For MCH, challenges from all directions

CEO: Medicaid rejection, network harm residents

PETERBOROUGH — Monadnock Community Hospital Chief Executive Officer Peter Gosline is disappointed that the N.H. Senate has killed a plan to expand Medicaid to cover more low-income New Hampshire residents who are currently uninsured. He’s also frustrated that his hospital was left out when Anthem Blue Cross Blue Shield put together its Pathway network to offer insurance for individuals under the Affordable Care Act, meaning those signing up for that coverage will be unable to use the doctors and services at MCH. But Gosline does see some positive signs for the future, if politics doesn’t get in the way.

“Up to 50,000 people in New Hampshire currently don’t have access to Medicaid,” Gosline said Monday. “They don’t qualify, but they can’t pay significant [medical] bills. They tend to go without coverage until they get sick. We need to close that gap.”

Gosline testified in Concord earlier this month at a hearing of the House Finance Committee on proposals by both the House and the Senate for Medicaid expansion. As part of the Obama administration’s health care initiatives, states are being encouraged to raise the level at which people could qualify for Medicaid to 138 percent of the federal poverty level. Gosline said states have been promised full federal reimbursement for up to three years.

“Many of the individuals who would be eligible for Medicaid expansion within our service area are no strangers to MCH,” Gosline said in his testimony. “Whether or not they have coverage will not keep a number of those people who need emergency care from our emergency service. This is why our bad debt and charity care numbers are rising each year, and a major reason why we struggle each year to balance our budget.”

Last week, two proposals to approve expansion failed to get approval in the Republican majority Senate during a special session of the Legislature, although some Senate leaders on both sides of the aisle have said additional discussions will take place next year. “It’s not dead,” Gosline said Monday about the prospects for Medicaid expansion. “But it’s disappointing that [legislators] don’t see the urgency. Those who will suffer are the citizens of New Hampshire.”

Gosline is also concerned about the lack of options for individuals who want to buy insurance through the Affordable Care Act exchanges. Anthem, the only company offering ACA plans in New Hampshire, has set up a network of 16 hospitals around the state, but MCH is not one of them. That means those choosing to enroll through the exchange would be limited on what doctors they could use.

Gosline said he, MCH Chief Financial Officer Rich Scheinblum and the hospital’s treasurer, Steve Reynolds, recently met with N.H. Insurance Commissioner Roger Sevigny to find out what is being done to ensure residents have a range of choices. “We wanted to find out what their vision is for a small hospital in rural New Hampshire,” Gosline said.

According to Gosline, Sevigny said the Insurance Department is hoping that more companies will participate in the exchange next year.

Gosline also met with Anthem President Lisa Guertin, who told him she had been surprised when Anthem was the only company to participate in the ACA exchange program.

Anthem had notified individual customers with plans that don’t meet ACA standards that those plans would be discontinued, but Anthem is allowing people to renew those policies for up to one year. That should help some people to get through the next year, Gosline said, especially given the difficulties associated with enrolling through the ACA exchanges and the uncertainties around implementation of the law. “It’s going to be a difficult year for people to be making new choices for insurance,” he said.

Gosline said MCH does a lot of business with Anthem, which insures many patients through both company and individual plans. Both Sevigny and Guertin indicated that MCH is likely to be part of a network in the future that will offer ACA coverage to area residents, according to Gosline. “My educated guess is that there will be more choices for 2015,” he said. “From our end, we’d want to be able to assess what Anthem is willing to pay. We’re willing to try to work with them. We left the door open.”

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