Navigating Change: Catching up with the NH Insurance Department on the ACA

NH Insurance Department staff works to inform and educate health care consumers and others amid an evolving landscape.

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CONCORD, NH  Earlier this week, the Centers for Medicare and Medicaid Services (CMS) reported that 11.8 million Americans signed up for the Affordable Care Act (ACA) health insurance for 2018. Closer to home, the NH Insurance Department reports that about 84,000 Granite Staters have enrolled in the ACA-also known as Obamacare- for 2018.

According to CMS, the national enrollment figure was down about 400,000 from 2017, which is somewhat surprising given the turbulent run-up to the open enrollment period. With repeal a core campaign issue for then presidential candidate Donald Trump, the ACA was the subject of fierce debate last year with repeal and replace legislation falling just short in a memorable late-night vote. The enrollment period itself (November 1 – December 15) was shorter than in previous years. Advertising for the ACA was cut dramatically from what it had been in the past. Due to the political uncertainty, many major carriers left the individual market across the United States. Finally, the tax plan signed into law late in the year, zeroed out the penalty for non-enrollment in the ACA in 2019, leading some to believe that they did not have to enroll in a plan at all.

Against this uncertain backdrop, year five of the ACA in New Hampshire (the health insurance exchange) is also seeing its share of changes. With the demise of Minuteman Health at the end of the 2017, two insurance co-ops had now exited the market leaving Anthem, which absorbed much of the former Minuteman book of business, Harvard Pilgrim Health Care and Ambetter as carriers on the state’s health insurance marketplace in 2018.

To provide a local perspective and insights on the recently completed open enrollment period, Medical Matters sat down with some key staff –  Jennifer Patterson, Michael O. Wilkey and Eireann Aspell –  at the NH Insurance Department (NHID). The trio have been on front lines of informing and educating consumers and other key stakeholders about the ACA.

Did any of the dialogue on the national level impact the enrollment process in NH?

“Certainly, the shortened enrollment period and the liquidation of Minuteman had an impact,” said Wilkey. He added that there was a state of flux during which it was unclear what subsidy levels would be available to members. This in turn made it difficult for carriers to set rates.

Patterson explained that in ordinary times, insurance carriers generally set their rates in spring for the upcoming year. The rates are then reviewed and approved by the department which then in turn submits their recommendations to CMS for approval. “The past year this was all done in an incredibly short time-frame,” she noted. As the Director of Health Policy and Market Conduct for the department, Patterson serves as the lead attorney for the Insurance Department with respect to health policy and ACA issues in New Hampshire.

In reviewing the NH marketplace over the past four years, the cast of insurance carriers has undergone a yearly change. The state has gone from a single carrier – Anthem  – in year one, to as many as five in a year as co-ops such as Minuteman and Maine Community Health Options joined the fray along with Harvard and others. With that insurance churn, did consumers move among plans, or stay put?

“For most part, all things being equal, people tended to stay with their plan,” said Wilkey, who is NHID’s Director of Life, Accident and Health. “If they liked their network and doctor, they remained with their plan.”

Aspell, who serves as the Department’s Outreach Coordinator, helped coordinate the department’s efforts to inform and educate navigators, enrollment assisters and insurance brokers, critical middlemen in the insurance process. “We tried to educate and inform them ahead of time,” she said.  “It was critical that their information was accurate as they were communicating directly with consumers.”

As the open enrollment period loomed, the department ran informational webinars and in-person meetings to keep stakeholders up to date. “This was an opportunity for us to share what we knew was happening, but also an opportunity for people to ask questions,” said Wilkey. The Department also put out a series of news releases on the open enrollment process. “It was important to be proactive,” he added.

Aspell said that the department seeks to provide the public and others with facts and information, so they can make their own decisions when it comes to insurance.

And in terms of NH’s enrollment, how does it compare to national trends?

Patterson noted that the numbers enrolled for 2018 were “pretty close” to year end 2017 numbers. She did caution that the department’s information comes via insurer reports and that each uses varying methods of capturing data. Wilkey also said that former Minuteman members had until the end of March to choose a new carrier and that may impact overall totals. He explained that each insurer has until the 15th of each month to submit figures.

The team said that other factors negatively impacting enrollment could have been confusion around the individual mandate tax penalty and steep premium increases (52 percent average for those without a subsidy who would stay with the same plan in the new year).

The department –  which numbers about 20 – sits at a challenging intersection of consumers, legislators and insurers, and must successfully navigate among these for a stable and effective marketplace, particularly where the ACA is concerned. “A big part of our role – in as neutral a fashion as possible –  is to inform legislators, the Governor’s office and the public what may be the effect of a particular policy or action that takes place,” said Wilkey.

Another key aspect of this work is interaction with the federal government. Patterson pointed out that whereas individual insurance plans varied from state to state prior to the ACA, the law has brought a uniformity to the market. This impacts what laws local states can pass in that regard. Working via the NAIC (National Association of Insurance Commissioners), she said the department “can inform NH legislators what likely consequences can be of potential legislation.”

The department has also been on the forefront of cost transparency and recently updated its special health cost website where consumers can contrast and compare costs for common medical procedures across the state. The site can be accessed here at nhhealthcost.nh.gov and in a future Medical Matters column, we’ll take a deeper look at this trend and how it can create more informed medical consumers.

As the ACA enters year five, Patterson, Wilkey and Aspell stressed the need for continued education for members, particularly the newly insured. “For someone who hasn’t previously had insurance, the system can be incredibly complex” stated Patterson. “It’s vital that they understand their benefits and how to use them.”

To learn more about the NH Insurance Department, please visit their website at https://www.nh.gov/insurance/


Chris Dugan is Principal at Dugan PR, where he provides strategic communications, public relations and marketing/communications support to a broad range of non-profit and for-profit clients across New Hampshire. Prior to starting his consulting practice, Chris held senior leadership communications roles at Anthem Blue Cross Blue Shield, the American Lung Association of NH, Optima Health and St. Joseph Hospital. A New Hampshire native, Chris is an active community volunteer and is a member of the Queen City Rotary Club, where he chairs the Marketing/Public Relations Committee. He has been recognized by the American Academy for Health Services Marketing and the NewEngland Society for Health Care Communications. He is a graduate of Leadership Greater Manchester and Leadership Greater Nashua.