Limited Health Care Options Coming to Some

One of New Hampshire’s largest insurers confirmed what many conservatives had expected and believed: When the Affordable Care Act is implemented next year, not only will people be forced to buy insurance, but people who need subsidies will not be able to access care at the hospital closest to their homes.

The Health Care Reform Oversight Committee on Sept. 4, featured testimony by a New Hampshire Insurance Department official and officials from Anthem Blue Cross Blue Shield, about the upcoming changes in health insurance coverage for many people currently without coverage.

Under the ACA, Americans without insurance will be forced to purchase a plan or be subject to fines. People needing insurance who are earning 400 percent above the poverty level will get access to plans that will be subsidized at various levels. There will also be non-subsidized plans available for those without insurance or above the income threshold.

However, the only company offering subsidized plans through the exchange, Anthem, has made side agreements with a little more than half the state’s hospitals, limiting coverage to thousands of potential new customers. Hospitals that have not signed onto the agreement will not be able to accept Anthem for coverage and those patients won’t be able to see doctors outside of the new network in 2014.

Hospitals that will not be covered by Anthem exchange plans include Concord Hospital, HealthSouth Rehabilitation Hospital of Concord, New Hampshire Hospital in Concord, Northeast Rehabilitation Hospital in Salem, Parkland Medical Center in Derry, Portsmouth Regional Hospital in Portsmouth, and Southern New Hampshire Medical Center in Nashua, as well as others.

Paula Rogers, the director of government affairs for Anthem, confirmed that the company had made contract agreements with 14 of the state’s 26 hospitals in an effort to contain costs while ensuring that hospitals in the agreement had “some expectation of increased volume” in the wake of those hospitals agreeing to lower prices for Anthem. She said many policyholders would be grandfathered in for a short period of time. As well, exceptions would be made for emergency situations, or current care situations, like a woman who is pregnant who switches providers between now and then. Rogers added that she was expecting “some consumer pushback” after the details of the plans are approved by the federal government in the coming weeks. The plan won’t also be put into place until January 2014, she said.

The state had already approved of the plans, according to Jennifer Patterson of the New Hampshire Insurance Department, but she said she wasn’t at liberty to discuss the details until October, calling the information “proprietary.” She added that she could only acknowledge that Anthem was a participate because it had become "common knowledge," but other information was not. 

Republicans on the committee were critical of the news, with state Sen. Andy Sanborn, R-Bedford, saying it proved that the president lied when he said that ObamaCare would allow people to keep their own doctors or hospital. He questioned the legitimacy of not being able to talk about the specifics when hospital officials in his district were calling to complain about the network limitations.

“There are hospitals no longer in the network … insurance brokers that are concerned … define to me what is common knowledge,” he said. “It’s 24 days out … we have an obligation to talk about this.”

State Sen. Jeb Bradley, R-Wolfeboro, said it seemed to go against the commitment that the federal plan wouldn’t ration care, calling the plan “controversial and confusing” especially in the wake of higher premiums and “elimination of choice.”

However, state Rep. Ed Butler, D-Hart’s Location, countered that the plan was being put in place to control costs and not to have 15 to 20 percent increases.

“In order to do that, you need this network of hospitals (and) you will guarantee them increased volume of consumers,” he said. “In return, they will control their costs.”

Details about potential plans, plan management, and costs of premiums, copays, coinsurance, and deductibles for Anthem or other potential carriers are not yet known at this time. However, the rates and information is expected to be available in October.