Lawmakers hear competing views on HB 548 to allow membership-based (direct-pay) health facilities

House Bill 548 would permit licensed health care facilities to operate under a membership-based, direct-pay business model that accepts direct payment from patients rather than participating in third-party payer networks. The bill drew sharply divided testimony at an April 16 hearing of the New Hampshire Senate Health and Human Services Committee.

Why it matters: Proponents say the law would expand pricing transparency and give self-pay or uninsured patients a lower-cost alternative for elective and routine services. Opponents said the bill risks creating two classes of patients, would undermine hospitals and nursing homes that rely on a mix of payer sources to cross-subsidize care, and could reduce access for Medicaid recipients.

Supporters' case: Representative (prime sponsor) argued the measure is a narrow, market-based expansion of the direct primary care model already authorized in state law and would only apply to facilities that exclusively accept direct payment. Greg Moore of Americans for Prosperity and supporters said the approach has had limited uptake where tried (citing a long-running example in Oklahoma) and would not likely destabilize critical access hospitals; proponents also emphasized price transparency benefits for self-insured or uninsured patients.

Opponents' case: County and hospital representatives warned of unintended fiscal consequences. Jerry Kinnirk (opposing testimony) and David Ross (Hillsborough County Nursing Home, New Hampshire Association of Counties) said Medicaid reimbursements already fall short of costs, and nursing homes and hospitals rely on private-pay and rehabilitation revenue to subsidize care for Medicaid patients. Ben Bradley of the New Hampshire Hospital Association and Catholic Charities' Bob Dunn said the bill would bifurcate patient protections and patient rights, omitting key protections for patients who later become Medicaid-eligible. Bradley noted the bill's proposed separate patient bill of rights lacks protections in current law that prevent involuntary discharge when a patient becomes eligible for Medicaid; he called that omission a serious policy gap.

Sponsor amendments and narrow scope: The sponsor provided amended language in the House to exclude nursing homes and added clarifying language requested by counties; the sponsor said the version included in the budget reflected her amended language. Sponsors said they would accept targeted clarifications to the legislation to address county concerns.

Committee outcome: The committee took testimony from numerous stakeholders and did not vote on the bill at the hearing. Sponsors and opponents asked for further technical work and suggested the bill might be revised to add explicit patient-rights protections and to ensure the moratorium on nursing home bed growth remains intact.