The new health exchanges are often described as something akin to Orbitz or Travelocity. A central place--a website--where insurance can be researched, compared, and purchased.
“Competition in markets, of course, is the way in this country we try to make reasonable prices and good quality available to people and so that is one of their roles,” says Professor Timothy Jost with Washington and Lee University in Virginia.
Jost says another key role of the exchanges is subsidies.
When the individual mandate kicks in January 2014, the Federal government will offer tax credits to low and middle income people. But the financial support is only available if you purchase through the new exchange.
"Although we are behind from the standpoint of doing some of the work that needs to be done, I don't think we are behind in the thinking regarding to where we need to go."
That’s why reform advocates say it is crucial that New Hampshire have its exchange up and running.
Insurance Department Commissioner Roger Sevigny says it will be.
“Although we are behind from the standpoint of doing some of the work that needs to be done, I don’t think we are behind in the thinking regarding to where we need to go. And frankly, in the end, we are going to be okay.”
Of course, this isn’t all resting on Sevigny’s shoulders. In fact, one thing complicating implementation is how many different bodies are involved in the state. The Insurance Department, Health and Human Services, Governor Hassan, two legislative committees, and a community advisory board are all jostling for authority.
But while that plays out, the big components of the exchange are actually left to the Federal government. That’s because New Hampshire is opting for what’s called a partnership exchange.
Five Partners, Different Paths
“Well, it is going fast and furious. We have these deadlines that I’m sure you are aware of,” says Cindy Crone. She directs the exchange in Arkansas, one of five other states conditionally approved by the Feds for a partnership.
Crone says Arkansas and Delaware are the furthest along in preparation.
In a partnership, the Feds create the website and ‘1-800 call center’, but the states need to set up systems to regulate the insurance plans sold on the exchange.
Partner states can also train and monitor what are called in-person assistors: people who will help the uninsured use the exchange.
In Arkansas, they’re already accepting applications for the position and will start training soon.
“Anything new, you have to have time to work out the bugs and we’ll continually work to improve,” says Crone. “But we are working hard to make it the best it can be, and we expect to be in operation October 1.”
Roadblocks and Politics
Other partnership states, including West Virginia, Iowa and Illinois, are roughly even with New Hampshire in terms of preparation. They’re all accepting applications from insurance companies to sell plans on the exchange. But each is also hitting roadblocks with the in-person assistor program.
Here in New Hampshire, Senator Andy Sanborn says those roadblocks are actually a good thing. He wants the state to tread slowly in implementing the partnership. The Republican from Bedford says the Feds just aren’t providing enough details.
“No one has their questions answered. There is no real road map of how this thing is going to operate. So we are at the point where everyone is really scrambling and those most at risk are the consumer, cause they truly, truly don’t understand what’s happening.”
Last month, Sanborn led a vote to freeze $5 million in federal grant money earmarked for the in-person assistor program. If New Hampshire doesn’t accept the funds, that portion of the partnership basically fades away.
"No one has their questions answered. There is no real road map of how this thing is going to operate. So we are at the point where everyone is really scrambling and those most at risk are the consumer, cause they truly, truly don't understand what's happening."
Sanborn says he’s always doubted the Affordable Care Act, but that right now, he’s simply protecting his constituents.
“It is not political. Now it is operational. Now it is making sure that we as legislators are doing right by taxpayers and small business owners and individuals.”
Representative Ed Butler sits on a legislative committee charged with oversight of the health law in New Hampshire, along with Senator Sanborn. The Democrat still sees a partisan divide, but not one strong enough to halt the partnership.
“I think in some respects, as difficult or complex as it is, you are seeing our state move ahead with a very complex and challenging process. One that is very politically charged, and yet, one that is the law of the land. So how do we do it? How do we make it something that New Hampshire can be involved in, and yet, listen to, hear and respect as much as possible all pieces of the puzzle?”
A complicated puzzle, and one that must be solved by October 1st.
