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Tuesday, February 11, 2014

Opponents of limited ACA exchange in NH pack hearing to call for change

CONCORD – Doctors and patients and business and political leaders from across the state on Monday attacked Anthem Blue Cross Blue Shield’s decision to keep 10 hospitals out of the Affordable Care Act exchange in New Hampshire.

Executives with Frisbie Memorial Hospital in Rochester sought this public hearing before the Insurance Department on the network adequacy of Anthem, the only insurer offering health care for individuals and small business owners under the Affordable Care Act. ...

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CONCORD – Doctors and patients and business and political leaders from across the state on Monday attacked Anthem Blue Cross Blue Shield’s decision to keep 10 hospitals out of the Affordable Care Act exchange in New Hampshire.

Executives with Frisbie Memorial Hospital in Rochester sought this public hearing before the Insurance Department on the network adequacy of Anthem, the only insurer offering health care for individuals and small business owners under the Affordable Care Act.

Those from all walks of life in the Rochester area helped pack a state agency auditorium and consumed much of the more than four hours of public testimony.

They complained about having to travel longer distances to see a doctor, driving past local hospitals that can no longer accept them.

Others business owners warned about the devastating ripple effect this could have on the local economy.

“In approving a health care network without some of the most basic components required by the department for establishing network adequacy, the department failed the people of New Hampshire,” said Jeremy Eggleton, a lawyer representing Frisbie.

Southern New Hampshire Hospital in Nashua is among the hospitals left out.

Dr. Evan Greenwald with the Counseling Center of Nashua said patients having to seek a new mental health provider across the state will wait at least two, and up to six, months for their first appointment.

“There is no access to care anywhere in this state,” Greenwald told state regulators. “There are no beds available in the state of New Hampshire period. That is a serious problem.”

Anthem executives announced last summer that that they would agree to offer insurance in the exchange, but only if it included 14 of the state’s 26 acute care hospitals.

In response to criticism in the North Country, Anthem agreed to add two hospitals to its narrow network known as Pathways.

Without these changes, Anthem officials said the cost of coverage for these individuals and small-business owners would have been 25 percent higher.

Tyler Brannen, health policy analyst with the Insurance Department, said the delivery of health care has changed so much that hospitals no longer are the default settings.

“I would encourage people to think more about access to health care services than access to specific health care providers,” Brannen said.

Insurance Commissioner Roger Sevigny left the roomful of Anthem opponents a little hope that changes would come soon, confirming he would name a working group to try to rewrite the network adequacy rules for next year.

In 2015, Harvard Pilgrim Health Care and Minuteman Health Plans of Massachusetts have announced plans to enter the individual market in this state.

Congresswoman Carol Shea-Porter, D-N.H., said New Hampshire consumers should not have to wait.

“It is still outrageous some of them would have to drive further for care, driving past providers and hospitals that could serve them,” Shea-Porter said in a statement. “Anthem should widen its network now.”

Republican Executive Council candidate Joe Kenney, of Wakefield, announced that he’ll moderate a public forum on the topic Feb. 24 in Claremont.

“As someone who has served my country in three war zones, I never thought I would see this in America,” Kenney said.

James Miller, of East Wakefield, said state regulators need to look out for the public interest, not what’s good for corporate America.

“The larger issue here is whether it is to stand by the people or yield to the demands of big business,” Miller said. “We have been repeatedly shown that corporate America cares only for itself.”

Steve Hatem is with Core Benefits Group, an insurance management firm that works in 30 different states and said New Hampshire is the “most challenging” market it’s in.

But Hatem said it’s a lack of choice that’s at fault, not the targeted insurer.

“The problem is not Anthem; the problem is we have no competition,” Hatem said.

Sen. Andy Sanborn, R-Bedford, blamed it on changes in state insurance underwriting laws dating back to the early 1990s when more than two dozen health insurers operated in New Hampshire.

“We have continued to see less competition. We have continued to see less access, and we have continued to see higher costs,” Sanborn said.

Lisa Kaplan Howe, policy director of Voices for Health, said narrow networks can work but urged state regulators to respond to consumer complaints.

“We believe that changes to provider networks can be appropriately used to favorably impact health care costs while continuing to protect people’s access to quality and appropriate health care within a reasonable time and reasonable proximity to their home,” Kaplan Howe said. “However, it is critical that the right balance be struck and that attempts at affordability do not inappropriately impact access to care.”

Under current network adequacy standards, Anthem must offer at least two primary care physicians within 15 miles or a 40-minute drive for 90 percent of covered people in the state.

The rules allow for exceptions, particularly for the care of specialists who are not available in every county of the state or even all of the state’s largest cities and towns.

But Jennifer Patterson, an Insurance Department lawyer, said they do not guarantee any hospital or doctor to have coverage from any insurer.

“The rules do not require any particular carrier to contract with any particular provider,” Peterson said.

Kevin Landrigan can reached at 321-7040 or klandrigan@nashuatelegraph.com. Also, follow Landrigan on Twitter (@Klandrigan).