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Virtual Town Hall: How Affordable Will The New Health Care Law Be For N.H.?


Now that the Affordable Care Act, or Obamacare, has launched, just how affordable will it make health insurance in New Hampshire? We hosted a special panel featuring Laura Knoy, host of NHPR's The Exchange, along with Tiffany Eddy of the Live Free or Die Alliance for a town hall discussion broadcast live on the web on Tuesday, November 19th. 

You can listen to the unedited audio from the event right here:

NHPR and the Live Free or Die Alliance co-sponsored this event, featuring a panel of experts who shared their thoughts about Obamacare's effects on New Hampshire businesses, health care providers, insurers, and residents.

The panel:

Lisa Guertin – President of Anthem Blue Cross Blue Shield in New Hampshire

Lisa Kaplan-Howe - Policy Director for New Hampshire Voices for Health, a non-profit consumer advocacy organization.

Steve Gerlach – A tax attorney at Bernstein Shur, he represents clients in matters pertaining to the Affordable Care Act

Rachel Verville - Vice President of Revenue Cycle at Elliot Hospital

This event will be broadcast on a special edition of The Exchange on NHPR on November 29th, at 9 AM and again at 8 PM.

Here is a live blog of questions answered by the panel:

6:58: Final question for all panelists: How will the success of ACA be measured?

Kaplan-Howe says primarily people will look to see how many people are covered and how much it costs. “But the analysis goes deeper than that.” People will look at the health of the health care system.

Verville says by how people are able to access their care, and by looking at data focusing on prevention

Gerlach says four factors: improving access, decreasing costs, keeping high quality and are people happy with it.

Guertin says, “It starts with access.” There’s a big picture we need to keep our eye one; in the short term, people need to educate themselves and make decisions on their health care.

6:56: Question about making costs of health care transparent. Verville says it’s a perennial problem for hospitals, “It is true some of the gross charges…there’s a chasm between that charge and what the actual payment is.” Hospitals need to focus more on outcomes.

Guertin says Anthem has been focused on preparing for ACA, but other strategic initiative is bringing real transparency tools to patients.

6:55: Kaplan-Howe on improving system, “There’s no doubt our health care system wasn’t working;” and I don’t think anyone thought this was going to completely fix that.

6:51: Question from the audience asks what we are doing to deal with structural issues of health care system? Gerlach says in Massachusetts last year, the sate acknowledged its health care law had not done much for health care savings. “It’s well known at this point that this (the ACA) isn’t the final solultion.”

Verville says it’s part of the overall conversation around health care. It’s “become more and more complicated every year. We really need to be taking steps toward fee for value.” Look for ways to meet the patients’ needs. “I do think this is an important part of helping us move toward that future.”

6:45: Question from audience asking with President Obama’s announcement of extension of law, what’s the impact? Verville says “it adds one more level of complexity.”

Kaplan-Howe says Obama’s announcement isn’t a huge change for New Hampshire because people had the option to early renew for their plans. “We want to make sure people are looking at all their options.” For some people, it may make sense to renew one more time, but there may be better benefits on the marketplace.

Guertin says many people have already elected to “grandfather” their plans; renewing early is the way to already keep their plans. We are looking at president's announcement to see if we need to do anything further.

6:44: Guertin says age of state plays into how costs are driven in New Hampshire. “The good news is that we are a healthier state than many.”

6:41: Gerlach on businesses cutting back hours, “I see employers considering it, which I think they should.” See very few actually cutting back hours and not making that extra hire, because there are other factors that come into play.

Kaplan-Howe says, “It’s one consideration;” but majority of employers offering coverage by choice. We’re not seeing a lot of that pan out.

Guertin says employers were taking a wait and see attitude in the first year; “Eventually, it will sort itself out. We’ll see different choices for different employers.” We’ve seen a lot of small employers lock into their plan now to avoid the 2014 mandates. 

6:39: Gerlach on how businesses feel about law, “I don’t think there’s a one-size-fits-all answer to that.” Certainly some out of the gates didn’t like it, including some restaurants chains, who said they would cut back hours. On the other hand, other employers way out in front of the law when it comes to complying.

6:37: Kaplan-Howe on decision for New Hampshire not to create own marketplace, the state has to work with what it has. “I think trying to make a change midcourse frankly just isn’t possible.” We should look at what a transition to state-based exchange means for New Hampshire.

