When it comes to health exchange, N.H. lags region

Several factors have been integral to the success neighboring states are having

Late last month, the New Hampshire House Commerce and Consumer Affairs Committee killed a bill that would have allowed New Hampshire to set up its own health exchange and let the state’s agencies work directly with the federal exchange. This came on the heels of Gov. Maggie Hassan, who supported the bill, saying the original law prohibiting a state exchange was “extremely misguided” and “should be reconsidered.”

Why is this important? Because just weeks into open enrollment for health insurance, residents in New Hampshire are at a distinct disadvantage from their New England neighbors.

If you look at a list of which health insurance exchanges are up and running and which ones are still glitchy, one thing is obvious – if the federal government is running the show, there continue to be problems. New Hampshire is partnering with the feds and has a robust health exchange advisory board, which means they are participating more than in some parts of the country. Unfortunately, they are stuck with the federal system, which continues to mean long waits for consumers to check prices and get enrolled.

For states that chose to run their own health care marketplaces, the picture is much clearer: Some states in New England are leading the way. Connecticut, Massachusetts, Rhode Island and Vermont all have fully functioning health insurance marketplaces. In fact, aside from New Hampshire, New England is leading the way compared to the rest of the country.

This region of the country has some of the lowest rates of uninsured nationwide. So does having fewer people to serve point to a higher chance of success? Unlikely. California has also launched a successful health insurance exchange and their percentage of uninsured is one of the highest in the country.

Several other factors are integral to the success these states are having.

New England has some of the best health care providers in the country, if not the world. Could that be a component of why health insurance exchanges in the region are up and running smoothly? In part, yes. There does seem to be an expectation of success from the various participants in the system, and that may have driven those states to work harder to make the Oct. 1 rollout a worthy accomplishment.

Setting up a new way to buy health insurance required months, if not years, of work to get health care providers, health insurance plans and purchasers — that is, individuals and employers, to agree on a plan of action. While New Hampshire, too, has a notable list of health care providers, the state’s reliance on the federal exchange meant the state’s providers never had the chance to invest their knowledge in setting up a technical framework that would work well.

That leads to the next attribute New Hampshire’s neighbors have in common: A willingness for agencies within each state to work together to deliver a new marketplace. Existing agencies and regulators were required to work with new decision-makers in each state. Connecticut’s exchange, Access Health CT, was set up as a public non-profit corporation. The Massachusetts Health Connector is a quasi-governmental entity. HealthSource RI, the Rhode Island health insurance exchange, sits within a division of the executive branch; and Vermont Health Connect is within the existing Department of Vermont Health Access. While the governance varies slightly, the necessity of cooperation with various other departments is the same. These four states are doing it better than many of their counterparts across the country.

But what truly sets these states apart is their focus on small business. If you want to truly transform the system we have, it has to be easier for small businesses to provide their employees with affordable coverage. These four states focused on business from the start.

Big companies get better prices on health insurance because health plans can spread their risk over a greater number of people . Now, small companies in certain states can also get access to this kind of low price. Which states? Not the ones that chose to let the feds run their health exchange. In those states, there will not be a marketplace for small business until 2015.

Small businesses know what they want out of these exchanges: A cheaper, easier way to provide their employees with health coverage and Connecticut, Massachusetts, Rhode Island and Vermont are delivering. While the federal exchange has plans, accessing them right now is more a factor of luck. Welcome to the new world of health insurance.

Brenda Gleason is president and founder of M2 Health Care Consulting, a Washington, D.C.-based firm focused on state health policy issues.