critical'access protections that preserve Medicare reimbursement levels, but they said allowing direct'pay competitors near critical access hospitals could nonetheless affect payer mix and viability.
Supporters said uptake of the model is likely to be limited and incremental, pointing to the direct primary care experience and to outpatient centers that operate at lower price points. The committee did not vote at the hearing; members asked staff to gather more data on rural access, payer mix and possible safeguards to prevent unintended consequences for hospitals and nursing homes.
