Health care’s  next hurdle

State, health providers just two months  away from launching health exchange

With the Oct. 1 target date for enrollment in new health insurance programs offered under the Affordable Care Act fast approaching, state officials — and at least one major provider, Anthem BlueCross BlueShield — are scrambling to get ready to provide information on options to currently uninsured New Hampshire residents. And many questions remain unanswered — including how effective and competitive the marketplace will be.

New Hampshire’s health marketplace, which is intended to offer affordable insurance with subsidies for low-income residents, will be run by the federal government, after the N.H. Legislature voted last year not to set up a state-based exchange.

“The goal is to get folks that are currently uninsured enrolled,” said Paula Minnehan, a vice president at the N.H. Hospital Association. “We want to move people into some type of coverage. That’s what everyone’s gearing up for now.”

Minnehan said the federal government will be setting up a virtual enrollment website, where people can learn what programs are offered and what the eligibility requirements are. The programs are currently under evaluation by the N.H. Insurance Department, which has responsibility for oversight of the programs and is due to submit recommendations to the federal government today. Those recommendations won’t be made public until Oct. 1, when the enrollment period opens.

While it’s not official, it appears that Anthem BlueCross BlueShield will be the only company participating in New Hampshire’s health marketplace program.

“Right now, Anthem is the only provider to have filed plans,” said Lisa Kaplan Howe, policy director for N.H. Voices for Health, a nonprofit advocacy organization working on health care issues. “We don’t have a ton of information yet. What we know is that we will have a marketplace. You will be able to shop there. We’re certainly still waiting to see what the options are.”

Representatives of Anthem did not return calls seeking comment on the company’s plans.

Kaplan Howe said the Affordable Care Act requires companies participating in the health marketplaces to offer at least two levels of coverage and that Anthem could offer more choices. She said a chief requirement for marketplace plans is that basic medical needs must be covered, including maternity and mental health benefits. The cost must be affordable, and subsidies will be available for individuals to help them purchase insurance.

“If insurance costs more than 8 percent of income, it’s deemed unaffordable,” Kaplan Howe said. “If you are below the poverty level, you may be exempt from having to purchase insurance.”

Jennifer Patterson, legal counsel for the N.H. Insurance Department, said two separate exchanges are being set up — one called the marketplace for individuals and the other, called the shop exchange, for small businesses of up to 50 employees.

Patterson said subsidies will be based on income level, with the government paying a portion of the premium directly to the insurance company. People will be eligible if their earnings are less than 400 percent of the federal poverty level. For a family of four, that annual income number is about $92,000, Patterson said, which means many people will qualify for assistance. Subsidies will only be available to those purchasing insurance through the marketplace.

Tom Welden of Greenfield, a consultant with Granite Group Benefits of Manchester and president of the Health Underwriters of New Hampshire, said the federal government changed the terminology from “health exchange” to “marketplace” in an effort to make the program more enticing, but for New Hampshire residents, options may be few.

“Anthem hasn’t released all the details, but it appears they’ll have a limited network, covering about 20 of the 34 hospitals in New Hampshire,” Welden said. “We don’t really know which ones will be covered, but we know they won’t include Massachusetts hospitals.”

Welden said the shop exchanges for small businesses aren’t ready to go yet and the requirements for individual policies under the Affordable Care Act will make policies expensive.

“They’ll have to include maternity and mental health benefits, as well as pediatric dental and pediatric vision up to age 19,” he said. “That can make it extremely expensive. We’re expecting the cost of individual products to go up dramatically.”

He said those eligible will get a subsidy toward premiums, but “We don’t know exactly what it will look like yet.”

Rich Scheinblum, chief financial officer for Monadnock Community Hospital in Peterborough, said no one from Anthem has contacted the hospital regarding the marketplace plan.

“As far as anything specific to the exchanges, we do have contracts with all the major payers,” he said. “My understanding is that we’ll be participating with them in the exchanges.”

Scheinblum said the insurance marketplace should, in theory, provide coverage for many people who are now uninsured. That might enable the hospital to reduce its losses.

“We take everybody, regardless of ability to pay,” Scheinblum said. “It may mean less unreimbursed care or bad debt.”

He estimated that the hospital this year will provide close to $3.4 million in charity care and will have close to $4.6 million in bad debt to be written off.

“That represents about 6.4 percent of gross,” Scheinblum said. “Some of that could be shifted. As the exchanges get up and running, it should provide individuals with more options.”

According to Minnehan, one of the big challenges is getting information about the marketplaces out to consumers. The federal government has authorized about $600,000 to fund a navigator program, in which trainers from approved organizations will reach out to the community, holding forums to update people and providing guidance to those wishing to enroll in an marketplace plan.

“We’re really concerned that there won’t be enough money to cover outreach and education for the entire state,” Minnehan said.

Another problem is the state Legislature’s reluctance to participate in the program.

“We’re behind on consumer assistance,” Kaplan Howe said. “In New Hampshire, we have $5.4 million available from the feds, but the money hasn’t been accepted by the Legislature. There’s no active discussion going on right now. It will remain available through 2014. If we don’t take it, we’ll lose it.”

According to Kaplan Howe, about 60 percent of the nation’s health marketplaces will offer multi-state plans, which could eventually open up more options for New Hampshire residents. But for now, the state and Anthem are going it alone.

“Many of us were disappointed to see just one carrier in the marketplace,” Kaplan Howe said. “We’ll be focusing on making sure more carriers come in. It’s not what many of us envisioned, but we have to remember, this is year one. It’s a building process.”

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

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