N.H. Officials Navigate 'Unprecedented' Uncertainty Around 2018 Insurance Marketplace

Aug 1, 2017

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Insurance Commissioner Roger Sevigny says he can’t remember another time when trying to map out New Hampshire insurance markets was quite as tricky as it is today.

“This kind of uncertainty is unprecedented,” Sevigny said Tuesday, when asked to put this year’s marketplace planning into context. 

“When the ACA came into play, it came into play — it was the law. The 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? Who knows where the priorities are going to be?”

Now, Sevigny and Department of Health and Human Services Commissioner Jeff Meyers are tasked with figuring out how to ask the federal government for help stabilizing the state’s insurance markets in the face of projected double-digit rate increases next year without offering up any money from the state or its insurers, as Sevigny originally proposed.

A plan on the table Tuesday would have created a “reinsurance program” that relied on money from both the federal government and mandatory payments from insurers. It would have set up a pool meant as a kind of safety net for carriers, offering a source of reimbursement that they could dip into as needed with the hope that would prevent them from hiking rates as high as they would have needed to in order to cover those costs otherwise.

That proposal, however, to failed to get support it needed from Republican lawmakers, who pointed to the fact that the proposal would have only modestly brought down rate increases and could have resulted in a $5 per member per month premium on insurers.

“We’re faced with a dilemma of huge proportions here, in almost the best-case scenario, if we did an assessment, we lower the projected increases from 40 percent to 35 percent,” said Senator Jeb Bradley, explaining his opposition. “To me, that’s not the definition of success.”

Gov. Chris Sununu also opposed plans to ask for payments from insurers, citing concerns that those costs would inevitably trickle down to consumers. In a letter released by his office ahead of Tuesday’s meeting, he called on lawmakers to instead authorize the insurance department to “explore all options to stabilize the market via a federal waiver in a manner that does not raise taxes on our citizens.”

“Asking us for more taxes onto the people of New Hampshire to put a Bandaid on this broken system, that’s just not going to work,” Sununu said in a separate interview Tuesday afternoon, after the reinsurance program was rejected.

One big question now is whether the federal government will have any appetite for helping New Hampshire when New Hampshire, at least for the time being, isn’t willing to put up any seed money of its own.

“I know that all states that have applied have had seed money,” Sevigny told lawmakers at Tuesday’s meeting. “I don’t know how difficult or not it’s going to be, but we certainly will approach the federal government without the seed money in our back pocket.”

But there are other unanswered questions that could have a big impact on what options New Hampshire customers have for health insurance in 2018, and what they’ll be asked to pay.

Some of the questions raised by those at Tuesday’s meeting: Whether Congress will try anytime soon to revive yet another attempt to repeal or change the Affordable Care Act, and whether the President was really serious when he tweeted that he might try to withhold federal money for cost-sharing reduction payments (or “CSRs”) from insurers. Those CSRs are essentially federal payments to insurers meant to allow them to offer discounts on their plans.

In the letter released by his office Tuesday, the governor reiterated calls to the Trump administration to keep these payments going “until a sufficient replacement for Obamacare is in place.”

Insurers at Tuesday’s meeting to talk through stabilization plans said they are watching closely to see what consumers will do amid all of the uncertainty. And that brings us to another big question mark: What carriers will actually stay on New Hampshire’s insurance market in the year ahead?

The governor, in the same letter where he outlined his opposition to the reinsurance program and his support for continuing CSRs, called on insurers to “immediately disclose is they are in or out of the individual insurance market and what a plan would look like.”

Representatives from two major carriers currently operating in the state, Anthem Blue Cross Blue Shield and Harvard Pilgrim, said they weren’t yet in a position to make a final commitment.

“We’ve been asked directly: Is Anthem in the marketplace, or is Anthem leaving? And that decision has not been made,” said Paula Rogers, Director of Government Affairs for Anthem Blue Cross Blue Shield in New Hampshire. “We’re weighing things very carefully. We’re very cautious. And we will make that sort of announcement within the next couple of weeks.”

Carriers have until Aug. 16 to file their rate filings for the 2018 marketplace with the state.   

If New Hampshire’s insurance markets do start to spiral, Sevigny may have another option in his back pocket: a provision in state law that allows the insurance commissioner to take emergency action, which could end up including the same kind of payments he proposed in the first place. But that, again, would likely still be subject to some level of approval from lawmakers.