N.H. Trails Vt. on Details Of Exchange

Insurance Marketplace Rates May Be Unknown Until Oct.

New Hampshire’s insurance department has less than a week to figure out which insurance plans it wants offered through the state’s health insurance exchange when the online marketplace opens to residents this fall.

While the federal government still will need to grant final approval, the state is “absolutely” on track to submit its recommendations by July 31, according to one insurance official.

For consumers, however, the deadline won’t make much difference. They might not have any information about the rates they’ll pay, details of the plans or even how many options there will be to choose from until open enrollment begins on Oct. 1, according to state and federal officials.

That still leaves three months for New Hampshire residents and businesses to bone up before the new insurance plans sold through the exchange become effective in January 2014, state and federal officials say. But the situation is one more example of how consumer education efforts in the Granite State contrast with neighboring Vermont, where plan designs have been out for close to a year and details about the rates have been public since April.

“I don’t know what New Hampshire’s exactly going to be able to do,” said Jim Weinstein, president and CEO of Dartmouth-Hitchcock. “Vermont looks like they’re going to be ready to go this fall with the exchange.”

A key provision of the Affordable Care Act, health exchanges are the online marketplaces where individuals and businesses will be able to buy insurance. Vermont is one of 17 states that chose to run its own exchange, while New Hampshire is among the majority of states that handed control to the federal government.

But when it comes to insurance, New Hampshire law says nothing has to be made public until the plans become effective. Technically, that’s not until next January, though practically speaking, the information will go up when the exchange launches Oct. 1.

Any decisions about what to reveal before then lies with the insurance carriers, said Jennifer Patterson, legal counsel for the New Hampshire Insurance Department. That means it is up to Anthem Blue Cross and Blue Shield, the only carrier so far in that intends to sell plans through New Hampshire’s exchange.

The confidentiality law governing insurance pre-dates federal health reform, Patterson said, and there is nothing that federal officials can do to force New Hampshire carriers to make the information public before Oct. 1.

“We can’t override the state insurance laws,” said Raymond Hurd, the deputy regional administrator for the Centers for Medicare & Medicaid Services in Boston. “If it’s confidential by the state, it’s confidential.”

Nevertheless, Hurd and others who have been working on the insurance exchange said they weren’t concerned. There is plenty of basic information that consumers need to have before they decide which plan is best for them.

“Obviously, we’d like to see consumers have the info ASAP, but I’m hopeful that having the info as of Oct. 1 will be sufficient,” said Lisa Kaplan Howe, policy director for New Hampshire Voices for Health, a consumer advocate. “The key immediate need is getting basic info to people ASAP so they know that new options and assistance are coming.”

That’s where health advocates in New Hampshire are concerned. The state has done little to educate consumers and has been unable to take advantage of millions of dollars in federal funding to do so. Last month, a joint legislative committee declared an impasse on whether to accept a $5.4 million “consumer assistance” grant that would go toward helping people figure out which plans and subsidies are available to them.

The inability of the legislature to take advantage of these funds has upset everyone from the governor to health and consumer advocates who say New Hampshire is failing to help its residents prepare to use the exchange.

“Repeated attempts by some members of the state legislature to stall, undermine and disrupt the health exchange process by opposing measures to preserve control at the state level and by blocking critical federal grants could make it extremely difficult for New Hampshire’s people, families and businesses to access insurance plans, tax credits and other benefits,” said Marc Goldberg, spokesman for Gov. Maggie Hassan.

Meanwhile, the federal government is going forward with its own efforts to inform New Hampshire consumers. Last month, it launched a website, HealthCare.gov, and a 24-hour call center to answer questions about how to buy insurance on the exchange. Federal officials also have set aside $600,000 to train “navigators” who will help people use the exchange. Another $800,000 in federal grants was awarded to federally qualified community health centers around New Hampshire to do outreach about the marketplace, Patterson said.

National campaigns won’t address a lot of state-specific issues, however, and Howe said much more has to be done to make sure New Hampshire residents have the information they need.

“There’s just not a lot of awareness,” she said. “What I keep saying to people is that, if you’ve been shut out of the system before, either because you had a pre-existing health condition or insurance simply wasn’t affordable to you, the only way you’re going to know to go back and take a second look is if you know there’s some new options, including tax credits. So getting that information out to people is really important.”

As the federal government leads education efforts in New Hampshire, Vermont continues to update information about the final plans and rates that will be offered to residents. Vermont is relying on its website, VermontHealthConnect.gov, to pass along many of these details and in September, it will open a call center for people who have questions. The state is also working with 18 organizations to train navigators to meet in-person with the estimated 270,000 people who will use the exchange.

In an email to the Valley News, Anthem spokesman Chris Dugan said the company was working with New Hampshire’s Department of Insurance to make sure the plans offered on the exchange were ready by Oct. 1. Once federal officials give final approval, Anthem will lead “an extensive public awareness campaign to inform and educate our current members as well as potential members” about the options they’d have available to them, Dugan said.

Still, health and insurance officials are skeptical about whether New Hampshire’s exchange will be ready by Oct. 1.

Ray White, an insurance broker in Bedford, N.H., who is on the advisory committee for New Hampshire’s health exchange, said he has been warning his clients to be prepared for the possibility that the system won’t be running by October.

“I’m not laying my hat on it,” he said. “I’m telling my clients that I really think you’re going to be in the commercial market for another year and telling them to be careful about being an early adopter.”

Weinstein, of Dartmouth-Hitchcock, also said he was concerned about New Hampshire’s progress, and especially in the scant information available to consumers.

“One of the failures of some of the legislation is the lack of communication about how any of this works,” he said. “I think it causes fear in people, not knowing. The sooner we get the facts on the table so the consumers can understand them and make informed choices, the better.”

Chris Fleisher can be reached at 603-727-3229 or cfleisher@vnews.com.