White River Junction
The New Hampshire Insurance Department released information in late June about what consumers will face when the next enrollment period for plans purchased through the state’s exchange starts on Nov. 1, and, this week, Vermont’s Green Mountain Care Board will consider rate increases for the two insurers — MVP Health Plan and Blue Cross Blue Shield of Vermont — offering plans on the state’s health insurance exchange, Vermont Health Connect.
“The biggest thing for us is the uncertainty at the national level,” said Stephanie Waterman, who runs White River Growpro, a hydroponics and gardening supply company in White River Junction, with her husband Kendall Smith.
The couple, who are in their third year of running the South Main Street business, are looking to add an employee and already purchase health insurance for themselves through Vermont Health Connect.
Though insurance rates for 2018 plans offered on Vermont’s exchange are proposed to go up 6.7 percent for MVP and 12.7 percent for Blue Cross and Blue Shield — the company insuring Waterman and Smith — Waterman said it’s not rate increases that most worry her.
Instead, it’s the potential repeal of the Affordable Care Act, aka Obamacare, in Washington, she said.
“What does that mean for those of us who buy through the exchange?” she said.
A little more than 80,000 Vermonters and about 93,000 Granite Staters are insured through plans purchased in online marketplaces created by the Affordable Care Act.
Waterman said she is particularly concerned about the threat the Republicans’ plan may pose to the requirement that insurance companies cover those with preexisting conditions. She also said she worries about threats to cut Medicaid funding in the future.
“I don’t know what they’re doing,” she said of members of Congress.
It’s not that Waterman thinks the Affordable Care Act necessarily offers the best approach to providing health insurance. Instead, she would like to see a single-payer system, or at least some way that small businesses like hers could pool resources with others to offer health insurance to their employees.
At Northern Stage, a theater on Gates Street not far from Growpro in downtown White River Junction, the nonprofit does not provide insurance for its 23 full-time employees, so it’s up to individuals to find insurance on their own.
Through contracts with a union including actors, directors and designers, Northern Stage does contribute to health insurance for some employees, said Managing Director Eric Bunge. But, because theater work generally is not highly paid, Bunge said the organization doesn’t want to interfere with employees’ access to subsidized coverage available through either state’s exchange.
“(We) don’t want to mess with anybody’s ability to have the most affordable health care possible,” he said.
Plans available on the exchange are proving costly for Bunge and his family. He purchases insurance for himself, his wife — who is self-employed — and his younger daughter on New Hampshire’s online exchange, formally known as the Marketplace. His older daughter is insured through a plan at her university.
The family, who live in Etna, does not qualify for subsidies and pays full price — totaling about $24,000 this year for the four of them in premiums, a health savings account and other out of pocket expenses — for health insurance.
“I don’t know how much longer, how many more annual increases we’ll be able to take … until we’ll just say we’re just going to take a chance,” Bunge said.
He anticipated the family’s health costs will rise to $26,000 in 2018.
Health insurance is a heavy burden for employers who do contribute to employees’ premiums, but for Curt Jacques of West Lebanon Feed and Supply it’s worth it — for now at least.
The company, which renewed its insurance through Harvard Pilgrim Health Care on July 1 and is not reliant on the exchange, pays approximately $150,000 for the health insurance it offers to its 32 employees, Jacques said. This year, the company’s rate for health insurance went up about 7 percent, he said. Not the 20 percent he has seen some years, he said.
The company’s share of the premium cost is dictated by the number of years an employee has worked there. For example, West Lebanon Feed and Supply contributes 80 percent of the cost of a premium for one employee who has worked there more than 25 years, Jacques said.
While it would be cheaper not to offer the coverage, Jacques said it’s not an option.
“We can’t just from the moral standpoint,” he said.
Offering employees a little more per hour without insurance wouldn’t do any good, Jacques said. In that case, employees would be less productive and more likely to come to work sick, he said.
Regarding the effect policy changes at the federal level could have on his business, Jacques said he was focused on the present.
“You have to live for today,” he said. “We’re locked in for a rate for a year. (We) could get hit with a 20 percent increase … Then we’d have to reevaluate.”
The cost of health insurance also weighs on executives at Chippers, a Woodstock-based landscaping, lawn and tree management company, according to John Keefe, the vice president of operations.
The company offers health insurance to its 70 to 80 full-time employees and pays about 50 percent of the cost of a premium for an individual.
Though Keefe, who previously worked as the company’s human resource manager, said the ACA has helped to stabilize cost increases, he is concerned that the burden of insurance is shifting to the employees.
“On the negative side, the actual coverage has diminished,” he said. “Insurance companies have gotten clever with getting premiums down.”
For example, he noted that some services don’t count toward the policy’s deductible. To help out, starting this year, Chippers began contributing to employees’ health savings accounts in addition to their premium costs.
Keefe said discussions at the federal level about health care reform add to the anxiety businesses and individuals already feel about the costs and quality of insurance coverage.
“It’s such a big cost for us and all of our employees,” he said. “Nationwide, people are going to start having real difficult decisions to make relative to care and finances.”
