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The Sidebar: Obamacare: Tales From The Front Lines


If you’ve been following the rollout of the Affordable Care Act in New Hampshire, you might be struggling to keep up with the twists and turns - from legislation passed in 2012 that barred creation of a state-run marketplace, to the thousands of letters Anthem Blue Cross mailed to policyholders this month, telling them their health plans did not meet the law’s coverage standards.

Anthem, the only New Hampshire carrier offering policies under the new law, has since told policyholders they can renew their plans for another year, which may turn out to have been unnecessary. President Obama, under pressure to keep his promise to allow people who like their insurance to keep it, announced that insurance companies can renew existing individual and small-group policies that don’t meet the law’s requirements, but only until Oct. 1, 2014.

A Republican bill passed in the House - and backed by Reps. Carol Shea-Porter and Ann Kuster - goes further, allowing insurance companies to continue selling the substandard policies to new customers through 2014.* The president has threatened to veto the legislation, which experts say could drive up premiums and undermine reform.

Meanwhile, software problems and technical glitches continue to hamper Healthcare.gov, the federal insurance marketplace. A little more than 4,000 Granite Staters were able to complete applications in October, according to figures released last week,and only 269 actually selected a marketplace plan.

In Concord, lawmakers are locked in a partisan battle over a key component of the Affordable Care Act - expanding Medicaid to roughly 50,000 of the state’s poorest residents. Because of a quirk in the law, failure to expand the program could push as many as 25,000 uninsured people into a “coverage canyon” - too poor to qualify for a premium subsidy under the federal law, but not poor enough for Medicaid.

For all the turmoil, it’s easy to forget the Affordable Care Act is still in its infancy, and that its true measure won't likely hinge on the political and regulatory maneuverings of the past seven weeks. What will ultimately matter are the experiences of real people who will soon be expected to have health insurance, whether they want it or not.

Over the past couple weeks, NHPR has collected stories from New Hampshire residents who, in one way or another, have been affected by the law. Here are some of them.

Liked it, But Couldn’t Keep It

Janna Hartley, a 39-year-old self-employed graphic designer from Derry, was pretty happy with her Anthem Blue Direct Plan. The premiums cost her $350 a month. The deductible was relatively low - $1,000 - which worked out well for someone who has undergone several knee and ankle surgeries.

But, not long after Anthem announced it would drop 10 New Hampshire hospitals from its network for individual policyholders, including Concord and Parkland, Hartley got notice from the carrier that her plan was being discontinued.

Hartley’s broker told her she could renew the policy and keep her doctors, but her premiums would increase 7.9 percent, or about $26; her deductible would also rise to $1,500. Another option was to wait until her enrollment anniversary in February. But then she’d lose access to Concord and Parkland, as well as coverage for three prescription drugs that won’t be included in Anthem’s 2014 formulary.

Or she could start shopping for a policy on the federal exchange. But wary of what that would cost - Hartley says she does not qualify for a premium subsidy - she opted to renew and pay a bit more now.

“I'm not happy,” she says. “I liked what I had, and I don't think Anthem would have changed the plan if it weren't for the Affordable Care Act. I don't think I had a substandard plan, as Obama insists, and, in fact, I feel I am losing benefits. All I have done by renewing early is delay a worse situation for me.”

Added Benefits

Steve Galperin, a 50-year-old software contractor, will also see his premiums rise under the Affordable Care Act, but he says he expected that. “I’ve been around long enough to understand that prices never go down unless it’s for something no one wants,” says Galperin, who lives in Litchfield.

After receiving a discontinuation notice from Anthem, Galperin went to Healthcare.gov, created an ID and began checking out the 11 different plans Anthem offers on the marketplace. The plans are spread over three coverage tiers — five bronze plans, with relatively low monthly premiums, but higher deductibles; three silver plans and two gold plans, which have lower deductibles and higher monthly premiums. (A catastrophic plan is also available for people under 30 and those eligible for a fanancial exemption from the individual mandate.)

Galperin, who does not qualify for a premium subsidy, decided on a silver plan that will cost him about $100 more a month than his current policy.

"On the good side, my new policy will include dental insurance, which I haven’t had for six years,” he says. “The new policy will also cover office visits that weren’t covered under my old policy."

Unintended Consequences

Nancy Clark had high hopes when the federal insurance marketplace opened for business Oct. 1. A member of the NH Health Exchange Advisory Board and a strong supporter of the Affordable Care Act, Clark owns Glen Group, a small advertising agency in North Conway. She’s always offered health insurance to employees and their families, even as premiums increased by double digits every year.

“We’ve turned down the heat, the lights,” she says. “But we never, ever took health care off the table.

Until now.

When Anthem told Clark premiums for her eight employees would go up 39 percent in 2014, she checked out the plans available through the Small Business Health Options Program, where companies with fewer than 50 employees can shop for group coverage. Those plans were less expensive, but would still increase Clark’s premiums by 14 percent.

