CONCORD, N.H. (AP) — New Hampshire's insurance commissioner has recommended that the state wait another year to implement a key feature of the new small business health insurance markets created by the Affordable Care Act.
Though companies have been able to purchase coverage in the Small Business Health Options, or SHOP, marketplace from brokers and insurance companies since October, the Obama administration delayed the launch of its online enrollment portal until November 2014 and the implementation of its employee choice feature until sometime in 2015.
That feature would allow individual employees, rather than business owners, to pick their coverage from a list of plans, but under rules made final last month, states with federally run marketplaces have the option to delay the employee choice feature even further, until 2016.
Those states had until Monday to send recommendations to Washington. In his letter made public Tuesday, New Hampshire Insurance Commissioner Roger Sevigny said he is concerned about maintaining a stable and competitive group market.
New Hampshire's small group market is dominated by two companies, Harvard Pilgrim Health Care and Anthem Blue Cross and Blue Shield. Anthem has about two-thirds of the market and insures a healthier population, he said.
"If the distribution of risk further shifts to Harvard Pilgrim or other small companies, a stable small group market is less likely to exist," he wrote.
Sevigny made his decision after hearing from insurance companies and brokers who urged him to seek a delay and consumer groups who want employee choice but recognized the potential problems.
Officials from several insurance companies said they were concerned that the Obama administration hasn't said when the employee choice feature will be available, which could create confusion if some companies were able to take advantage of it while others weren't, depending on when they sign up. They also said extensive testing will be needed to ensure the system works properly. Broker Raymond White, a former state senator, agreed, citing the problems that plagued the healthcare.gov portal for individuals last year. He began trying to help clients sign up in October but didn't succeed until December.
"I fear a similar situation will develop with the SHOP exchange, especially given that it was unable to launch this year because of the technological and logistical problems," he said. "It would be much better to crawl before trying to walk."
Members of a state board representing insurers, consumers and health care providers also discussed the issue at a recent meeting. Lisa Guertin, Anthem's president and chairwoman of the Health Exchange Advisory Board, noted the businesses still can use the marketplace to get tax credits to lower their costs even without the employee choice feature, so delaying the employee choice provision isn't a barrier to coverage.
"We all went through the pains of the past year, but the very clear payoff to all that pain is there are people who have insurance who didn't have it before. I don't see SHOP in quite the same way," she said. "We owe it to everybody to get the next round really right. ...I think we're a little gun shy, and appropriately so."