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After Abortion Concerns Alleviated, Lawmakers Select Insurance Model

Alex E. Proimos
Flickr/Creative Commons

The Affordable Care Act says that every state has to select a health plan that will basically serve as a model for other plans.

So, if the model plan covers, say, infertility treatment, eyeglasses or autism services—those same benefits must be included in other plans.

This requirement only applies to the individual and small group markets, where about 200,000 New Hampshire residents shop for insurance.

It’s up to the Joint Health Care Reform Oversight Committee to pick the model plan. And Republican Representative John Hunt wasn’t thrilled with having to choose these minimum benefits.

"We are making a choice that none of the choices are good choices. All are painful decisions. All are choices that we’d just as soon not have to make. We feel this is once again, one of the problems of the Affordable Care Act is they are asking the states to do things they don’t want to do, and certainly I myself, and this committee, don’t want to make this decision."

But with a September 30th deadline looming, the Committee hired a consulting firm to help analyze its options.

The three finalists were HMO Blue New England, Matthew Thornton Blue, and GEHA, the plan federal employees in New Hampshire get.

All three plans cover different services and have different price tags. After crunching the numbers, the consultants reported that Matthew Thornton would be the least expensive option.

That was enough to get the support of Senator David Boutin, a Republican from Hookset.

"We are trying to drive down cost for our constituents and small businesses and make it affordable. It was the smart thing to do."

Matthew Thornton is sold by Anthem, and covers those infertility treatments, eyeglasses and autism services.

But it also covers abortions, and that made selecting it a potential political red herring this election season.

The worry is, if the model plan covers abortions, then all other plans in the individual and small group markets, would also have to.

Or at least, that’s what lawmakers like John Hunt feared.

"Many of the Committee members are very uncomfortable with that decision," says Hunt. "I myself, am certainly pro-choice, but I am not about to go voting to mandate abortion coverage for every insurance company."

But Alex Feldvebel with the NH Insurance Department looked into the question, and found that abortion is not part of the Essential Health Benefits question.

"Choosing a benchmark that covers abortion services does not mean that you, that abortion health services are part of the essential health benefit package, because they are not. The ACA sort of carves that question out, and leaves it separate."

That means health insurance companies will continue to have the choice in whether or not they cover abortion.

And with that reassurance, the Committee selected Matthew Thornton on a 5-to-1 vote.

But uncertainty about the entire process, from selecting these benefits, to how insurance exchanges will function in New Hampshire, left many on the committee frustrated with the ACA.

Senator Boutin offered this analogy.

"For me, it’s like driving down I-93 in the middle of the night with my headlights off."

Matthew Thornton will serve as the benchmark in New Hampshire through 2015, when the Feds will revisit this issue.

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.

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