Clark then compared the price of individual policies available at Healthcare.gov to what she currently offers. She figured she could save 13 percent, or about $15,000, by discontinuing her group plan. She told her employees to pick a policy offered on the marketplace, and she’ll increase their pay to cover half the cost of the premiums.

It’s not ideal, Clark says, and it’s not how she envisioned the Affordable Care Act would work. But it’s better for her business and, because the marketplace plans offer lower deductibles than her current policy, better for her employees.

“That’s the positive,” she says, “and that’s why I hold out this level of optimism that once the dust settles, this is still going to be a good thing."

Persistence Pays Off

Maria Belva is one of the roughly 145,000 New Hampshire residents without health insurance. So the 58-year-old choral director from Peterborough was pretty excited when October 1 rolled around and she could start shopping for a policy at Heathcare.gov.

"The website didn’t work, so I called the 800 number for help,” she says. “The people were nice, but they said, ‘We’re very sorry, but the website doesn’t work, so there’s not much we can do.’"

Belva’s next call was to a marketplace navigator, whose job it is to help consumers sign up for coverage. They weren’t much help either. She waited another week, at which point she was at least able to establish an ID before being booted off the site.

Finally, after three weeks and a change in web browsers, Belva got a list of plans off the online portal. After calling Anthem for help understanding the options, she decided on a high-deductible bronze plan. With a subsidy, her monthly premiums will be about $250. While her potential out-of-pocket costs are high -  the Affordable Care caps them at $6,350 for an individual, $12,700 for a family - she’s not worried.

“I’m healthy,” she says. “I’ll never meet the deductible, unless there is a catastrophe.”

Happy Beneficiaries

Tim Miner and Patsy Slothower, of Center Sandwich, are both 61 years old, healthy and self-employed — Tim as a building contractor, Patsy as a licensed nursing assistant. Their current policy, issued by Anthem, costs them $1,116 a month and also covers their 21-year-old son. It comes with a $10,000 family deductible and one free physical a year.

“It’s onerous — a lousy plan,” Miner says. “We’re looking at spending $23,000 before the insurance kicks in. Almost anything is better.”

In October, after failing to navigate Healthcare.gov, Slothower visited an insurance broker in Wolfeboro, who walked them through their options under the ACA. While the couple have yet to make a final decision, they are leaning toward a silver-level policy that will cut their premiums in half. While their potential out-of-pocket costs are high — $8,000 — they chose a plan with a health savings account that lets them put some money aside each month for health care services.

“We’re pretty excited,” Miner says. “We’ve listened to people talk about their policies being canceled, then they find out it’s junk, and they’re gonna get a better policy, in many cases for significantly less than they are paying now. We’re not hearing much about that."

Lingering Concerns

The Obama administration has promised to have HealthCare.gov running smoothly by the end of the month. In the meantime, the president is encouraging Americans to keep trying to use the marketplace, while urging supporters of the law to help people sign up by phone and through the mail.

Lisa Kaplan-Howe, policy director for the nonprofit NH Voices for Health, says that, despite the upheaval of the past seven weeks, the Affordable Care Act appears to be working largely as designed. That is, thanks to the premium subsidies, people with lower incomes — individuals who make less than $45,960 and a family of four making less than $94,200 — are gaining coverage at a more affordable price. The tradeoff, of course, is that some people are paying more for their health plans.

“The Affordable Care Act makes the insurance market more fair and equitable so, generally, people who have benefited under the less equitable system - young, healthy people - are more likely to see increases and those who have been priced out of coverage in many cases are more likely to see decreases,” Kaplan-Howe says.

That’s true, says Paul Doran, an independent insurance broker in Wolfeboro, but it’s not likely to help people who can’t access the marketplace or who lack accurate information about the law.

Doran began conducting Saturday-morning information sessions on the Affordable Care Act in March. Unlike navigators, who help people sign up on the marketplace, brokers like Doran can offer advice on which policies can best meet his clients’ needs.“We’ve tried to put ourselves out there as a sounding board for people who want to know, ‘How do we go about this,’” he says.

Doran says the rollout has produced a fair amount of frustration for his clients, as well as for his small staff, who are working 10 hours a day, six days a week answering questions and calming fears. His agents have been repeatedly stymied by the technical problems on Healthcare.gov, and they’ve been unable to get much help from the marketplace help line.

Brian Wallstin is NHPR's Digital Journalist

That “disconnect behind the scene” could have dire implications for his clients, he says, and for the future success of the Affordable Care Act.

“We have a couple hundred people that in the first quarter next year need to change their insurance plan," he says. "At the end of the day, are our clients going to have an actual card in their hand to be able to bring to the doctors and hospitals? I can’t say that we’re very confident about that right now.”

*Note: This story was updated to clarify the difference between the Republican bill and President Obama's new rule.

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