My Turn: On health care, state is at a distinct disadvantage
Just this week, the New Hampshire House Commerce and Consumer Affairs Committee killed a bill that would have allowed New Hampshire to set up its own health exchange and the state’s agencies to work directly with the federal exchange. This comes on the heels of Gov. Maggie Hassan, who supported the bill, saying the original law prohibiting a state exchange was “extremely misguided” and “should be reconsidered.” Why is this important? Because three weeks into open enrollment for health insurance and residents in New Hampshire are at a distinct disadvantage from their New England neighbors.
That’s because if you look at a list of which health insurance exchanges are up and running and which ones are still glitchy, one thing is obvious: If the federal government is running the show, there continue to be problems. New Hampshire is partnering with the feds and has a robust health exchange advisory board, which means it is participating more than in some parts of the country. Unfortunately, though, the state is stuck with the federal IT system, which continues to mean long waits for consumers to check prices and get enrolled.
For the states that chose to run their own health care marketplace, the picture is much clearer: Some states in New England are leading the way. Connecticut, Massachusetts, Rhode Island and Vermont all have fully functioning health insurance marketplaces. In fact, aside from New Hampshire, New England is leading the way compared to the rest of the country.
This region has some of the lowest rates of uninsured nationwide. Only 11 percent of New Hampshire residents are uninsured, according to the latest available data from the Kaiser Family Foundation. Vermont has a 9 percent uninsured rate, Connecticut 10 percent and Rhode Island 12 percent. Does having fewer people to serve point to higher chance of success? Unlikely. California has also launched a successful health insurance exchange and its percentage of uninsured is one of the highest in the country.
But several other factors are integral to the success these states are having in setting up high-functioning health insurance marketplaces. First, New England has some of the best health care providers in the country, if not the world. Hospital and specialist names in the region read like a “Who’s Who” of best-in-class health care services. Could that be a component of why health insurance exchanges in the region are up and running smoothly? In part, yes. There does seem to be an expectation of success from the various participants in the system, and that may have driven these states to work harder to make Oct. 1 a worthy accomplishment.
Many people are focused on the technical glitches the websites are having, which do hinder access to these new health insurance marketplaces. But it’s important to focus on what is underneath the hood. Setting up a new way to buy health insurance required months if not years of work to get health care providers, health insurance plans and purchasers – that is, individuals and employers – to agree on a plan of action. While New Hampshire too has a notable list of health care providers, given the state’s reliance on the federal exchange, these providers never had the chance to invest their knowledge in setting up a technical framework that would work well.
This leads to the next attribute New Hampshire’s neighbors all have in common: a willingness for agencies within each state to work together to deliver a new marketplace. Existing agencies and regulators were required to work with new decision-makers in each state. Connecticut’s exchange, Access Health CT, was set up as a public, nonprofit corporation. The Massachusetts Health Connector is a quasi-governmental entity. HealthSource RI, the Rhode Island health insurance exchange, sits within a division of the executive branch, and Vermont Health Connect is within the existing Department of Vermont Health Access. While the governance varies slightly, the necessity of cooperating with the department of insurance, the Medicaid agency, health and human services agencies, a centralized chief information function and various other departments is the same. These four states are doing it better than many of their counterparts across the country, and their relative success in these first few weeks is the proof in the pudding.
The most important component of all, however, has been completely overlooked by the media and pundits. What truly sets these states apart is their focus on small business.
Most people who currently have health insurance get it through their employer. But if you work for a small business, health insurance can be hard to come by. Health insurance marketplaces will be a great leveler when it comes to this current discrepancy, and these four New England states are leading the way. If you want to truly transform the system we have, it has to be easier for small businesses to provide their employees with affordable coverage. Why were these four states ready for business Oct. 1 when so much of the country is floundering? Because they focused on business from the start. In all of these states, a priority has been to provide a new way of buying health insurance for small employers. Big companies get better prices on health insurance because health plans can spread their risk over a greater number of people – what businesses call employees and insurance companies call covered lives. Now, small companies in certain states can also get access to this kind of low price. Which states? Not the ones that chose to let the feds run their health exchange. In those states there will not be a marketplace for small businesses until 2015.
Small businesses know what they want out of these exchanges: a cheaper, easier way to provide their employees with health coverage, and Connecticut, Massachusetts, Rhode Island and Vermont are delivering. While the federal exchange has plans, accessing them right now is more a factor of luck. Welcome to the new world of health insurance.
(Brenda Gleason is president of M2 Health Care Consulting, a small business focused on state health policy issues. She is a special adviser to HealthSource RI and a lecturer at The George Washington University School of Public Health Services.)