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The Job Interview: Policy expert urges lawmakers to forge ahead with insurance plan

Lisa Kaplan Howe, the policy director for NH Voice for Health, at her office in Concord on April 18, 2013. 

(ANDREA MORALES / Monitor staff)

Lisa Kaplan Howe, the policy director for NH Voice for Health, at her office in Concord on April 18, 2013. (ANDREA MORALES / Monitor staff)

On Friday, the Legislature’s Joint Fiscal Committee voted to delay a decision on a $5.4 million federal grant for training and deploying experts in the new insurance exchanges, also called marketplaces, created under the Affordable Care Act. Members of the committee felt the grant, and other steps state agencies have been taking to implement the health reform law, need to be approved first by a joint oversight committee. That committee was scheduled to meet Wednesday, but the meeting was canceled Friday with no notice of when it will be rescheduled.

After the vote, several health policy groups urged both committees to move forward with the grant sooner rather than later. One was NH Voices for Health, a nonpartisan group “committed to securing quality, affordable health care for all in New Hampshire,” where Lisa Kaplan Howe is the policy director.

What does that mean you do, on any given day?

My days are quite variable. A lot of proposals have come out, federal regulations or grant applications at the state level, or plans for implementation. . . . I spend part of my time looking at the different proposals and regulations, analyzing what it will mean for people in New Hampshire, for small businesses and for individuals. And I spend part of my time communicating about those proposals, to businesses or individuals who don’t have the expertise and want to know what it will mean to them. We provide no official or unofficial comment on the laws, just analysis.

What is the goal of the grant that the Joint Fiscal Committee voted to table Friday?

The grant would give the (state) insurance department and the Department of Health and Human Services the chance to create and control a consumer assistance program in New Hampshire. That would entail them creating an assister program: They will be funding local entities, many or all of which already provide direct community services, to sit down with people and make sure they understand the exchange, which is now being called the marketplace. The assisters will be telling people that it exists and what it might provide and walk them through how to apply for private insurance or be screened for Medicaid and the premium tax credits and go through the process of actually enrolling in coverage. They may also recommend that people work with producers, who are licensed insurance brokers, who can actually help them select a health plan.

How would people first interact with these assisters?

Say you go in to get taxes prepared or to get assistance with a housing issue. Maybe you’re going with your kid to register for school and they ask you, “Hey do you have health insurance?” It may be those organizations that already provide community services, or those groups may refer you to the assisters, but when you go for that meeting, they’ll first talk to you about the marketplace and sit down and help you go through the process of getting screened for Medicaid and premium tax credits. They’ll talk to you about what you should be thinking about, make sure you understand
what a co-pay is, what a deductible is.
. . . They’ll walk you through how to use the web portal to look for coverage.

Isn’t some of that already common knowledge?

For a lot of people who will be newly coming in to the system, these are concepts they may have never heard of. For those of us who maybe shop online or use Turbo Tax, that may not sound too meaningful, but for a lot of the population, it may be overwhelming to make those decisions over the internet.

Do the assisters help people weigh different companies or plans?

No. If it gets to, “Do you think carrier A versus carrier B,” the assister is going to say, “I can’t help you make that decision, but I can help you find the provider network. Here is a list of producers in our community who are registered to sell coverage through the exchange. Let’s get you set up for an appointment.” What we’re hoping is there is a strong communication between the assisters and the producers, who get commissions from the insurance companies for selling plans.

Why don’t the producers do the work of the assisters then?

They could. But producers won’t get commissions from the insurance companies to talk through the eligibility for Medicaid and other programs.

Why does the state have to be the one involved with this assisters training grant funding?

Through the partnership exchange that the state is setting up with the federal government, the state insurance department will be able to do the on-the-ground, day-to-day monitoring of the assisters. . . . The third piece is that it will enable local entities to do outreach work. We understand that the insurance department is thinking of this as training the trainers. They’ll want to train local organizations who will be acting as assisters, to make sure they have an understanding of the marketplace and educating people on an ongoing basis so when it’s time and it’s up, it rings a bell they should be going to an assister or a producer. . . . This is just not a type of work we think will happen without the grant. There will be some efforts at the federal level but every state is different, and it’s important to design a model of outreach and education and engagement that works.

What does it mean that the committee tabled the vote on the grant?

We think this is something that needs careful consideration, and we’re happy that policy makers are being thoughtful. But it is also a really timely and time-sensitive opportunity. Taking a little bit more time to further understand it is fine and makes sense, but this work really needs to start, particularly the education and training of folks who will be providing the assistance. If we push it out further, it will be really hard to get it all together before the program expires. The grant is a short-term program intentionally, because the assistance will be most greatly needed in the first year. I see a potential for a missed opportunity for individuals and small business to learn about the marketplace and their eligibility for Medicaid and premium-assistance grants. People may be unintentionally left uninsured because they don’t know there are new opportunities for them, and that’s not good for them, their employers or the state. And I think we’re going to see existing community resources tapped for assistance by people looking for information, regardless of whether we have this funding to train them. . . . I think it’s going to be frustrating for organizations and entities that really want to help. Small community organizations will find themselves overwhelmed – neither provided the information nor the resources to respond to those requests.

You’ve mentioned small-business tax credits. What are those and how are they connected to the exchange?

There are tax credits currently available to small businesses, with 25 or fewer full-time equivalent employees who make on average less than $50,000 a year, so really targeting low- to moderate-income employees. The business needs to contribute at least 50 percent of the cost of the premium, and currently, since 2010, they can get a tax credit for some of the amount of money they as an employer contribute to a premium for the employees. In 2014, the only way to access the credit will be through purchasing coverage through the marketplace. Currently, it’s 35 percent credit for for-profit employers and for nonprofits, its 25 percent. In 2014, it will be 50 percent for for-profits, and 35 percent for nonprofits.

Have you heard any common myths or misconceptions about the insurance marketplace?

A concept that people are confused about, maybe, is that I have heard people make indications they think it’s a government-run, or government-funded public health insurance program. That’s not what it is, it’s a place where people go and purchase private insurance.

Is there anywhere for people to get more information?

Definitely I would suggest checking out healthcare.gov, that’s a really great site with lots of information. And for small businesses, at smallbusinessmajority.org, they have a lot of information about the tax credits and a calculator for employers to figure that out.

(Sarah Palermo can be reached at 369-3322 or
spalermo@cmonitor.com or on Twitter @SPalermoNews.)

Correction: Lisa Kaplan Howe, policy director for NH Voices for Health, was misquoted in a prvious version of this article. Her organization analyzes proposals and regulations related to the Affordable Care Act, and provides both official and unofficial input for businesses, individuals and policy makers at the state and federal level.

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