With 100 days to go, N.H. efforts on Affordable Care Act lacking
With 100 days to go until the expected launch of a new health insurance marketplace, many organizations promoting the federal health care reform law are kicking education and outreach efforts into gear.
Just not necessarily in New Hampshire.
The requirement that all Americans obtain health insurance goes into effect Jan. 1, 2014, but Oct. 1 marks the expected opening of the new marketplaces created by the Affordable Care Act.
Individuals and small businesses should be able to start shopping in the marketplace for coverage then. They should also be able to find out if they are eligible for tax credits toward the cost of that coverage.
But with 100 days to go, the Republican-controlled Senate and the Democratic leadership in the House haven’t yet agreed on how involved the state government should be in regulating or communicating with New Hampshire citizens about the marketplace – if at all.
National educational campaigns are likely to focus on states with no involvement in the marketplace, while New Hampshire has declared intent to partner on some aspects. And even though more than 120,000 New Hampshire citizens are without health insurance, larger states with more uninsured people will receive more attention from those national public relations and educational campaigns.
The state insurance department describes the marketplace website as a box within which companies put insurance policies for sale. While the last Legislature passed a law prohibiting the state from building that structure, Democratic Gov. Maggie Hassan declared in February her intent to partner with the federal government in helping people use the marketplace and regulating the plans sold there.
Last week, after much debate and delay, legislative negotiators approved a law giving the insurance department some abilities to regulate insurance policies in the marketplace, measuring them against federal laws.
The state insurance commissioner had argued that a long list of changes to state law were needed to preserve the state’s traditional regulatory role. The compromise specifies that the bill should not be read as expanding the insurance department’s authority to adopt new rules, which opponents feared could move the state toward full responsibility for the marketplace – something specifically prohibited by state law.
The law still needs approval by the full House and Senate.
The future of expanded Medicaid in the state is also still up for debate in the Legislature, but was originally intended to open with the marketplace on Oct. 1.
A study commission is scheduled to meet this summer to weigh whether to expand Medicaid as allowed under the Affordable Care Act, and if so, when.
Approximately half of New Hampshire uninsured people would be eligible for coverage through the expanded Medicaid program.
On Oct. 1, the marketplace and the Medicaid system – expanded or not – should also be able to talk to each other, so a person can fill out one application and receive an answer about his or her eligibility for Medicaid, premium subsidies, tax credits and plans on the marketplace. That information technology is being developed by the federal government.
A joint legislative committee declared an impasse earlier this month on whether to move forward and accept $5.4 million for the state to train and deploy navigators who will help people determine their eligibility for different programs and subsidies on the marketplace.
The Affordable Care Act gives the federal government $600,000 to spend in New Hampshire doing that work, if the state turns down the grant.
The committee will continue to meet through the summer, and with the insurance department regulations settled through a conference committee last week, this grant will be one of the main focuses of those meetings.
“A national public education campaign, while important, won’t address the nuances state by state. People in New Hampshire gather information differently, our market is different, and it does need to be a locally based effort,” said Lisa Kaplan Howe, policy director for NH Voices for Health.
If the state accepts the grant money, the plan has been to create public-private partnerships with organizations including health care providers, community-based nonprofit groups and others, through a public request for proposals.
With that funding in doubt or at best delayed, whether people know about the marketplace itself, how to access it and what’s available there will depend on the efforts of a host of volunteers and officials working this summer.
They have a big task: In survey results released Wednesday, the Kaiser Family Foundation reported slightly more than 20 percent of people say they’ve heard at least “some” about the health insurance exchanges. Only two in 10 lower-income Americans and 12 percent of the uninsured, two key target groups of the law, say they have heard more than a little about the health insurance marketplace so far.
Organizing for America, the political advocacy group that grew out of the president’s campaign, released an ad last Monday, launching a seven-figure media buy on national cable channels.
The ad presented three cases of people benefiting from the parts of the law already implemented, from a doctor being reimbursed for preventive care for seniors, to an insured person receiving a rebate from their insurance company for overspending on administrative costs. Later ads in the national campaign will focus on education about the newer parts of the law, an Organizing for America official said.
The organization also has more than 800 summer fellows heading out to the states, with 12 of them coming to New Hampshire, the official said.
The federal government will also be launching a national education campaign and tour by Health and Human Services Secretary Kathleen Sebelius this summer. Consumer advocates say they hope the state takes into account that Sebelius and her surrogates aren’t stopping within 200 miles of New Hampshire. And the national marketing campaign – with a heavy focus on social media and the internet – won’t be tailored to meet many uninsured Granite Staters where they are – in rural towns with little internet connectivity or literacy.
A presentation of the national marketing and education plan was leaked last week to the website Buzzfeed. It showed the 29 priority target states for outreach; Maine is one, while New Hampshire is not. The closest planned events are in New Jersey.
In addition to having an older, less internet-savvy population, the state’s rural areas don’t feature many centralized locations for distributing information, a conversation Kaplan Howe said was discussed at an insurance department stakeholders meeting last week.
“People were talking about how we might have to have people who go door to door, and frankly I hadn’t even been thinking that way,” she said. “. . . Certainly somebody from outside of New Hampshire isn’t going to be thinking that way.”
(Sarah Palermo can be reached at 369-3322 or firstname.lastname@example.org or on Twitter @SPalermoNews.)