CONCORD, N.H. -- New Hampshire has taken two significant steps in implementing the Obama administration’s health overhaul law, though there’s a lot left to do and not a lot of time to do it.
Gov. Maggie Hassan recently announced that New Hampshire will partner with the federal government to operate the new insurance markets required under the law, and she wants to take advantage of the federal government’s offer to temporarily cover the cost of expanding the state’s Medicaid program. In both cases, going further requires the approval of other parties, however.
The Legislature has the final say over whether to expand Medicaid to include poor adults in addition to the children, pregnant women and other groups who are currently covered. And while the federal government has awarded the state some funding to set up the insurance markets, known as exchanges, the Legislature’s joint fiscal committee and the governor’s Executive Council must approve spending any of the money.
"The next steps for New Hampshire pursuing a federal-state partnership health benefit exchange that will protect state control over our health insurance market include applying for federal grants and negotiating with the federal government about exchange details," said Hassan’s spokesman, Marc Goldberg.
The markets will offer individuals and their families a choice of private health plans resembling what workers at major companies already get. The government will help many middle-class households pay their premiums, while low-income people will be referred to safety-net programs they might qualify for. Enrollment starts Oct. 1 with coverage taking effect Jan. 1. After that, virtually everyone in the country will be required by law to have health insurance or face fines.
To help meet those deadlines, New Hampshire has a health exchange advisory committee that includes a mix of members representing the public, health care providers, insurers and businesses. Most of the 12 members supported Hassan’s decision to have the state enter into two types of partnerships: a planned management partnership that would make the state responsible for regulating insurance companies and the plans they offer under the exchanges and a consumer assistance partnership that would involve helping consumers access the exchange.
"Rather than leaving all of the funding for implementing this in Washington, having some of it come back to the state and allowing us to control our destiny is a positive development," said Russ Grazier of Portsmouth.
Grazier, a musician and director of the Portsmouth Music and Arts Center, is uninsured himself. He said he is particularly happy that the consumer assistance partnership is going forward because one of his key concerns is how the public will get up to speed on how to use the exchange.
"We’re on a very tight timeline, and the biggest concern is making sure the information is communicated effectively," he said.
A partnership approach will allow the state to tailor its education and outreach efforts rather than accept a "one-size-fits-all" package from the federal government, said Sandy Ruka, director of Home Care and Hospice of Carroll County. And she said the state has a solid, existing network of resources that could be tapped to play a role.
"If we really look at ourselves and our own communities, I think there’s a very good provider network that’s used to working collaboratively," she said.
But fellow committee member Raymond White thinks some groups may be a bit too eager to step up and collect the federal money. He described a flow chart committee members were given to explain how the partnership would work, saying it amounted to lots of money going every which way.
"Quite frankly, it looked like a bonanza for (advocacy) groups," he said. "We have all these groups that it seems are always hungry for funding, but I don’t think that’s the way to go."
White, a former state senator who runs an insurance company, accepted the idea of a planned management partnership but doesn’t like the consumer assistance piece. His main complaint is that the system remains largely undefined.
"It has the potential for spending a lot of money on infrastructure, and that’s money that’s not going to be spent on health care," he said.
He also worries about the effect on his business, which focuses on insuring small businesses with fewer than 20 employees. Brokers like him could end up cut out of the delivery system, he said.