6:36: Question via email, asks why are NH residents limited to Anthem? Guertin says the other carriers didn’t choose to participate in the exchange. “We felt as part of our commitment to the market...we decided it was important to do.” Certainly there are “plenty of people looking over our shoulders;” regulators, federal government. Rebate provision ensures customers get money back for overcharging.

Kaplan-Howe says there’s one carrier in the marketplace, but there are other carriers outside the marketplace, but "We all are hopeful more carriers will enter the marketplace."

6:31: Question from audience, why can’t insurance companies and hospitals meet halfway with respect to provider networks? Verville says she sees things moving in that direction. Guertin says she believes there will be people showing up in the marketplace that had been receiving charity care with health care plans; “meeting halfway” to her means taking a lower reimbursement for those patients.

6:26: Question from email, asking about whether encouraging more competition creates more affordability. Guertin says, “It’s not a straightforward economic principle.” In terms of having an immediate impact of lowering premiums, the principle doesn’t hold up very well.

Kaplan-Howe says she would agree competition functions differently in health care. “Having more options, having meaningful choice would be helpful, but I think it matters what type of competition we’re talking about.” If the insurance isn’t licensed by the state, you could have adverse effects.

Verville says unlimited choice “could add to patient confusion.”

6:25: Question from audience asks what happens to people if lawmakers fail to expand Medicaid; Gerlach says those not covered if Medicaid expansion fails, their employers may be required to cover them under the ACA. Kaplan-Howe says either way, those people are going to through private insurance plans; “It’s whether they’re through the Medicaid Managed Care program or the exchanges.”

6:20: Kaplan-Howe: “The cost is not just the premium.” Just having a health insurance card doesn’t do anything if you can’t access your care. “I am hopeful as the years move on that will change.” Small employers can now offer a choice to their employees.

6:20: Verville: It’s important for people to understand their costs; “There are maximums” for out-of-pocket expenses. Preventive measures are provided without cost to the patient and important to keeping the population healthy.

6:19: Question from Facebook asks about a high deductible, despite the law. How is this law going to make health care more affordable for me? Guertin says “We have definitely seen employers and individuals buying plans with a high deductible as a tradeoff for a lower premium.” All of the factors that make health care expensive haven’t gone away; important people understand their options.

6:15: Guertin says about the idea that this movement to pay for value, “It’s also about giving the tools and information so the care is coordinated; We’re always looking at quality as well as cost.” You have to look at the program holistically.

6:13: Verville: This is a great first step to move from fee for service to fee for value. “The payment has to be tied to value provided to the patient.” The law focuses on prevention, which is key to effective health care.

6:11: Gerlach: There’s a lot of consideration whether to offer health coverage, including. If you sit down and look at cost of providing care of paying penalties, it will be less expensive to pay the penalty. But the question arises does the employer feel a moral obligation to provide coverage? “Many do, but not all.” Most employers are making solid business decisions to continue offering coverage, some considering dumping.

6:09: Kaplan-Howe: When asked about website slowdowns, “It is a piece of the law, not the entire law;” says call centers are also options for people. "We are seeing improvement...but I don't think anyone would say they're pleased with how it's going."

6:09: Guertin: “We were the only ones who decided to be on the exchange this year. I believe we did the right thing and that ultimately the consumers will tell us that by either buying it or not buying it.”

6:08: Guertin says she doesn’t regret taking the narrow-network approach under the law. “The reason I feel that we did the right thing because we asked the consumers and tried to build a product they would value.” 

6:06: The first question from host Laura Knoy: What worries you most about the Affordable Care Act? Lisa Guertin, president of Anthem Blue Cross Blue Shield in New Hampshire says “I’m not worried.” We’re anxious for the day when everything works perfectly; the people getting a subsidy will find greater affordability and making sure there “

Lisa Kaplan-Howe, policy director for New Hampshire Voices for Health, points out “patient protection” part of the law’s name as well; “We are definitely moving in the right direction.” Has hope people getting better, clearer sense of their options in the law.

Steve Gerlach, a tax attorney with the Bernstein Shur law firm: “Many are” worried; works with employers, the primary concern is “a lack of factual actionable information for employers;” Small groups could see higher costs; I do have a concern that the larger employers not put off their compliance efforts

Rachel Verville, vice president of revenue cycle at Elliot Hospital, “More a call to action on behalf of patients;” worried about confusing information for patients; working to help patients navigate what their options are. "It's a lot to digest." 

5:29: We're about to get started here at our town hall discussion. The panelists have arrived and the audience in Studio D is filling up. We'll be providing live updates as the conversation unfolds tonight. 

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