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Breaking Down A Big Day In Health News

A big day in the world of health policy, nationally and in New Hampshire. State regulators are still trying to gauge how to handle the President’s offer to let consumers keep canceled insurance plans. And in Concord, lawmakers continue to negotiate over Medicaid expansion, one week into a special session. NHPR’s Health Reporter Todd Bookman talks with All Things Considered Host Brady Carlson.

BC: Let’s start with Medicaid. Today is the halfway point of a two week long special session that will decide if and how the state expands the health program for the poor…so, where do things stand?

TB: Up in the air, Brady. There are still two different bills, one in the House, one in the Senate.

The plans essentially start in the same place. Anyone who makes under about $16,000 a year would be eligible for Medicaid in 2014. If they already get insurance through their job, they would have to keep that insurance, however.

Everyone else, and we are talking roughly 30-35,000 currently uninsured, would enroll in one of the new managed care plans that all current Medicaid recipients are transitioning into at the moment.

Here’s where things differ.

Republicans in the Senate want to move that group into the exchange after one year…so the federal government would basically be paying for them to buy insurance through the private marketplace.

BC:  And what are the Democrats proposing?

TB: The Democrats, being led by Governor Hassan, put forward an offer yesterday that moves them toward the same basic concept, but on a different timeline.

They say that rushing to move people into the exchange in one year may not give enough time for other insurers to begin selling products on the exchange. Anthem, you’ll recall, is the only vendor in 2014. There’s no guarantee that other insurance companies are going to start selling plans in 2015, though an extra 30,000 potential customers would likely entice some. But it takes months, if not longer, to get plans negotiated and priced and approved by regulators.

So, Democrats want to slow down that transition to the exchange.

The Senate says if the will is there, New Hampshire can make this work.

BC: So it doesn’t sound like the two sides are too far apart?

TB: That’s actually tough to know.

While we had hearings today where committees approved these two concepts, the real negotiations continue to take place behind the scenes.

There will likely be public posturing right up until November 21st, when a final vote takes place. Indeed, the Governor has scheduled a press conference tomorrow morning on this issue. But, still unclear where this thing will end

BC: Alright, well, the other big news today is the President’s announcement that he will let insurance companies keep selling policies that don’t meet the new regulations of the Affordable Care Act for an additional year. How does this impact New Hampshire?

TB: Anthem, the state’s largest carrier sent out cancelation notices to 22,000 customers last month.

But we don’t yet know for certain if those customers will be allowed to keep those plans.

Here’s why: the President is leaving it up to state insurance regulators to make the final call on if insurance companies can still offer the old plans. New Hampshire’s Insurance Department hasn’t yet made an announcement on what it plans to do. They say they are still weighing the options.

BC: Why wouldn’t the insurance department go along with the President?

TB: The concern that regulators may have, and that insurance companies are certainly expressing, is that if you let people that like their current plans keep their current plans, it alters the risk pool. That is, healthier people may hold onto their bare bones plans that don’t meet the new mandates of the law. That puts sicker people into the marketplace, since they likely want the better protections and lower out of pocket costs available if you shop through the exchange.

That could impact premium costs down the line.

Washington State’s insurance commissioner already announced that his state will not allow these canceled policies to be extended. We should learn tomorrow what New Hampshire is going to do.

BC: But if you renew your policy, it means you can’t access the tax subsidies that become available on January 1st.

Right, you couldn’t get those tax subsidies

The other thing to remember is that whether New Hampshire decides to take the President up on his offer, tomorrow, November 15th, is the current deadline for people who want to renew their current plans.

For people concerned about the narrow network--the fewer hospitals in Anthem’s plan starting next year--that may be a good option, but again, you can’t get subsidies if you renew by tomorrow on those products.

Todd started as a news correspondent with NHPR in 2009. He spent nearly a decade in the non-profit world, working with international development agencies and anti-poverty groups. He holds a master’s degree in public administration from Columbia University. He can be reached at tbookman@nhpr.org.
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