HIX Pains Now, But Hope for Long-Term Relief in NH
New Hampshire has only one health insurer participating in its federal exchange marketplace, but state lawmakers and regulators are optimistic that other payers will join the market in 2015.
Anthem's standing as the sole insurer in New Hampshire's federal exchange marketplace has created a painful experience for some hospitals and patients, but relief is on the horizon, state lawmakers and regulators say.
NH Rep. Thomas Sherman, MD (D)
"I think it's going to self-correct in a year, which is a long time for patients and providers to wait, but it's the law," said Thomas Sherman, MD, a gastroenterologist and Rye Democrat who was elected to the state House of Representatives in 2012.
Sherman says Anthem Blue Cross Blue Shield of NH appears to have complied with state and federal law when it crafted Anthem Pathway, the only health insurance exchange product in the Granite state approved to enroll patients in 2014. The Anthem Pathway network includes 16 of the state's 26 acute care hospitals.
Anthem officials have cited the need to contain premium increases for individual policies—estimated as high as 40 percent—as the driving force behind the company's decision to design a narrow network.
"The ACA was designed with the fundamental premise that the public would not tolerate public funding of health care," said Sherman, who practices at Exeter Hospital, which is in Anthem Pathway's network. "You can't really punish people for following the rules."
"I absolutely get the devastating effect of a narrow network on patients and providers," he said. "But a knee-jerk reaction to pass legislation may not solve the problem."