Nashua Telegraph: NH women’s health at issue under Anthem hospital selection
CONCORD – State senators grilled executives with Anthem Blue Cross Blue Shield of New Hampshire on Wednesday over the insurer’s decision to drop Southern New Hampshire Medical Center and nine other hospitals from its network for individual health care coverage.
And for the first time since this simmering controversy began a few weeks ago, access to abortion surfaced as a prominent theme.
Sen. Bette Lasky, D-Nashua, said it’s unfair to women that St. Joseph Hospital, the chosen Nashua location, does not offer “full reproductive services,” including access to abortion referral counseling or contraception services, while Southern New Hampshire Medical Center does.
“I don’t understand how you can choose a hospital that doesn’t serve the full needs of women in a health center,” Lasky said.
Anthem New Hampshire CEO Lisa Guertin said all 26 hospitals offer qualify of care and that all women in Nashua will get those services within a reasonable driving distance.
“We didn’t just think we had to have them in Nashua,” Guertin said. “We had to have them with access to Nashua.”
Senate Democratic Leader Sylvia Larsen said it’s particularly critical that all low-income or uninsured women have easy access to these services.
“In addition to reproductive rights, we’re talking about making folks change the pediatrician they may have had for decades or the OB-GYN who delivered their babies,” Larsen said. “This is a very legitimate issue that concerns a lot of us.”
Jennifer Frizzell, policy director for Planned Parenthood of Northern New England, said women at a Catholic hospital have no access to contraception, in vitro fertilization or treatment for an ectopic pregnancy in which the fetus develops outside the uterus, such as in a fallopian tube.
“As a leading provider of and advocate for women’s health care services, we would have serious concern if New Hampshire women in any region of the state were limited to a health care network that does not offer the full range of reproductive health services,” Frizzell said in a statement.
“We share the concerns raised by policy-makers today and look forward to learning more from Anthem and St. Joseph Hospital about how they intend to ensure women will have access to a full range of medical services.”
Cornerstone Action New Hampshire is a leading interest group for social conservatives that has lobbied for further legal restrictions on abortions.
But Executive Director Ashley Pratte said this ideological point of view is trumped by the impact of making women and families change providers.
“Obviously, we are advocating for the pro-life community, but at the end of the day, you need to look at the family aspects of this decision to reduce hospital and doctor choice for women and their children,” Pratte said.
Guertin said the intent of this Pathways program is that any woman in the midst of a pregnancy could keep their current providers and then transition to different ones inside the network after a “medical event” has ended.
This “narrower” network will still place 90 percent of all residents within a 20-mile distance from a hospital, Guertin said.
“There are some consumers who won’t like this particular product for their needs, but it is a vast improvement for the majority of our customers,” Guertin said.
Anthem negotiated privately with executives of the chosen hospitals, because those talks were what led to reducing proposed rates by an average of 25 percent, she said.
Starting Jan. 1, this will affect all Anthem individual health insurance customers, whether they are in or out of the exchange also known as the marketplace under the Affordable Care Act.
About 5,000 current Anthem customers will be exempt from these new restrictions because they’ve had coverage since before the Affordable Care Act was signed into law in 2010.
Since some Anthem customers will drop coverage and go with competitors in the private market, Anthem lowered an earlier estimate and said it expects that about 20,000 with individual health plans now will come under the smaller network.
Anthem stressed Wednesday that anyone with a chronic condition can request to keep their current provider outside this new network, and anyone with a health emergency will be brought to the nearest hospital – whether it’s in the network or not.
Anthem is the only carrier offering coverage under this exchange aimed at significantly reducing the 180,000 residents without insurance.
Anthem released a thumbnail sketch of some of the 11 plans it will offer individuals under the exchange and three plans for small-business owners who choose a so-called shop exchange option.
Limiting hospital and provider networks is the best way to improve health care costs in a state with the second-highest premiums in the country.
“If we aren’t willing to live with some disruption and some change, we are never going to be able to change that,” Guertin said.
This new network will affect about 10 percent of Anthem’s customer base.
And Guertin said smaller networks aren’t likely to take over either the small- or large-employer group market right away.
“I think the market will tell us what it wants. I don’t think we are going to get to a world where that is all that is for sale on the group market, period,” Guertin said. “I think there is a movement in that direction, and I think it is driven by affordability.”
Guertin said there’s no telling how many without insurance will buy it under the exchange rather than face having to pay a $95 penalty to the Internal Revenue Service.
Americans for Prosperity New Hampshire Director Greg Moore called on Anthem officials to release information on current health insurance rates for individuals.
“Even with these cuts, no one is suggesting that rates are going down. That’s why we need more data to determine how much Obamacare has increased costs while still reducing opportunities to get care,” Moore said in a statement.
Apples-to-apples comparisons are difficult because the Affordable Care Act requires new mandated benefits not routinely offered under individual plans before, such as maternity services, Guertin said.
Sen. Andy Sanborn, R-Bedford, argued that many individuals with these changes will still face large out-of-pocket costs through payments for premiums, deductibles and co-insurance.
In response, Guertin pointed out that the federal law makes all insurers in the exchange offer a range of plans that at the furthest end requires customers to bear 40 percent of health care costs.
“To get there, you need big co-insurance,” Guertin said.