Despite new hurdles, N.H. health care sign-ups mostly steady in 2017

  • The HealthCare.gov website, where people can buy health insurance, is displayed on a laptop screen in 2015. AP file

Monitor staff
Wednesday, December 27, 2017

New Hampshire’s individual health insurance market saw a surge of sign-ups this year, surpassing expectations and defying some fears that new policy changes would weaken turnout.

New figures from the federal Centers for Medicare and Medicaid Services (CMS) show that 50,275 Granite State consumers signed up to a plan overall – just slightly fewer than last year’s 53,024 – despite a sign-up period only half as long as in years past.

In April, CMS announced it would reduce the enrollment window from 12 weeks to six, in what it called an attempt to stabilize the insurance pool and cut down on people who might sign up when they get sick. The department also slashed the state-exchange advertising budget from $100 million to $10 million, and it reduced sign-up availability time on Sundays for website maintenance.

Analysts had warned that the new policies would create barriers for consumers and would likely reduce turnout. But the numbers have shown otherwise. Nationally, the number of sign-ups stood at 8.8 million as of Dec. 15, compared with last year’s 9.2 million – though a number of hurricane-hit states have extended deadlines for sign-ups.

The crunched sign-up window also impacted daily figures for enrollment.

In New Hampshire, an average of 631 people signed up per day in the 2016 period; more than 1,197 a day did the same in 2017.

In a Dec. 21 statement, CMS administrator Seema Verma said the success was a testament to the efficiency of her department.

“Our goal from the beginning was to empower patients across the healthcare delivery system ... and the results show that we accomplished our goal,” she said.

But New Hampshire organizers have a different take. With CMS commanding a dramatically lower advertising budget, much of the outreach and education for the sign-up window fell to grassroots organizations and nonprofits, organizers say. Meanwhile, New Hampshire’s navigator organizations – which help consumers choose optimal plans – saw average budget cuts of 24 percent, according to data from the Kaiser Family Foundation, a nonprofit health care research group.

“Nonprofits stepped up for this, not the government,” said Carol Bunk, client care coordinator at Equality Health Center in Concord.

Bunk’s organization, which helped sign-up efforts through volunteers and staff, also paid for Facebook advertisements and other outreach efforts to keep people informed, Bunk said.

One of the hurdles was linguistic, added Dalia Didunas, Equality’s executive director. This year, much less care was taken by CMS to make sure the materials were presented at a universal reading level, meaning many of the new conditions added confusion, she said.

“I think that was a real disservice,” Bunk agreed.

Adding to the uncertainty was a string of misleading or confusing letters sent by insurers, the perception that premiums would skyrocket and subsidies would be taken away, market shifts in New Hampshire that saw some plans disappear, and an ever-changing series of signals from Washington, D.C., over the future of the Affordable Care Act overall, organizers said.

Nonetheless, the sign-ups poured in at a steady clip. Bunk said that the shorter period likely created more urgency, motivating more people to sign up or face the punishment of the individual mandate, which doesn’t expire until 2019.

Donna Toomey, certified patient navigator at HealthFirst Family Care Center in Franklin, said the sheer confusion this year may have had the paradoxical effect of driving higher sign-ups. Some people faced letters from insurers that at times falsely stated that premiums would jump up. Others were told, misleadingly, that they would automatically be transferred from Minuteman Health – which left the market this year – to Anthem, creating more confusion.

The muddled messaging prompted many to call community health centers for advice, and eventually to continue through the sign-up process.

“Once we were able to sit down and show them the (correct) quotes, more people were eager to sign up and get it done with,” Toomey said.

Still up in the air is who exactly next year’s marketplace enrollees are. If sign-ups are dominated by too many people more prone to using health services and not enough healthy people to offset that risk, individual markets like New Hampshire’s could face higher premiums down the road. An April analysis in the journal Health Affairs predicted that by cutting the enrollment period in half, CMS raised the risk of missing out on “healthy procrastinators” – those younger and with fewer risks who might need the extra weeks to be coaxed into signing up.

Representatives of the three insurers in the New Hampshire marketplace – Anthem, Harvard Pilgrim and Ambetter – said Wednesday that data is not yet available on the health of those who have signed up; determining that will likely take several months to analyze initial claim data, an Anthem spokesman said.

But after an intensive six weeks ahead of an uncertain new year for health care, organizers on the ground are taking a victory lap.

For Bunk, the experience carries a simple takeaway.

“I think people like having health care, and they want health care,” she said. “And I think people were afraid this is going to be their last chance to get it.”

(Ethan DeWitt can be reached at edewitt@cmonitor.com, or on Twitter at @edewittNH.)