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Anthem defends new health plan

State House Bureau

September 18. 2013 9:38PM

CONCORD — Anthem Blue Cross Blue Shield officials said the insurer lowered premiums 30 percent by narrowing the provider network for individual policies it will offer through the electronic marketplace or exchanges established under the Affordable Care Act.

The company received federal approval for its plans Tuesday, the final step before the exchange opens Oct. 1 for policies that go into effect Jan. 1.

Anthem NH President Lisa Guertin told state senators at a meeting Wednesday the company was not aware it would be the only general health insurer to offer plans when it negotiated with hospitals for its Pathway plan, which she described as "the best balance of access and affordability."

But Alan Felgar, president and CEO of Frisbie Memorial Hospital in Rochester — one of 12 of the state's 26 hospitals not in the plan — criticized the Affordable Care Act, saying it promised competition in the marketplace and that everyone could keep their own doctor. Neither is true, he said.

"We've done everything we are supposed to do. Is this the way New Hampshire operates?" Felgar said. "We were never asked to participate and I think that is unfair."

Guertin said the network was not "quality-tiered" because all the state's hospital do a good job, but based on distance and travel time for patients. She noted: "If we do not stick with what we've got now, the whole thing blows up."

Anthem will offer 11 plans in four tiers, with premiums ranging from $177 a month to $2,226 based on age and the level of coverage. Deductibles range from $1,000 for an individual to $11,500 for a family.

For those who qualify, subsidies will lower or eliminate the premiums.

For example, an individual earning $11,490 or less or a family of four with an income of $23,550 or less would owe no premium for a "Bronze policy," which has deductibles of $5,750 for an individual and $11,500 for a family, with a 10 percent co-pay.

Guertin said her company believes most of the first-year exchange customers will be individuals at 138 to 400 percent of the federal poverty level who will receive a federal subsidy.

Anthem is also offering three plans on the small business exchanges, but does not expect many customers because small business mandates do not go into effect until Jan. 1, 2015.

All other business customers will continue to use the company's broader network, Guertin said, noting 90 percent of its customers will not see a change.

Others not affected include self-funded programs administered by Anthem or those on Medicaid or Medicare.

Anthem currently has 29,000 people on individual plans, of which 5,000 are exempt because they were in place before the ACA passed in March 2010.

The insurer did not compare prices between current policies and those it will offer on the exchange, but did say the exchange policies have additional benefits required under the ACA.

"While showing people how much policies will now cost through the exchanges is a good first step, it's critical that the public gets a chance to see the impact of the Obamacare mandates and regulations on the cost of health insurance," said Greg Moore, AFP-NH state director. "The President and other supporters have said that this law will make care more affordable, so it's important that we see whether or not that's a reality or fiction. Anthem should have provided comparable data from this year to allow everyone to see the difference."

Sen. Russell Prescott, R-Kingston, said he owns a business with 38 employees and pays 100 percent of the cost of insurance, but will probably stop doing that.

He criticized the ACA and its community rating, which narrows the premium costs between young and old, and eliminates other discounts, noting rates will go up between 9 and 29 percent.

Guertin downplayed the impact the narrower network would have on hospitals, saying 90 percent of its customers are on its broader network. All hospitals should see a reduction in charity care with more people covered by health insurance, she said.

"Do I think this is putting a knife in the hearts of these other hospitals?" Guertin said. "I really do not."

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