Q&A with health policy expert Ned Helms

Ned Helms, founding director of the New Hampshire Institute for Health Policy and Practice at the University of New Hampshire, has strong opinions about the Affordable Care Act.

He is a supporter of the law, not because he thinks the policy is perfect, but because he’s convinced it’s a rational and necessary step in the right direction for a dysfunctional and economically inefficient health care system.

Few in the state bring a perspective like his. He has more than three decades of public and private sector experience in state health policy and politics. He has served as the state’s commissioner of the Department of Health and Human Services and was chief administrative officer of Blue Cross/Blue Shield of New Hampshire, at the time the state’s largest health insurer.

Q. What is your assessment of how the Affordable Care Act is unfolding in New Hampshire?

A. I think it’s kind of a mixed bag. We have made progress, but the website rollout was botched, and there was no excuse for that. The administration should have done a better job telling Americans what this law was all about.

But let’s be clear. There was a chance to do an awful lot of stuff since 2010, but the state Legislature turned down every single resource. There’s a faction in the U.S. Congress and in the Legislature whose primary goal has been sabotage. It didn’t help that we didn’t even create our own state-based exchange, and this is tremendously unfortunate because it flies in the face of what has been done in the past – local control and best practices for the people of the state.

I’m still scratching my head because I don’t know one single serious person who believes there is a logical reason for not designing our own exchange.

Q. The state Senate hasn’t yet approved a plan for Medicaid expansion in the state. How do you think it could impact the overall impact of the ACA in the state if Medicaid isn’t expanded?

A. We won’t know for another year or two, but it’s never too late to do the right thing. It seems to me that Gov. Maggie Hassan and Democratic lawmakers went out of their way to find a compromise. It was telling that the Republican-sponsored plan in the Senate (a fast transition from Medicaid to the private insurance marketplace) didn’t pass because they were told it couldn’t be done.

This was a significant blow, because from a health care perspective, this means that tens of thousands of state residents, many of whom are working people, are left vulnerable and unable to get health insurance. I believe the arc of history moves towards rationality and justice, but why would we deny even a sniff of some health security to so many vulnerable neighbors? We will have hospitals continuing to absorb bad debt they can’t afford.

To me this was totally illogical because of the positive and huge multiplier effect the $2.5 billion in federal money for health care will have on the state economy. This was a no-brainer, which is why the business community and organizations such as the Business & Industry Association supported it. The business community doesn’t like uncertainty, but this Legislature gave it to them.

Q. What will we be talking in another year about the ACA?

A. What I hope we aren’t talking about is today’s political food fight about the ACA. Too much credibility is given to those who say it will never work and not enough about what has already happened and how it is benefiting people. This is settled law deemed constitutional by the Supreme Court.

This is a major policy shift, and what we need is thoughtful conversation. Despite the 24-hour cable news din of political shouting and criticism, the ACA is not rampant socialism. The status quo that was consuming up to 20 percent of our economy was unsustainable, and we can’t go back because too much has happened.

We already know there will be more competition on the state health insurance exchange in 2015, and if can get past the media to focus on what is wrong, we will see tremendous, ongoing changes and hopefully many untold stories will be told.

Q. What are some examples of untold stories?

A. There are so many, and very few reporters have paid attention to how the health care system is being transformed.

If necessary, young adults have been staying on their parents’ plans until the age of 26. Children were the first, but now there are no longer any preexisting condition stipulations that insurers can use to deny or drop coverage. Seniors do not have pay out-of-pocket expenses for wellness visits to the doctor and the so-called “donut hole” of their prescription drug coverage is being filled. Large organizations like Dartmouth-Hitchcock are shifting away from a fee-for-service system and to prevention and wellness, and it’s happening all around the state. We are already seeing pioneer programs in Medicare that target results and healthy outcomes and accountable care organizations in the North Country. One untold story is that we are creating healthier communities.

Q. From a policy perspective what is happening?

A. We are going to see a health care “arms race” between states that continue to fight against the ACA and those who welcome it. For the 23 governors who have the seen the light, it will be a constant process of improvement in their states because there will be no argument about going forward. Despite the law’s many imperfections, conversations are taking place across the country to implement best practices and healthier outcomes that will continue to change the health care system. Frankly, it’s not going to stop.