By Louise Norris
March 3, 2014
By February 1, the number of people who had made their plan selections in the New Hampshire exchange had grown to 16,863 – an increase of more than five thousand people since the end of December. 26% of them had enrolled without any financial assistance. Another 4,734 applicants were eligible for Medicaid coverage. After four months of open enrollment, only 20% of enrollees were between the ages of 18 and 34, but New Hampshire still has plenty of potential to attract “young invincibles”. The uninsured demographic in NH tends to be male and younger than the national average: 55% of the uninsured in NH are under age 40.
The state-federal partnership exchange in New Hampshire uses Healthcare.gov as its online enrollment portal, so residents initially had difficulty enrolling due to the initial technological glitches in the federal site. On November 22, New Hampshire’s Insurance Commissioner Roger Sevigny announced that the state-run high risk pool will remain in effect “until the federal marketplace is fully available (it had previously been scheduled to cease operations on December 31). The most recent update on the New Hampshire Health Plan (the state’s risk pool) website is still dated November 27, and informs members that there is not yet an end date scheduled for the plan in 2014, but that members will receive at least 60 days notice before the plan ends.
New Hampshire allowed existing 2013 health plans to renew until late 2014, but residents also had the option to cancel their existing plan and switch to a new ACA-compliant policy instead.
Although New Hampshire has not opted to expand Medicaid under the ACA’s guidelines, the state legislature met in late November for a special session to consider the possibility of expanding Medicaid to 50,000 state residents who would otherwise be likely to remain uninsured. Ultimately, the Republican Senate refused to go forward with Medicaid expansion, but Democratic Governor Maggie Hassan and Democratic lawmakers have vowed to try again in 2014.
The New Hampshire Health Plan, which runs the state’s high-risk insurance pool, was approved in September for a federal grant to help facilitate education and outreach for the exchange. In addition, Planned Parenthood and Bi-State Primary Care were both awarded grants to serve as navigators for NH residents who have questions or need personal assistance with the enrollment process.
The exchange creation process in New Hampshire has been a legislative battle. In February 2013, Gov. Hassan announced that New Hampshire would operate its health insurance marketplace as a partnership with the federal government. Prior to the 2012 elections, New Hampshire seemed firmly on a path to relying on the federally facilitated exchange. Former Democratic Gov. John Lynch had no effective means to push back against a Republican-dominated state Legislature that was united against a state-run exchange. The 2012 elections gave control of the state House to Democrats, put more Democrats in the Senate, and kept the governor’s office in Democratic hands. The political shift and a law that allowed the state to take on specific exchange functions enabled the state to adopt a partnership model.
New Hampshire is responsible for plan management and consumer assistance, and the federal government is managing all other marketplace functions. The NH Health Exchange Advisory Board holds monthly meetings, the minutes of which are available here.
Only one insurer — Anthem Blue Cross — applied to participate in the exchange in New Hampshire, and currently offers 11 health plan options. Harvard Pilgrim plans to participate in 2015, and Minuteman Health also announced in late December 2013 that it will participate in the exchange in 2015. Officials hope that additional insurers, including MVP Health Care, might also join the marketplace in 2015. New Hampshire consumers can compare plan options and premiums and submit an application for coverage at www.healthcare.gov. Despite the fact that the exchange has just one carrier, premiums in New Hampshire are comparable to rates in states that have many carriers offering policies.
Anthem’s dominance of the New Hampshire individual market was not triggered by the new marketplaces: it already sells more than eight of ten individual policies. However, the company’s restrictions on its hospital and physician networks are drawing fire. Critics say the exclusion of 12 of the state’s 26 hospitals, which applies to individual policies sold on and off the marketplace, will force consumers to wait longer and drive farther to get care. Anthem countered by noting that the narrower provider network was key to keeping premiums as low as possible, since their negotiations with providers hinged on the promise of each hospital in the network getting more patients than they would with a wider network. This issue has continued to be contentious well into 2014. Communities in NH where the only local hospital is not on the network explain that it’s difficult to get people to enroll in coverage when they know that they have no local options for healthcare even if they do purchase coverage.
According to state officials, about 170,000 state residents do not have health insurance. About 65,000 people are expected to purchase coverage for 2014 through the marketplace.
New Hampshire Department of Insurance: Health Benefit Partnership Exchange Advisory Board
Includes meeting agendas and documents from November 2012 until the present.
State Exchange Profile: New Hampshire
The Henry J. Kaiser Family Foundation overview of New Hampshire’s progress toward creating a state health insurance exchange.
New Hampshire Consumer Assistance Program
Assists consumers who have purchased insurance on the individual market or who have insurance through an employer who only does business in New Hampshire.
(800) 852-3416 / firstname.lastname@example.org
Covering New Hampshire – a statewide effort by the New Hampshire Health Plan to inform residents of their coverage options in the exchange and the resources that are available for those who need assistance.
Let your New Hampshire governor and legislators know how you feel about the state’s proposed health insurance exchange.