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Expert points to lessons for health overhaul in NH

Holly Ramer, Associated Press

CONCORD, N.H. (AP) -- As New Hampshire prepares to implement the federal health care overhaul law, it could learn some lessons from its experience with providing subsidized health insurance to children over the years, a policy expert told lawmakers Tuesday.

Tricia Brooks, who spent nearly 15 years as CEO of the nonprofit New Hampshire Healthy Kids Corp., spoke to the Legislature's Health Reform Oversight Committee about the challenges her staff faced in reaching out to eligible families and getting them enrolled. Obstacles included confusing paperwork, skepticism that low-cost options really were available and a lack of understanding of the value of insurance, she said.

"I can't tell you how many times when we were in rural New Hampshire and we would encounter parents who would say, 'I don't have insurance, my parents didn't have insurance, my grandparents didn't have insurance. Why do I need insurance?'"

The changes coming this fall — when a mix of government programs and tax credits for private insurance kicks in — will present even greater challenges, Brooks said. While those involved in the process may believe there has been a lot of media coverage of the changes, surveys have shown that three-quarters of those who stand to be helped by the new law don't know what's coming, she said.

"Enrollment is not going to be a snap," she said. "This is not going to be ready on day one. We're going to be tweaking it and refining it over time."

Under the overhaul law, new insurance marketplaces will offer individuals and their families a choice of private health plans resembling what workers at major companies already get. The government will help many middle-class households pay their premiums, while low-income people will be referred to safety-net programs they might qualify for. Enrollment starts Oct. 1 with coverage taking effect Jan. 1. After that, virtually everyone in the country will be required by law to have health insurance or face fines.

Brooks said the state will need "all hands on deck" to help rebuild the partnerships that were key to Healthy Kids, and those assisting consumers will need significant training.

"It's really critical to lay the groundwork for what's coming," she said.

New Hampshire opted not establish its own marketplace, and is partnering with the federal government to regulate insurers and provide consumer assistance. But the process has been slowed by persistent disagreements about who has the final say over implementing the law.

The Legislature's fiscal committee delayed action last month on accepting $340,000 to start setting up a program to help consumers explore their options under the new law, and another $5 million in grant funding is in the Insurance Department's budget request. While the $5 million amount is more important, the smaller grant also would have been a significant help because it would've allowed the state to hire a coordinator to get started on outreach, Insurance Commissioner Roger Sevigny said this week.