The Affordable Care Act is Making a Difference in New Hampshire

Editor’s note: This is the first installment in a three-part series on how the Affordable Care Act is making a difference in health care in the New Hampshire.
By Suzanne Laurent

This week explores the Health Insurance Marketplace and changes to private insurance.

More than 40,000 Granite Staters signed up for health care coverage through the Affordable Care Act’s Health Insurance Marketplace between Oct. 1, 2013, and April 19, 2014.

“This exceeded the federal expectations of 19,000,” said Aaron Holman, spokesman for the N.H. Department of Health Insurance.

Each state had the opportunity to use the federal exchange or a state exchange and New Hampshire chose to be a partnership state.

On June 18, 2012, former Gov. John Lynch signed into law HB 1297, which prohibits the state from participating in or enabling a state-based Health Insurance Marketplace. However, HB 1297 allows for state agencies or departments to “operate specific functions of a federally facilitated exchange.”

Gov. Maggie Hassan informed federal officials on Feb. 13, 2013, that New Hampshire would pursue a state-federal partnership exchange.

According to the U.S. Department of Health and Human Services, New Hampshire has received $12,534,078 in grants for research, planning, information technology development and implementation of its marketplace.

Early frustrations with the Health Insurance MarketplaceWeb site glitches frustrated many enrollees when the marketplace opened, and the state responded by offering www.coveringnewhampshire.org to answer questions about eligibility for the marketplace and to learn about the plans available. However, people still had to go to www.healthcare.gov or call by phone to actually sign up.

“A hot topic in New Hampshire was that Anthem Blue Cross and Blue Shield was the only insurance carrier to deliver the ACA marketplace plans this first year,” said Dr. Thomas Sherman, a gastroenterologist with Core Physicians in Exeter, who is also Democratic state representative from Rye.

Anthem also has a narrow network that excluded 10 of the hospitals in the state, including Portsmouth Regional Hospital.Holman explained that there will be five insurance carriers to choose from during the open enrollment period that begins Nov. 15.”

Across these five carriers, all the hospitals will have at least two carriers and some will have three or more,” he said. “There will be more than 50 plans to choose from.”

Anthem offered 11 plans that were tiered by metal — bronze, silver and gold — with a catastrophic plan offered to people under age 30.

Almost 60 percent of the state’s enrollees in the ACA Marketplace chose a silver plan and 26 percent selected a bronze plan.

Of all enrollees, 77 percent received financial assistance from tax credits and/or subsidies. Under the ACA, people earning up to 400 percent of the federal poverty level can get tax credits to use toward buying insurance as well as cost-sharing subsidies. Those who can afford health insurance must buy it or pay a tax penalty, which increases each year.

Changes in health care delivery through the ACA

“The insurance reforms outlined by the ACA represent long-standing complaints from patients and physicians,” Sherman said. “These address some of the most egregious barriers to care imposed on patients by their insurers.”

The ACA increased access to comprehensive coverage by requiring most health plans to cover 10 essential health benefit categories, to include hospitalization, prescription drugs, maternity and newborn care, and mental health and substance abuse disorder services.

Preventive services are covered with no deductible or co-pay. These include colonoscopy screening, Pap smears and mammograms for women, well-child visits and flu shots for all children and adults. A yearly physical is also covered with no deductible or co-pay.

The ACA offered a new coverage option for young adults by allowing parents to keep their children on their family plan until age 26.

Another provision was that people could not be denied coverage for pre-existing health conditions. As many as 597,000 non-elderly New Hampshire residents, including 68,589 children, have some type of pre-existing condition such as asthma or diabetes. Women can no longer be charged more for coverage because of their gender.

The law bans insurance companies from imposing lifetime dollar limits on health benefits. This is a relief for cancer patients and individuals suffering from other chronic disease from having to worry about going without treatment because of their lifetime limits.

Because of the 80/20 rule, health insurance companies now have to spend at least 80 cents of each premium dollar on health care or improvements to care, rather than administrative costs like salaries or marketing, or they have to provide customers with a refund.

What this means according to DHHS statistics is that 46,338 New Hampshire residents with private insurance coverage benefited from $5,468,712 in refunds from insurance companies, for an average refund of $161 per family.

In every state, and for the first time under federal law, insurance companies are now required to publicly justify their actions if they want to raise rates by 10 percent or more. New Hampshire has received $7,585,186 under the new law to help fight unreasonable premium increases.

“I would add that, regardless of party affiliation, all of these reforms represent areas that have broad-based support,” Sherman said. “There are also incentives for prevention and using a comprehensive approach to the individual patient.”

Open enrollment in the ACA marketplace begins Nov. 15. Those already covered on the exchange can choose a different plan that is better suited to their choice of hospital and/or doctor.

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