A panel of lawmakers has rejected a key part of the plan put forward by the state’s insurance department to keep New Hampshire’s individual health insurance market from collapsing next year.
With uncertainty in Washington surrounding the Affordable Care Act – including whether President Donald Trump will fund cost-sharing reductions, a key Obamacare subsidy – some premiums under the ACA are set to skyrocket next year. It’s also unclear which, if any, of the three insurers who have submitted preliminary rate information in New Hampshire – Ambetter, Harvard Pilgrim and Anthem – will actually stay in the state’s individual market.
“From my standpoint, this kind of uncertainty is unprecedented,” Insurance Commissioner Roger Sevigny said. “When the ACA came into play, it was the law. It was the law. Carriers had to play by it, we had to administer it to the best of our ability. But now, who knows what Congress is going to do?”
The New Hampshire Insurance Department had proposed a “reinsurance” program – a pool of money that carriers in the individual market could dip into as needed. The program would have been primarily funded via a $32 million assessment on all of the insurers operating in New Hampshire, along with some federal money.
The Republican-controlled Joint Health Care Reform Oversight Committee voted unanimously to allow the state to attempt to establish such a program and to ask for any available federal funds. But they voted along party-lines, 4-2, not to include a fee for insurers in the plan, with Republicans arguing it wasn’t worth the expected return.
“We’re faced with a dilemma of huge proportions here, in that, in the best-case scenario, if we did an assessment, we lower the projected increases from 40 percent to 35 percent,” said Sen. Jeb Bradley, a Wolfeboro Republican. “To me that’s not the definition of success.”
Gov. Chris Sununu, a Republican, had also opposed the part of the plan that asked insurers to pay, arguing the cost would ultimately be borne by their customers.
“It is wrong to create an additional assessment on the backs of Granite Staters who are already struggling to pay exorbitant health care costs,” he wrote in a letter to the committee.
The insurance assessment, plus the federal funds they could have helped generate, were expected to help reduce premiums by a little over 7 percent. With no seed money from the state, officials weren’t optimistic about the money the federal government might send New Hampshire to help stabilize the market.
“Without any assessment, it’s going to be really minimal,” Sevigny said.
About 94,000 Granite Staters get insurance on the individual market, although about half are covered through expanded Medicaid.
The median monthly premium for a nonsmoking 40-year-old on a “silver” plan this year was $335 in New Hampshire, according to NHID. Based on preliminary rates filed by insurers, the same plan would cost the same person $479 next year, a 43 percent increase.
Sununu also demanded in his letter that insurers “immediately disclose if they are in or out of the individual market and what a plan would look like,” but representatives from Anthem and Harvard Pilgrim told lawmakers Tuesday they didn’t have an answer.
“We are making a decision within the next couple of weeks,” said Paula Rogers, the government relations director for Anthem in New Hampshire.
Ambetter, Sevigny said, had indicated they planned to stay, but had until mid-September to put their commitment in writing.
“They gave a strong indication that they want to be committed to this market, but until they sign the contract – I’m not comfortable until the contract is signed,” he said.
Rogers and Matt Veno, a representative from Harvard Pilgrim, also emphasized that they were watching the news out of Washington – and other insurers’ decisions about whether to stay in certain markets – extremely closely.
“I would say that what we’ve looked at here would have relatively modest impacts on stability in the marketplace. When we weigh that against the other very disruptive elements out there – I would say it’s not very high on the list,” Veno said of New Hampshire’s proposal.
Veno and Rogers discussed cost-sharing reductions in particular, an Obamacare subsidy for low-income people that Trump has threatened to ax.
Sununu, in his letter to the committee, also mentioned CSRs, noting that he had called on the Trump administration to not hold back the funds “until a sufficient replacement for Obamacare is in place.”
“Witholding CSRs at this late date as carriers are facing looming deadlines to set their rates for 2018 is compounding the problem,” he wrote.
If New Hampshire’s individual market does collapse, state law would allow Sevigny to take emergency action to impose an assessment on insurance companies after all, at least for one year. The assessment, at that point, would be much higher than originally proposed, the department warned lawmakers last week.
(Lola Duffort can be reached at 369-3321 or lduffort@cmonitor.com.)