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MISSOURI: The 96th General Assembly convened on January 5 and is expected to adjourn on May 30, 2011. With 106 members to the Democrats' 57, the GOP has the largest number of seats it has ever held in the House and is just three members short of being veto-proof.  Given the large Republican majorities in the General Assembly and 70 percent voter support for Proposition C -- an effort to turn back health care reform, the legislature will be under pressure to do nothing to move Missouri closer to enactment of federal health reform.

Significant health care bills filed this session include a resolution calling on the Attorney General to file a lawsuit challenging the constitutionality of the PPACA, a bill requiring statutory authorization by the General Assembly to implement PPACA, a bill expanding the autism mandate, an MLR bill for large carriers requiring a 90 percent MLR for Missouri-associated revenues and 85 percent for smaller carriers, a bill requiring the state employee health plan to offer a minimum of three high-deductible options with differing annual deductibles and annual out-of-pocket expenses, a bill prohibiting "Most Favored Nation" clauses, legislation creating transparency and publication of carriers' fee schedules and requiring carriers to contract with providers willing to meet certain provider participation terms and conditions, and creation of a uniform group application for insurance.

NEBRASKA: The 102nd unicameral legislature has convened in Lincoln where it is expected to spend much of the session grappling with a budget deficit approaching $985 million for the 2011-2013 biennium. Implementation of the PPACA is expected to receive serious attention as well, with six bills relating to implementation or rejection of PPACA introduced to date. Bills of interest include legislation creating an Exchange Task Force, an interim committee for PPACA study, and several bills challenging the individual mandate, prohibition of abortion coverage, and a cochlear implant mandate. In addition, a bill banning discretionary clauses in health and disability income insurance contracts has been introduced.  The legislature began its work on January 6 and is tentatively scheduled to adjourn on May 26, 2011.

 NEW HAMPSHIRE: The legislature convened on January 5, 2011, and is scheduled to adjourn on June 30, 2011. Governor John Lynch will continue as the state Executive; however, Republicans have gained control of both chambers in the legislature. In addition to the state's budget deficit, implementation of federal health care reform will continue to be a priority for the governor and the legislature. Given the Republican majority and anticipated revenue shortfalls, there will be limited, if any, activity on health insurance issues. The legislature will, however, be paying close attention to federal health reform implementation issues and activities. 

In addition, there have been discussions about eliminating certain state mandates if they are not included in the essential benefits required under the PPACA. In 2010, the state enacted legislation granting certain powers to the commissioner with respect to implementation of PPACA.  This legislation also created a legislative oversight committee, to which the Department of Insurance (DOI) must report monthly. This month the DOI submitted a request for a waiver of the 80 percent minimum loss ratio (MLR) requirement for individual health insurance market policies until 2014.

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