NH Health Care Exchange

I have been following national health care issues since 2009 long before there was a bill in the congress.  NH took one of the most aggressively negative positions during the last session of the legislature and is now far behind implementing the law.  Since December I have been attending the meetings of NH’s Health Exchange Advisory Board to monitor how transparent NH will be in establishing a Health Benefit Exchange.  Below is background on what an Exchange is, where NH stands in rolling out its Exchange, and some observations from attending the first three meetings. 

As part of the Affordable Care Act each state is required to have a Health Benefit Exchange operating within the state.  These Exchanges are meant to be one-stop online marketplaces where individuals and small businesses can buy health care insurance.  In addition individuals will be able to determine whether they are eligible for an insurance premium tax credit and/or cost-sharing subsidy, determine eligibility for Medicaid, and purchase health insurance.  

Each state is required to have an Exchange operational by October 1, 2013 in order to enroll applicants for health care insurance that will become effective Jan 1, 2014 when everyone is required by law to be covered by health insurance. Even members of Congress will receive their health insurance through an Exchange. 

There are three alternatives for setting up an Exchange in the states:

State Run Exchange -  The O’Brien led NH House passed HB1297 - a law that prohibits NH from establishing a state run Exchange.  NH was one of two or three states that turned down $1,000,000 grant to plan and operate an Exchange.  Even if the law were repealed tomorrow the money is no longer available and the deadline for notifying the Federal Government that NH desires to run its own Exchange has passed. 

Federally Facilitated Exchange (FFE) - if a state notifies the Federal Gov't that it will not be setting up a state run Exchange then the Federal Gov't will set up and run the Exchange for the state. 

State Partnership Exchange - partnership between the state and the Federal Gov't where the state will assume primary responsibility in operating certain functions of the Exchange.  In this model the state continues to be the primary point of contact for consumers and insurers.  States have until Feb 15, 2013 to notify the Federal Gov't that it wants to pursue a joint Federal-State Partnership.  There is grant money available for states opting for the State Partnership alternative. 

There are two areas where states can choose to partner: one is Plan Management goal is to preserve state insurance departments’ roles and responsibilities in insurance markets – including inside the Exchange - in order to ensure market parity inside and outside the Exchange and to guard against adverse risk selection within the Exchange.  There is a lengthy but well written document on Plan Management at the Georgetown Health Policy Institute website for those who like details. 

The other area of partnership is Consumer Assistance.  This is all about how residents of NH are made aware of the Exchange and how to use the Exchange to buy health care insurance. Staff will help individuals determine if they qualify for subsidies or for Medicaid.  They will also help small businesses determine how to apply for any subsidies they may be eligible for.  Consumer Assistance addresses the operational part of the implementation of the Health Care Exchange. 

Partial list of the role of the Federal Government’s role in a State Partnership Exchange: they will carry out all minimum Exchange functions not performed by states (such as enrollment, website, call center), and will be responsible for overall operation of the State Partnership Exchange. 

NH can move from a State Partnership Exchange overtime assuming it repeals HB1297 which precludes the state from implementing a State Run Exchange.  The earliest possible date would be Jan 1 2015, but that is highly unlikely give NH has barely started down the road of a State Partnership Exchange. 

During the 2011/12 session of the Legislature a NH Health Exchange Advisory Board was authorized with the mission statement: “Created for the purpose of advising the Commissioner [of the Department of Insurance] and the Commissioner of Health and Human Services regarding the interests of New Hampshire businesses and consumers with respect to any Federally Facilitated Exchange.“ 

Since the previous legislature was so anti-Obama anything and the belief that either the ACA would be ruled unconstitutional and/or Obama would not be re-elected no appointments were made to the Board.  Former Senator White of Bedford originally designed the Advisory Board to be 8 people 5 of them from the insurance industry.  Now that it is clear that the ACA is the law of the land the current make-up of the board is 12 persons, 4 each from the private sector, health care industry, and the insurance industry.  Somehow former Senator White has managed to be assigned as a member of the board which I believe is a conflict of interest and he should step down.

During the January 12th Advisory Board meeting there was much conversation around Customer Assistance.  At the end of the discussion the chair polled the room (as an Advisory Board they agreed not to vote but rather represent the position of their stakeholders) and everyone but one member strongly supported partnering on Customer Assistance.

The lone objection on the board came from former Senator White who happens to own an insurance brokerage firm.  His objection was that since 85% of NH residents had health insurance why focus all this effort on a 15% problem.

During the public session there was also a very strong objection raised by Tom Weldon, principle of Eaton and Berube an insurance company.  He claimed that NH would not be able to focus adequately on both areas simultaneously so it should only focus on planned management.

It seems that insurance brokers/agents feel threatened by the Exchange so they throw out spurious arguments to try to deflect NH away from the real issue of providing consumers with quality and timely information about buying health insurance.

The Commissioners of Health and Human Services, and Insurance Department will provide their recommendations on partnering with the Federal Government in the area of Planned Management and/or Customer Assistance to NH’s Joint Health Care Reform Oversight Committee and then on to the Governor. The Governor must notify the Federal Government by Feb 15th if NH will pursue the State Partnership alternative.  Best I can tell both the Insurance and Health and Human Services Commissioners will recommend partnering with the Federal Gov't for Plan Management.  They appeared to be looking to the Advisory Board for input on the Customer Assistance portion.

 I have no idea how the Commissioners will recommend on Customer Assistance Unfortunately the mission statement of the Advisory Board: “Created for the purpose of advising the...[Commissioners] ...regarding the interests of New Hampshire businesses....” is a higher priority than the “...interests of consumers.”

 One of the best sources for current information on NH Health Care Exchanges or any health care issue in NH is NH Voices for Health.

 The Advisory Board meets every 2nd Friday from 9:15am to 11:00am.  The next meeting is scheduled for Feb 8th; location will be made available on the Insurance Department’s website which also contains minutes, agenda, and appropriate documents

 I try to attend the meetings; if you can not make a meeting and have a question you would like brought up email me and I will see if I can ask it during the public session.

steve