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Health care

Unhealthy amount of uncertainty?

Patients, doctors struggle to find answers in region’s quickly changing health care landscape

  • Nancy and Chuck Van Horn say they are angry and frustrated that the Affordable Care Act is likely to require them to pay more for Nancy's health care coverage if she wants to remain with her longtime doctors. "Our choice is now being taken away," Nancy says.

    Nancy and Chuck Van Horn say they are angry and frustrated that the Affordable Care Act is likely to require them to pay more for Nancy's health care coverage if she wants to remain with her longtime doctors. "Our choice is now being taken away," Nancy says. Purchase photo reprints at Photo Finder »

  • Nancy and Chuck Van Horn say they are angry and frustrated that the Affordable Care Act is likely to require them to pay more for Nancy's health care coverage if she wants to remain with her longtime doctors. "Our choice is now being taken away," Nancy says.

    Nancy and Chuck Van Horn say they are angry and frustrated that the Affordable Care Act is likely to require them to pay more for Nancy's health care coverage if she wants to remain with her longtime doctors. "Our choice is now being taken away," Nancy says. Purchase photo reprints at Photo Finder »

  • Nancy Van Horn says she is angry and frustrated that the Affordable Care Act is likely to require herto pay more for health care coverage if she wants to remain with her longtime doctors. "Our choice is now being taken away," she says.

    Nancy Van Horn says she is angry and frustrated that the Affordable Care Act is likely to require herto pay more for health care coverage if she wants to remain with her longtime doctors. "Our choice is now being taken away," she says. Purchase photo reprints at Photo Finder »

  • Nancy and Chuck Van Horn say they are angry and frustrated that the Affordable Care Act is likely to require them to pay more for Nancy's health care coverage if she wants to remain with her longtime doctors. "Our choice is now being taken away," Nancy says.

    Nancy and Chuck Van Horn say they are angry and frustrated that the Affordable Care Act is likely to require them to pay more for Nancy's health care coverage if she wants to remain with her longtime doctors. "Our choice is now being taken away," Nancy says. Purchase photo reprints at Photo Finder »

  • Nancy and Chuck Van Horn say they are angry and frustrated that the Affordable Care Act is likely to require them to pay more for Nancy's health care coverage if she wants to remain with her longtime doctors. "Our choice is now being taken away," Nancy says.

    Nancy and Chuck Van Horn say they are angry and frustrated that the Affordable Care Act is likely to require them to pay more for Nancy's health care coverage if she wants to remain with her longtime doctors. "Our choice is now being taken away," Nancy says. Purchase photo reprints at Photo Finder »

  • Nancy and Chuck Van Horn say they are angry and frustrated that the Affordable Care Act is likely to require them to pay more for Nancy's health care coverage if she wants to remain with her longtime doctors. "Our choice is now being taken away," Nancy says.
  • Nancy and Chuck Van Horn say they are angry and frustrated that the Affordable Care Act is likely to require them to pay more for Nancy's health care coverage if she wants to remain with her longtime doctors. "Our choice is now being taken away," Nancy says.
  • Nancy Van Horn says she is angry and frustrated that the Affordable Care Act is likely to require herto pay more for health care coverage if she wants to remain with her longtime doctors. "Our choice is now being taken away," she says.
  • Nancy and Chuck Van Horn say they are angry and frustrated that the Affordable Care Act is likely to require them to pay more for Nancy's health care coverage if she wants to remain with her longtime doctors. "Our choice is now being taken away," Nancy says.
  • Nancy and Chuck Van Horn say they are angry and frustrated that the Affordable Care Act is likely to require them to pay more for Nancy's health care coverage if she wants to remain with her longtime doctors. "Our choice is now being taken away," Nancy says.

In a report issued Wednesday, the U.S. Department of Health and Human Services says the health insurance marketplaces being set up under the Affordable Care Act will lead to increased competition, lower than expected insurance premiums and “new and affordable choices for consumers” in most states. Yet the night before, Texas Sen. Ted Cruz stayed up all night on the Senate floor, in an effort to make defunding the ACA a requirement for extending federal budget authorization. Clearly, the nation remains deeply divided on the pros and cons of the complicated new regulations known as Obamacare.

But in the Monadnock region, one thing is clear. The decision by Anthem Blue Cross and Blue Shield to leave Monadnock Community Hospital out of the network of approved providers in Anthem’s health-exchange plans doesn’t always sit well with people who are looking for individual health plans.

“You become established. You have caregivers you know and trust,” said Nancy Van Horn of Hancock, who has had an individual health plan through a company that is pulling out of the New Hampshire market. “Now, after having had care for 29 years at Monadnock, I may have to go elsewhere. That makes me very unhappy.”

Van Horn, 63, is the sole employee of her husband’s company, R. Charles Van Horn, CPA of Antrim. Chuck Van Horn, who is 72, is covered through Medicare and a supplemental insurance plan that is not changing, so the new law doesn’t affect him. But Nancy is due to lose coverage because her current plan can’t be renewed, and the couple is struggling to figure out what options they have.

“Our feet are firmly planted in mid air, as my father used to say,” said Chuck Van Horn. They have been talking to their insurance agent, who may be able to provide a corporate plan. But so far, it looks like premiums for Nancy’s coverage might rise by $120 to $250 per month. And it’s not clear if she’ll even qualify for a new plan.

