Obamacare Insurance Choices Shrink for Individual Buyers in New Hampshire

MANCHESTER, NH - AUGUST 20: People watch as Republican presidential candidate, former Massachusetts Gov. Mitt Romney speaks during a campaign stop at Saint Anselm College on August 20, 2012 in Manchester, New Hampshire. Romney and and his vice presidential candidate U.S. Rep. Paul Ryan (R-WI), held the town hall-style event just two days after President Barack Obama made campaign stops in New Hampshire. (Photo by John Moore/Getty Images)
National Journal
Clara Ritger
Oct. 31, 2013, 4:06 p.m.

In the new health in­sur­ance mar­ket­places cre­ated by the Af­ford­able Care Act, 95 per­cent of Amer­ic­ans will have at least two in­sur­ance com­pan­ies from which to com­pare and se­lect plans, ac­cord­ing to a Health and Hu­man Ser­vices De­part­ment ana­lys­is.

But that also means 5 per­cent of Amer­ic­ans — in­clud­ing all res­id­ents of New Hamp­shire and West Vir­gin­ia — will not have a choice.

An­them Blue Cross and Blue Shield is the only in­sur­ance com­pany par­ti­cip­at­ing in New Hamp­shire’s ex­change. “The leg­acy of our com­pany has been to par­ti­cip­ate ag­gress­ively in the state,” said An­them spokes­man Chris Dugan.

An­them cov­ers ap­prox­im­ately 80 per­cent of res­id­ents pur­chas­ing plans on the state’s ex­ist­ing in­di­vidu­al mar­ket, said Tyler Brannen, a health policy ana­lyst at the New Hamp­shire In­sur­ance De­part­ment. Be­cause of New Hamp­shire’s small pop­u­la­tion, the fin­an­cial re­turns of an­oth­er in­sur­ance com­pany of­fer­ing com­pet­ing policies in the state would not be as great as in an urb­an mar­ket.

“Any oth­er car­ri­er would have to weigh the risk,” Brannen said.

An­them is of­fer­ing 11 plans on the ex­change, with monthly premi­um con­tri­bu­tions ran­ging from $177 to $1,784 be­fore tax sub­sidies. One big change An­them is mak­ing to its cov­er­age is the num­ber of doc­tors and hos­pit­als in­cluded in its in­sur­ance net­work.

“By part­ner­ing with cer­tain pro­viders, we are provid­ing a product that is 25 per­cent lower than it would be by us­ing a broad­er net­work,” Dugan said.

There is a down­side, though. The shift elim­in­ates 10 of the 26 ma­jor hos­pit­als in New Hamp­shire from the An­them net­work for people who cur­rently pur­chase An­them in­sur­ance on the in­di­vidu­al mar­ket and will shift to An­them’s ACA ex­change mar­ket next year, Brannen said.

Dugan was not sure if An­them would con­tin­ue to of­fer plans in the in­di­vidu­al mar­ket, in ad­di­tion to its ex­change mar­ket op­tions. Re­gard­less of what An­them does, Brannen said, he ex­pects the in­di­vidu­al mar­ket will phase out.

“To the ex­tent that people may qual­i­fy for a sub­sidy,” Brannen said, “I can’t think of any reas­on to pur­chase products from An­them out­side of the ex­change.”

Con­sumers are frus­trated and see the changes as a loss, Brannen said, es­pe­cially be­cause they don’t have an al­tern­at­ive to An­them.

But the use of nar­row net­works to drive down the cost of health in­sur­ance isn’t just a func­tion of the An­them mono­poly — it’s a na­tion­wide trend. A re­cent study from the Health Re­search In­sti­tute at Price­wa­ter­house­Coopers found that 69 per­cent of in­surers re­por­ted nar­row-net­work con­tracts.

Next year, some people could have to drive as far as 45 minutes to see an in-net­work doc­tor, Brannen said. But that doesn’t vi­ol­ate the state’s ad­equacy stand­ards that reg­u­late pro­vider dis­tance in in­sur­ance plans, he ad­ded.

Rais­ing those stand­ards could be the next task for poli­cy­makers, he sug­ges­ted, as voters enter the ex­change and come to terms with the real­it­ies of their new cov­er­age.

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