So Far, So Good: Open Enrollment and the Affordable Care Act (ACA)

What a difference a year makes. The second Open Enrollment period for the Health Insurance Marketplaces in New Hampshire, Maine, and Vermont opened at midnight this past Saturday.  So far, so good.  This is a big change from the start of last year’s Open Enrollment when so much that could go wrong with the new technology, did.

This year, though, four days into year two of the ACA’s online insurance marketplaces, most reports say that they are working well.  According to the federal government, on Sunday alone more than 100,000 people enrolled in the 2015 health plans on

Vermont Health Connect (VHC) has also received positive reports so far.  The VHC website was shut down for most of the last two months; however, it is up and running now and good for Vermont.

The U.S. Health and Human Services Department, the agency responsible for implementing the ACA’s federal online health insurance marketplace, is predicting between nine and ten million people will purchase their medical coverage on in 2015.  That’s two to three million more than bought plans in 2014.

At Northeast Delta Dental, we’re expecting thousands of individuals and families to choose one of our stand-alone plans on either or VHC again this year.

Our new partnership with Maine Community Health Options (MCHO) is going to be something to watch this year, too.  We are handling the claims processing for the pediatric dental benefit they are including in three of their medical plans in Maine and New Hampshire.  More than 80% of individuals and families in Maine who bought a medical plan on last year bought it from MCHO.  We’re wishing them equal success as they branch out into New Hampshire this year.

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Books I am Reading: Paid to Think

One of my employee colleagues attended a Public Relations Society of America conference in sunny Florida earlier this year and brought back Paid to Think written by David Goldsmith, one of the keynote speakers.  The book discusses Enterprise Thinking, a revolutionary, research-based approach to leadership that explains how successful leaders perform a dozen important activities on a daily basis in the areas of strategizing, learning, performing, and forecasting.

Goldsmith also mentions the idea of taking a 50,000 feet approach to running a company.  For example, it is my responsibility to make sure Northeast Delta Dental meets our annual Smart Goals and while I do worry about the little things occasionally, I know that we hire capable employees who know how to do their jobs right the first time.  At Northeast Delta Dental we focus on attracting and retaining skilled employees and require all job applicant finalists to complete a Predictive Index® assessment and a critical thinking assessment before they are hired.  We serve a number of different audiences including our customers, participating dentists, and producers and we require these tests to help make sure our employees communicate and solve problems effectively and efficiently.

Paid to Think provides leaders with the necessary tools to “keep the trains running” and serves as a reminder that while the little things are important, if you have capable staff in place and a strategic plan, it’s okay to relax a bit. I recommend all corporate leaders pick-up a copy.

Paid to Think

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Don’t let your Halloween fun haunt your oral and overall health

There is a chill in the air and it’s finally starting to feel like fall. This past weekend, I participated in the Granite State 10 Miler to benefit the Concord Boys and Girls Club followed by the Making Strides Against Breast Cancer Walk to benefit the American Cancer Society with my employee colleagues. I enjoy running year-round but especially in the fall.

With Halloween around the corner, I would be remiss if I didn’t mention the importance of oral and overall health, especially when candy is often the highlight for many children who will roam the neighborhood trick-or-treating to gather as many sweet treats as they can.

While candy is fine to enjoy in moderation, it’s important that you encourage your children to eat a full meal before trick-or-treating to prevent them from filling-up on candy. Also, try to limit the amount of hard candies or chewy candies your children eat. Hard candies can chip or crack teeth and increase the amount of time teeth are exposed to sugar. Chewy candies stick to teeth, also increasing the amount of time teeth are exposed to sugar. When teeth are exposed to sugar for extended periods of time, it provides a welcoming environment for bacteria to grow which in turn, produces cavity-causing acids.