In a recent meeting with N.H state senators, Anthem Blue Cross Blue Shield president Lisa Guertin took heat over the company’s health exchange plan because it excludes so many parts of the state. According to a report on the meeting in the Concord Monitor, State Sen. Andy Sanborn told Guertin, “Every single one of us [is] exceptionally, exceptionally disappointed in this.” Guertin responded by saying that Anthem was seeking to reduce the cost of its plans and the participating hospitals agreed to accept lower reimbursement rates because they expect to gain patients. Guertin said more than 90 percent of their potential customers live within 20 miles of a short-term general hospital.

Monadnock Community Hospital CEO Peter Gosline said last week that Anthem never contacted his hospital about participating in the health exchange program.

“It seems that Anthem is trying to steer patients to the larger hospitals in their network,” Chuck Van Horn said. “That means the smaller hospitals will become more expensive for the patients that remain. And will the larger hospitals even be able to handle all the patients they are going to have?”

Difficult choices

The Van Horns are both patients of Dr. Scott Jaynes, who runs North Meadow Family Health in Peterborough with his wife, Dr. Annika Brown. Their practice was independent until two years ago, when it was purchased by Monadnock Community Hospital. Jaynes says the Van Horns are not his only patients who are struggling with what to do.

“At least in our area, the Affordable Care Act is going to harm the very people it’s intended to help,” Jaynes said last week. “For example, I have a patient who is 30, very healthy, runs his own business. He has no health insurance. He sees us when he has to and he’s always come in and paid his bill. Now, he either has to buy insurance that doesn’t cover his doctor’s office, or go on the open market for an even more expensive policy or pay a penalty to continue doing what he’s always done.”

Jaynes has another patient who is due to deliver a baby in February. She had been planning to go to the exchange for health care coverage. Now, with Anthem’s plan being the only option on the exchange, she’ll have to switch doctors and hospitals if she wants the lower cost of the health exchange. Or she’ll have to pay a higher rate for a plan that will let her remain with North Meadow Family Health.

“It’s really the less affordable care act for a lot of us,” Jaynes said.

Jaynes said it’s also difficult to make health insurance decisions when the costs aren’t clear. Consumers are eligible to start signing up with the health exchange on Oct. 1, with coverage to go into effect at the start of 2014.

“Anthem hasn’t even posted rates yet, and Jan. 1 is right around the corner,” Jaynes said.

The data released by the Department of Health and Human Services on Wednesday gives at least a broad picture of the cost to consumers. In New Hampshire, Anthem is the only company participating in the exchange. It offers 12 health plan choices, in categories known as bronze, silver and gold based on the level of coverage as well as a catastrophic plan. According to the HHS report, the lowest cost choice in the bronze category would have a monthly premium of $186 for a 27-year-old who does not qualify for tax credits. If that person’s income is less than $25,000, tax credits apply and the premium would be $94 a month. For a family of four with an income less than $50,000, the premium on the lowest cost bronze plan would be $96.

New Hampshire’s weighted average premiums of $359 for the lowest cost silver plan and $282 for the lowest cost bronze plan are considerably higher than the national weighted averages of $310 and $249, respectively.

Extending coverage

U.S. Rep. Annie Kuster, a Democrat, believes the Affordable Care Act will be beneficial to those who are currently uninsured, many of whom do not have a doctor.

“The goal of the Affordable Care Act is clear — to ensure access to affordable, quality health care for all Americans,” Kuster wrote in an email to the Ledger-Transcript on Wednesday. “No change will be necessary for the vast majority of Granite Staters, who will keep their health care coverage through their employers. Individuals who do not currently have health insurance will now gain access to a number of affordable plans through the exchange.

“My goal is to work with all stakeholders to increase coverage options for families and businesses going forward. I believe increased competition will bring down costs and improve quality of care for hardworking families in the Monadnock region and all around the state.”

But people like the Van Horns, who have always had insurance, are finding the act is reducing their options. They said they were surprised that Anthems health exchange proposal, which includes just 16 New Hampshire hospitals, was approved by the N.H Insurance Department.

But Commissioner of Insurance Roger Sevigny says the department is limited in what it can do about the situation.

“The law does not give the department the authority to mandate that any particular hospital be included,” Sevigny said in a phone interview on Wednesday. “What authority we do have is to make sure the network complies with state’s network adequacy laws. There are minimum requirements if a carrier is to market in a geographic region. In this instance, Anthem complies with the law. That’s a process we use regardless of whether it’s part of the exchange or not.”

Sevigny said the commission had no choice but to approve Anthem’s proposal.

“Anthem was the only one that applied. It’s very disappointing,” he said. “I wish we had several, but the fact is that we didn’t. We’re hoping as this continues to unfold, we’ll see increased participation in the future.”

That’s little consolation for the Van Horns.

“Yes, next year, they might have more. But it’s just wishful thinking,” said Chuck Van Horn. “There’s no guarantee.”

Dave Anderson can be reached at 924-7172, ext. 233 or danderson@ledgertranscript.com. He’s on Twitter at @DaveAndersonMLT.

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