Some may opt out of insurance coverage, others may go bankrupt trying to pay for it, he said.
He noted that a co-worker’s child had recently broken a leg in an athletic event and taken an ambulance ride to the hospital for care. The ambulance ride was not covered by insurance and cost the family thousands of dollars, he said.
“It’s almost like catastrophic insurance now, really,” he said. “It’s not like insurance used to be.”
Broadly, Keefe said he sees a path forward for single payer, a system in which the state — financed through taxes — would provide health insurance for everyone.
“That’s going to have to happen in order for things to change in a positive way,” he said.
Though it would mean higher taxes, Keefe said people are already paying high costs for health care with higher premiums and higher out-of-pocket costs.
Kathy Hubert, a co-owner of Hubert’s Family Outfitters, said health insurance costs are her top concern for the business. There are, of course, other pressures on retailers, but they aren’t as significant as health care costs, she said.
The company used to offer all 80 employees health insurance, but now offers coverage to management only, Hubert said. The Newport-based company, which has stores in Newport, Claremont, Lebanon, New London and Peterborough, N.H., after closing stores in Woodsville and Goffstown, N.H., last year, is organized in separate corporations, allowing it to skirt the ACA’s requirement that employers with more than 50 full-time employees offer insurance.
“If we did not have separate corporations … I don’t know if we could have afforded it,” she said.
Some Hubert’s employees are able to purchase insurance on the exchange for less than the company would be able to offer, she said.
But others fall into a “donut hole,” in which they don’t qualify for subsidies, but the cost of coverage is a substantial portion of their earnings, she said.
“I do really feel bad for the middle class,” she said. “It’s just one more thing.”
Which comes back to Hubert’s bottom line, she said. When the middle class has less to spend, they’re less likely to shop in her stores.
“I do believe there should be affordable options,” she said.
But, she wondered why the burden of these costs has to be shouldered by small businesses.
Not offering insurance to most employees has helped Hubert’s save money, but it comes at a cost. Hubert’s recently lost an assistant manager to another company that does offer health insurance, Hubert said.
“I’m losing good help (and) unemployment is going down,” she said.
Every year, Hubert said she dreads learning new rate information in September. Though the rate hikes vary, the result is the same: Increases in out-of-pocket costs, she said.
Hubert is not alone in her anxieties about the future.
On Wednesday morning, Sunapee insurance broker George Curt was preparing to send out an email to his clients — people who purchase plans on the exchange and through the private market — with the information he has on what plans might look like for 2018.
According to information from the state’s insurance department, there will be fewer insurance carriers participating in the New Hampshire exchange and fewer plans offered in 2018 than this year. Minuteman Health has dropped out, bringing the number of carriers down to three and the number of plans down to 21, from 49 this year.
“Rates are going up and the networks are going to get smaller,” Curt said.
Nationally, many fewer insurers are expected to participate in the federal exchanges, which are used by 39 states including New Hampshire, in 2018, according to the Centers for Medicare and Medicaid Services. Last year at this time 227 issuers had submitted an initial application compared to 141 this year, for a 38 percent drop in filings, CMS reported in a news release last week.
Rate information in New Hampshire won’t be available until later this year, but in Sunapee, Curt is telling current clients to expect double-digit rate increases for 2018 in plans purchased both on and off the exchange, he said.
“This rate increase that I’m anticipating will be higher than we have seen recently,” Curt said.
Curt pointed to uncertainty at the federal level as the culprit driving up rates.
“When insurance companies are uncertain, they are going to be very, very conservative,” he said.
For example, if companies foresee the elimination of the individual mandate — which is intended to level out costs by requiring that younger, healthier people also buy insurance — they will anticipate having to insure older and sicker people, on average, he said.
For his part, Curt said he thinks health care reform should allow people to pick from a buffet of coverage options. So, for example, he could opt out of things like prenatal care, mental health or substance abuse treatment.
“I’m happy to take the risk on certain things,” he said.
Despite the “saber rattling” in Washington, Curt said any changes are unlikely to have an immediate effect.
“Nothing is going to come of that that will help in the next year or two,” he said. “Nothing is going to help for 2018. It could possibly hurt, but it’s not going to help.”
Overall, uncertainty about health care costs acts as a drag on the economy, said Rob Taylor, executive director of the Lebanon Chamber of Commerce.
“One way or the other we need to make a decision,” Taylor said. “The uncertainty is the problem at this point.”
Taylor, who also is the chairman of the Plainfield Selectboard, said municipalities aren’t immune to increasing health care costs. Though the town long paid 100 percent of its employees’ health insurance premiums, it no longer does, he said. Town employees are now asked to contribute 5 percent.
“Costs just kept on going up,” he said.
Open enrollment for 2018 health insurance plans purchased on either state’s exchange runs from Nov. 1 to Dec. 15 this year. For more information visit: healthconnect.vermont.gov or nh.gov/insurance/consumers/mp_plans.htm.
Staff Writer Nora Doyle-Burr can be reached at ndoyleburr@vnews.com or 603-727-3213.
