By Kevin Landrigan
The New Hampshire Union Leader
CONCORD, N.H. — A caravan of slow-moving ambulances circled the Legislative Office Building Wednesday morning as executives inside warned that a House-passed rate for commercial insurance reimbursement could drive more companies out of business.
Ambulance service providers, fire chiefs and other first responders packed the small room of the Senate Health Care Committee to protest the House proposal that would set commercial insurance rates for services at 202% of the federal Medicare rate.
“This bill falls short and puts our entire EMS system at significant risk,” said Chris Stawasz, regional director for American Medical Response and someone who has fought over this issue with insurers for four decades.
“It doesn’t fix the crisis; it actually makes it worse.”
Rep. John Hunt, R- Rindge, pushed back promoting his bill (HB 316) that cleared the House of Representatives on a voice vote last month.
The rate in the bill was along the lines of an actuarial study the Legislature in 2024 had called upon the Insurance Department to commission.
The state Senate has already gone on record with its own bill (SB 425) with the backing of ambulance carriers that would reimburse 325% of the Medicare rate.
Hunt said it’s not fair to jack up the price tag for small businesses with commercial insurance since Medicare for seniors and Medicaid for low-income residents makes up at least 80% of all ambulance calls.
Large businesses come under the federal ERISA program and would be exempt from the higher rate, Hunt noted.
“Let’s let all the suckers who happen to have insurance from their employers … let’s screw them. No, that’s not what we were going to do in the House Commerce Committee,” Hunt said.
“To simply say this will relieve the pressure on fire departments and EMS and let’s just go after small businesses and individuals and make them pay for it, it’s just not fair, it’s just not right. This bill is well thought out; it’s the right answer.”
Less than 50 cents on the dollar
Studies confirm Medicare pays about 46% of the actual cost to transport by ambulance, and Medicaid about 42%.
State Sen. Sue Prentiss, D- Lebanon, a paramedic and executive director of the American Trauma Society, pointed out Berlin EMS — which has held the ambulance contract with that North Country city since 1985 — is shutting its doors next week, forcing the local fire agency to pick up emergency calls.
“How can these rural carriers hang on if they don’t get relief?” Prentiss asked.
State Rep. Mark Proulx, R- Manchester , a retired city firefighter, urged the Senate to kill this bill.
“We have already had a couple of companies go out or running on skeletal crews,” said Proulx, who has also served as deputy chief of Epping Fire Rescue and a call member of the Auburn Fire Department.
“We’d rather go back to the old system and have the insurance company pay the bill they send them and if not then, we will balance bill.”
House sponsor defends his proposed rate for ground ambulance transport
House Commerce and Consumer Affairs Committee Chairman John Hunt, R- Rindge and lower right inset, defended his proposed commercial rate for ambulance services at 202% of the Medicare that ambulance company executives said could drive many of them out of business.
The campaign to set a “ground ambulance” rate looks to eliminate balanced billing, in which the insurance company gives the ambulance firm less than its cost and the ambulance company then sends a “surprise” balanced bill statement to the consumer to try and collect the rest.
“We want to see a prohibition on balanced billing. We believe that is a pro-consumer protection measure if we can do that. This has been a problem in this state for a very long time,” said Insurance Commissioner D.J. Bettencourt.
“Additionally, we want to do what we can to support our EMS providers.”
Bettencourt urged both sides to reopen talks to settle on a compromise rate structure.
Former Insurance Commissioner Paula Rogers now lobbies for America’s Health Insurance Plans (AHIP), a trade organization that includes the largest carriers including Anthem, Harvard Pilgrim and Cigna.
“Something is going to happen this session; it’s gotten to the point where something has to be done,” Rogers said. “The study came in at 202% and the Prentiss bill is at 325%.”
As usual, legislative leaders from both parties have already identified a potential fallback position if an agreement can’t be reached.
Sen. David Rochefort, R- Littleton, is chairman of Senate Health Care and authored a separate, Senate-passed bill (SB 130) to name a 12-person commission to study delivery models for EMS and report back to lawmakers with recommendations by Nov. 1.
Hunt floated a possible compromise by convincing his committee to retain until next year a fourth bill (HB 725) from Rep. Jerry Stringham, D- Lincoln, that would have set the same 325% rate as in Prentiss’s bill.
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