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New Hampshire health insurance

NH rolls out ‘private option’ Medicaid expansion in 2016

New Hampshire residents enjoy very good health relative to much of the country, and the state’s recently expanded Medicaid program is now providing realistic access to health insurance for many low-income residents. Public health and leadership’s stance on healthcare reform are significant factors that play a role in quality of life, productivity, and health outcomes.

Here’s a summary of how New Hampshire compares with other states in terms of overall health, access to health insurance, and the state’s approach to healthcare reform:

New Hampshire health ratings

In 2015, New Hampshire was ranked 5th out of the 50 states and the District of Columbia by The Commonwealth Fund’s Scorecard on State Health System Performance. The state performed in the top quintile for four out of five measures: Access, Prevention & Treatment, Healthy Lives, and Equity. It placed in the second quintile for Avoidable Hospital Use & Costs.

In the Access category, New Hampshire scored well for its below-average uninsured rate and factors related to the cost of care and preventive care visits.

New Hampshire’s scorecard provides more specific details about public health in the state and how the overall score was determined.

New Hampshire took 5th place in America’s Health Rankings 2015, too, this time out of the 50 states and not including DC. The state ranked well for access- and affordability-related measures such as lack of health insurance, dentists, immunizations, children in poverty, disparity in health status, clinical care, and primary care physicians.

However, it placed 33rd for three measures: public health funding, excessive drinking and salmonella – 33rd was New Hampshire’s lowest placement for any measurement.

Trust for America’s Health provides yet another look at overall public health in New Hampshire in their 2016 listing of Key Health Data About New Hampshire. Their summary includes socioeconomic health indicators, access to care, and the prevalence of various illnesses and health outcome predictors.

You can also see how the ten counties in New Hampshire compare with one another in terms of health factors and outcomes, using this interactive map created by the Robert Wood Johnson Foundation. No single area of the state stands out as better or worse than any other; high and low ranking counties are dispersed throughout the state.

Carriers and rates in NH individual market

When 2017 open enrollment begins, individual plans will be available from five carriers in New Hampshire. All five carriers offer plans both on and off the exchange and are the same carriers that offered plans in 2016:

  • Ambetter by Celtic
  • Anthem Blue Cross Blue Shield of New Hampshire
  • Community Health Options (previously known as Maine Community Health Options/MCHO)
  • Harvard Pilgrim Health Care of New England
  • Minuteman Health

In 2017, there will be four dental carriers offering plans through New Hampshire’s exchange. They include Anthem and Delta, which are new to the exchange for 2017.

How has Obamacare helped New Hampshire residents?

New Hampshire operates a state-partnership exchange and expanded Medicaid, both typical of states that have embraced the Affordable Care Act.

Before the ACA was implemented, the uninsured rate in New Hampshire was 13.8 percent, lower than the national average in 2013. By the end of June 2014, six months after full Obamacare implementation, 12.4 percent of New Hampshire residents were uninsured at the end of June 2014.

That rate has continued to drop, and as of late-2015 had reached 8.8 percent – a total of five percentage points lower than one year before Obamacare took full effect. Nationwide, the uninsured rate dropped from 17.3 percent to 11. 7 percent within the same time period.

New Hampshire enrollment in qualified health plans

In late 2013, the Kaiser Family Foundation estimated that the potential market for New Hampshire’s health insurance exchange was 137,000 people and that about 81,000 of them would qualify for premium subsidies. By June 2015, nearly 45,000 people were enrolled in qualified health plans (QHPs) through the state’s exchange, and nearly 63 percent of them were receiving premium subsidies.

The New Hampshire exchange had just one carrier – Anthem Blue Cross Blue Shield – in 2014. Anthem had 90 percent of the market share in the state prior to 2014, so the fact that only one carrier participated in the first year didn’t substantially changed things for most customers in New Hampshire. But starting in 2015, there was far more competition and plan choice in the New Hampshire exchange, with five carriers participating in the exchange in both 2015 and 2016.

At the end of the 2016 open enrollment period, New Hampshire’s total enrollment in QHPs reached 49,853. There were 41,798 people enrolled in New Hampshire’s Premium Assistance Program, PAP.

New Hampshire and the Affordable Care Act

In 2010, New Hampshire’s U.S. Senators were split on the ACA. Democrat Jeanne Shaheen voted yes, while Republican Judd Gregg voted no. In the U.S. House, Carol Shea-Porter and Paul Hodes, both Democrats, voted yes. Shaheen is still in the Senate, but Gregg has since been replaced by Kelly Ayotte, a fellow ACA opponent. In the House, Ann Kuster replaced Hodes in 2013. She is an ACA supporter who wants to keep the law but improve upon it.

In the 2014 Senate race, Shaheen was one of relatively few Democrats who fully embraced the ACA and the changes it has brought about. She defended the law, saying it was “absolutely” an achievement of which she is proud. Shaheen won re-election against Republican opponent Scott Brown in 2014.

