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Al Felgar: Patients can’t wait for state to fix narrow Obamacare network

March 12. 2014 6:42PM

On Feb. 10, hundreds of concerned citizens, physicians, hospital workers and lawmakers gathered for a public hearing to urge the New Hampshire Department of Insurance to fix the obvious flaws in the state’s new “narrow network” health care coverage plan as part of the Affordable Care Act (ACA) that took effect this year.

Because of the new rules, the most significant and damaging impact has been the fracture of doctor/patient relationships throughout New Hampshire. Anthem’s narrow network has severe restrictions. Despite promises to the contrary from every level of government, thousands of Granite Staters are being told to find new doctors and hospitals.

Frisbie Memorial Hospital in Rochester, Monadnock Community Hospital in Peterborough, Valley Regional Hospital in Claremont and other providers want to be a part of Anthem’s narrow network, but none of these facilities was even allowed to negotiate with Anthem to join. That was wrong.

So as the state signs up nearly 12,000 new people into the new insurance plan, there are 10 fewer hospitals that can participate in providing care to those people and all others who are on the new federally mandated network. Something needs to change right now.

The hospitals outside the network understand that Anthem was the only insurance provider to offer ACA coverage in New Hampshire. And let me be clear: My colleagues and I are not trying to “end Obamacare,” as some in the political arena demand. We just want to participate.

Patients, providers and doctors took this case to the New Hampshire Department of Insurance, whose experts reviewed the Anthem network and approved it. We demanded resolution because the department has the power right now to find this network inadequate. We are still awaiting a response. Even today, it is not clear why Anthem’s network was allowed to exclude some of the least well-off parts of our state, or what the department was going to do about it.

There has been no progress. Everything is on hold, and there is no pressure to move forward.

Rochester Mayor T.J. Jean told the insurance department, “People are being forced to sever their long standing relationships with doctors and their hospital. This plan was thrust on you, you can thrust this back to Anthem, tell them to engage with Frisbie and other hospitals.”

We call on the department to act today. The department did promise to hold public hearings to scrutinize the rules that ensure that insurance networks are adequate and being fairly managed. That’s important because even though this is a public policy mandate, the public, doctors and hospitals have no access to the details about how these networks were put together. The lack of public scrutiny raises serious questions about basic fairness for patients.

We are not certain when this is going to happen, but fortunately, it looks like New Hampshire senators are not waiting to force the transparent review the public is demanding.

Today the Senate is scheduled to vote on Senate Bill 340, which calls for a review of the network, public hearings, and also establishes a process for bringing new insurance providers to New Hampshire to offer alternatives to Anthem at the same price range. If this bill passes, hearings must begin this spring and new companies can inquire about offering coverage this fall. This bill offers a sense of transparency and fair play regarding who can participate under the ACA.

Still, as Frisbie reminded the insurance department at the public hearing, the state has the power right now to do these things and correct network inadequacies for patients this year. Patients should not have to wait until 2015 for adequate health care. It’s time for the state to shed light on the details of this narrow provider network, and it’s time to provide real alternatives to this statewide mandate. If we don’t change the status quo, we won’t improve access or affordability.

Al Felgar is president and CEO of Frisbie Memorial Hospital in Rochester.

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