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Few in N.H. Understand Health Plan

Survey: Residents Do Not Know Much About Exchange Options

Concord — As New Hampshire prepares for the new insurance markets required under the federal health care overhaul, a recent survey highlights how little residents agree on or even know about the looming changes.

New Hampshire Voices for Health — a network of more than 40 organizations that advocates for affordable, quality health care — hired an independent consultant to design and administer an online survey seeking input on how the marketplace should operate in New Hampshire.

State insurance and health and human service officials helped develop the questions. The survey was distributed in late January to industry associations and advocacy groups representing health care providers, insurers, consumers and businesses, with requests that it be shared widely both within and outside each organization.

By the time the survey ended early this week, 648 people had responded, according to results provided to The Associated Press. And while the survey was unscientific, its findings suggest that much work remains to be done to inform and educate businesses about the health insurance marketplaces, which will offer consumers one-stop shopping along the lines of amazon.com.

“Those who live in this bubble of hearing about the marketplace all the time forget that the vast majority of the people in the state know very little about it,” said Lisa Kaplan Howe, policy director at Voices for Health. “Those of us who’ve spent a lot of time thinking about it can envision it, but otherwise you’re talking about something very amorphous.”

Under the new health care law, middle class people will be eligible for tax credits to help pay for private insurance plans, while low-income people will be steered to safety-net programs such as Medicaid. Enrollment begins Oct. 1 for coverage that takes effect Jan. 1, the day when a mandate that nearly all Americans carry health insurance kicks in.

Because a state law prohibits New Hampshire from building its own market, the state will have a federally run system, though the state will partner with the federal government to regulate insurers and provide consumer assistance. But many details have yet to be worked out, leaving some survey participants frustrated.

“It is currently a mystery to me how this will work out,” wrote one small business owner who employs mostly seasonal workers.

Another participant, who plans to retire in July and then seek coverage through the market, described a fruitless search for information.

“I have tried to do my homework but everyone (insurance companies, state insurance reps, my human resources dept.) tells me that they have no information and will not have any until at least October. This leaves me unable to plan,” the survey participant wrote.

A third participant rattled off a string of unanswered questions and expressed concern that education and outreach efforts would fall short.

“Personally, I hope I do not have to purchase health insurance through the exchange but if I am required to I would probably cry first, then attempt to sort out my options,” the survey participant wrote. “Stress would be running high.”

Those kinds of comments, and similar testimony given at a public hearing earlier this month, highlight the urgent need for consumer assistance efforts that will “reach people where they’re at,” Howe said.

“People might not even know to come for assistance,” she said. “Taking a step back from educating them, we need to make sure they know a marketplace even exists.”

Confusion aside, there was some consensus among survey participants in some areas. Asked how much the marketplace should prioritize a series of characteristics, more than 90 percent said providing people with accurate, easily comparable information about health plans should be a high priority.

And most participants said they don’t trust the government to provide them with information about the marketplace and their health plan options. About 40 percent said they would trust a local nonprofit group, compared with 14 percent who said state officials and 9 percent who said federal officials. Other groups, including the media, health care providers and insurance brokers, were viewed as even less trustworthy.

More than half the participants said there should be a balance between making a lot of insurance plans available so people have as many choices as possible and making sure the plans are standardized and limited so people can easily compare their options.

They disagreed on whether all health insurers should be required to sell plans through the marketplace — half said yes, but a third said they didn’t know.

Maria Sillari said she sent the survey to several hundred friends and associates and was shocked at how many told her they either had never heard of the marketplace or exchange concept or had trouble answering questions because they knew little about it.

“I don’t feel like I know a lot about it, but I’ve certainly been hearing about it in the news, so I was surprised that people didn’t understand that this was part of the Affordable Care Act,” she said. “For the most part, the people I sent it to are working, they’re pretty well educated, they listen to the radio and read the newspaper, so I wonder about all the people who don’t fit that criteria.”

Sillari is on the board of directors of Womenaid of Greater Portsmouth, a small, all-volunteer group that provides up to $500 to individuals and families who are referred by social service agencies because they need a bit of help making ends meet.

She previously spent 15 years working for the United Way, and said in both jobs, she has seen that even when resources are plentiful, those who need help often aren’t aware of their options. And that makes her worry that people will have trouble finding and accessing the health marketplace.

“It’s coming, and it’s coming fast, so it’s disconcerting that people don’t know about it,” she said.