At the state level, the legislature is politically split, with a Republican majority in the Senate, and a Democratic majority in the House. Governor Maggie Hassan, a Democrat, took office in early 2013. She is supportive of the ACA, and shortly after taking office she confirmed that the state would work with HHS to operate a partnership exchange in New Hampshire.

Hassan also prevailed in expanding Medicaid under the ACA, although New Hampshire is one of five states utilizing a unique approach to Medicaid expansion that involves subsidizing private health insurance for low-income residents – there are currently five states using the private option for Medicaid expansion, but Iowa announced in July 2015 that they will switch to a more standard approach to Medicaid expansion as of January 2016.

New Hampshire Medicaid/CHIP enrollment

New Hampshire is one of four states that expanded Medicaid in 2014 following a path that differs from the straight Medicaid expansion outlined in the ACA. Senate Bill 413 was signed into law by Governor Hassan in March 2014, and called for Medicaid expansion to begin that summer, with residents able to begin applying on July 1.

The Kaiser Family Foundation estimated that about 39 percent of the uninsured population in New Hampshire would be eligible for Medicaid starting in July 2014. There is no longer a coverage gap in the state now that New Hampshire has become the 26th state to expand Medicaid under the ACA.

As of August 8, 2014, the state reported that 9,399 people had enrolled in expanded Medicaid in the preceding five-and-a-half weeks, with coverage set to go into effect on August 15. That number was significantly more than the 7,235 people who had enrolled in Medicaid through the New Hampshire exchange by mid-April, before the expanded eligibility guidelines went into effect.

By August 2015, total New Hampshire Medicaid enrollment had grown 47 percent since 2013 — the 12th biggest change nationwide.

Until the end of 2015, Medicaid expansion in New Hampshire was following the program outlined in the ACA, and all legal residents with household incomes up to 138 percent of poverty were eligible to receive Medicaid coverage.

But starting in January 2016, the state transitioned to a privatized version of Medicaid expansion (i.e., Premium Assistance Program), using Medicaid funds to subsidize private coverage. As of March 2016, New Hampshire’s PAP enrollment through the exchange stood at 43,732.

Does New Hampshire have a high-risk pool?

Before the ACA reformed the individual health insurance market, coverage was underwritten in nearly every state, including New Hampshire. This meant that pre-existing conditions could result in an applicant being rejected for coverage, or offered a plan with significantly higher premiums or policy exclusions. The New Hampshire Health Plan (NHHP) was created in 2002 to provide an alternative for residents with pre-existing conditions who were not eligible to purchase private individual health insurance because of their medical history.

But the ACA brought significant changes to the individual health insurance market, including a ban on medical underwriting; all policies are now guaranteed issue, in all states. This meant that high-risk pools are no longer necessary the way they once were, since applicants with pre-existing conditions now have the same insurance choices as the rest of the population.

NHHP was originally slated to cease operations at the end of 2013, but the troubled rollout of Healthcare.gov meant that many members were unable to purchase new coverage by the start of 2014. As a result, NHHP continued to provide coverage until June 30, 2014. At that point, any remaining policies terminated, giving members a 60-day special enrollment period during which they could purchase a new plan (involuntary loss of other coverage is a qualifying event that triggers a special enrollment period).

Medicare enrollment in New Hampshire

New Hampshire Medicare enrollment reached 266,210 in 2015, nearly 20 percent of the state’s population compared with 17 percent of the total U.S. population enrolled in Medicare. New Hampshire is tied with six states for the highest percentage of population enrolled in Medicare.

As of 2013, the percentage of New Hampshire Medicare enrollees who qualified based on age alone was 82. The balance was eligible for Medicare as a result of a disability.

New Hampshire ranked 40th in terms of overall Medicare spending with $1.9 billion per year in 2009. Annually, Medicare spends about $7,602 per enrollee in the state compared with an average of $8,970 nationwide.

New Hampshire Medicare recipients can select a Medicare Advantage plan instead of original Medicare if they wish to gain some additional benefits. Only 7 percent of New Hampshire beneficiaries choose Medicare Advantage instead of traditional Medicare coverage. Only two states, Wyoming and Alaska, have a smaller population enrolled in Medicare Advantage.

Fifty-seven percent of New Hampshire Medicare recipients are enrolled in Medicare Part D plans, which provide stand-alone prescription drug coverage. Forty-five percent of all Medicare enrollees have Medicare Part D plans.

State-based health reform legislation

In addition to the bill that expanded Medicaid in New Hampshire this year, the legislature was quite active on health and healthcare reform. A variety of bills were introduced during the 2015 legislative session, including establishing a single-payer system and allowing individuals and small business to buy coverage from out-of-state companies. There was also a failed effort to legalize the sale of policies that don’t conform to the ACA’s coverage mandates.

Here’s a summary of health reform-related bills in New Hampshire:

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