EagleTribune.com, North Andover, MA

September 6, 2013

Parkland excluded from program under the Affordable Care Act

By John Toole

---- — DERRY — A new program to cover uninsured people in New Hampshire, proposed under the federal Affordable Care Act, excludes a dozen hospitals, including Parkland Medical Center.

That could mean people who sign up for the program have to leave Derry to get health care or use a different doctor, officials said.

“I wasn’t happy about it,” Rep. Frank Sapareto, R-Derry, said yesterday after learning Parkand is out. “You can’t cut out that many providers and say we’re going to keep our own physician.”

Sapareto planned to raise the issue with fellow Republican legislators yesterday at the Statehouse, but was unsure what they can do.

Rep. Robert Fesh, R-Derry, also was displeased.

“I can’t see why Parkland is not there,” Fesh said. “I’ll be checking into it.”

Sen. Jim Rausch, R-Derry, could not believe the results of the federal law.

“My feeling is if this is the only way they can make health care affordable and accessible, then they’ve failed on all fronts,” Rausch said.

Parkland is Derry’s hospital and it’s just wrong if residents have to go elsewhere for care, he said.

“That’s a failed system,” Rausch said. “Some people may not be able to get there.”

At this point, Rausch said, state lawmakers would have to turn to the Congressional delegation and appeal to them to stop the law.

Anthem Blue Cross and Blue Shield is the only insurer participating in the New Hampshire insurance exchange.

Anthem officials this week told a legislative health care committee the company would exclude about a dozen of the state’s hospitals, including Parkland.

“Anthem is choosing to offer this select network of providers to offset the premium increases that would otherwise be necessary,” the company said in a press release issued yesterday.

Participants would save about 25 percent with the smaller network, Anthem said.

The company pledged a campaign to educate customers once the federal government approves the proposal.

The federal law is intended to provide health care coverage to people who are uninsured.

The issue with Anthem does not affect people who have insurance through their workplace, but it could affect people who purchase insurance on their own outside the exchange, officials said.

Because state insurance regulators knew what was happening, political leaders in Concord are sparring over the situation.

“It is troubling the executive branch knew about these impending reductions for over two months, saw fit to send to the federal government for approval, and through it all said nothing to the people who will be directly affected by the changes,” Senate President Chuck Morse, R-Salem, said in a prepared statement.

Morse said he looked forward to working with the governor’s office and the Insurance Department to understand why the restrictions are necessary.

Marc Goldberg, a spokesman for Gov. Maggie Hassan, said state insurance regulators are only able to review such a plan for adequacy under state standards and can’t disclose proprietary information about insurance networks.

“We have encouraged Anthem to quickly and clearly provide information to consumers, legislators and all stakeholders about the scope of their network,” Goldberg said, “as well as how they intend to reduce costs and ensure the affordability of the insurance products they intend to offer.”

The governor’s office lashed out at Republicans, claiming they have impeded and obstructed implementation of a health benefit marketplace in the state.

There may be developments later this month that could give consumers other options.

“Help could be on the way, right away,” said Lisa Kaplan Howe, policy director with New Hampshire Voices for Health, a group advocating for affordable health care options for consumers.

Howe said plans for a multi-state insurance exchange could be announced by mid-month, though it’s uncertain whether New Hampshire will be included.

“Coming down the pike are multi-state plans,” she said.

Federal approval of the New Hampshire exchange is expected by October. People would get insurance starting Jan. 1.

The controversy at the Statehouse underscored the rapidly changing insurance and health care landscape.

“2014 is kind of an initial year we can learn from and grow from,” Howe said.

“This is kind of an evolutionary process,” New Hampshire Hospital Association vice president Paula Minnehan said. “Come 2015, it could be a very different landscape.”

Other insurers could get into the New Hampshire exchange a year from now. Harvard Pilgrim Health Care has signaled it wants to join.

With hospitals on either side in the Anthem dispute, the state association isn’t formally taking a position. But Minnehan said the group does have concerns about a limited network and what it means for consumers used to getting care in the community.

“This is a very big change for us,” she said.

But limited networks are not unprecedented in New Hampshire and are in place in other states, Howe said.

People may have to drive to Manchester or Nashua with their coverage, she said.

“This is something people may need to get used to,” Howe said.

About 11 percent of the state’s population, 130,000 to 140,000 people, are estimated to be uninsured, she said.

The exchange controversy is unrelated to emerging Medicaid expansion under the federal law, Minnehan said.

Parkland Medical Center did not respond to requests for comment.