I wish you and your family a happy and safe Halloween! To access fun Halloween activities and oral health tips, visit

If you are looking for something outdoors to do this weekend after this dreaded rain, check out these three family-friendly Halloween-themed road races/walks to think about:

Trick or Trot 3k (Manchester, NH)

Witch Way to the 5k (Bedford, NH)

Wicked FIT Run (Concord, NH)

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Small Business Health Options Program (SHOP) Exchanges: Upcoming 2015 Changes

Coverage is available to firms with 50 or fewer full-time equivalent employees through the SHOP Exchanges. One intent of the SHOP is to decrease small firms’ costs for health insurance coverage.  From 1999 to 2009, health insurance premiums increased 123 percent for small businesses, a significant amount considering that within the United States there are 34 million employees working for 5.8 million small firms. Small firms constitute 96 percent of all firms according to the Council of Economic Advisers.

Another goal of the SHOP Exchange is to increase employee choice in health insurance plan options. “Employee choice” allows an employee to choose from several options selected by an employer from the tiered system of medical plans the SHOP offers (Platinum, Gold, Silver or Bronze). States had the option to delay that function due to concerns that it would not be fully operational by the beginning of the open enrollment period. Maine and New Hampshire opted to delay employee choice until 2016 for that reason.

As many know, the SHOP Exchange side of the Federally Facilitated Marketplaces did not open in fall 2013 when the individual exchange did.  The Obama administration postponed the kick-off due to technical problems. Five test states will soon test the federally-run SHOP Exchanges under the assumption that they will be ready for the open enrollment start date on November 15.  As with last year, states that do not have functioning online SHOP Exchanges for 2015, like Vermont, will permit medical and dental carriers that have approved SHOP plans to offer them directly to small businesses.  Small businesses can also access those plans through producers.

Some have expressed doubt that SHOP Exchanges will be ready for November 15.  Even if the five states testing results discover issues that necessitate system updates, I think it is likely that the federal government will open up SHOP Exchanges for political reasons. At Northeast Delta Dental, we currently have two SHOP groups in Maine, and none in New Hampshire. For several reasons, few small businesses have utilized the SHOP Exchange.  That may change once the online function is operating.

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A stroll through downtown Concord for wellness…

This morning I participated in the Mayor’s Walk through downtown Concord, New Hampshire, alongside Mayor Bouley and nearly 100 community members. The event was in support of the Capital Area Wellness Coalition’s I Prefer to Walk campaign to promote wellness, community, walkability, and highlight Concord’s downtown community.

As a member of the Capital Area Wellness Coalition and a company that encourages employee wellness, Northeast Delta Dental was proud to sponsor the Mayor’s Walk. As I describe in chapter three of my book, There Are No Do-Overs: The Big Red Factors for Sustaining a Business Long Term, in business, the importance of physical and mental health fitness cannot be over-emphasized. To run a successful business, you need to keep the players on your team healthy.

To keep our team healthy, we have two on-site fitness centers and offer yoga and aerobics classes to employees. We also have a running and walking team (The Toothaches) that meets weekly. We encourage employees to remain fit while doing the exercise of their choice.

If you’re looking to improve or maintain your personal fitness, you might find the following resources helpful:

New Hampshire:

Capital Area Wellness Coalition (

City of Concord Conservation Commission trails (

Runner’s Alley (

Millennium Running (


Eastern Trail Alliance (

Maine Recreation & Parks Association (

Portland Trails (


Burlington Bike Path (

Burlington Parks and Recreation (

Vermont State Parks (

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Sad news about a business colleague

Over the weekend, I was sad to learn about the passing of my business colleague, Gary Long, former president of Public Service of New Hampshire.  We spent many hours working together on the Council of Junior Achievement and the Granite United Way.  We also served together on the Board of Directors for the New Hampshire Business Committee for the Arts.  Gary’s leadership and passion for giving back to the community was more than admirable.

Gary was many things to many people including a wonderful husband to his wife, Mary, father to Martha, Thomas and Timothy, grandfather to Lily and James, a son, a brother, and the list continues.  He will forever be remembered as a leader and force at PSNH and the many organizations and people who had the pleasure of knowing or working alongside him.

My wife, Lisa, our family, and the entire Northeast Delta Dental community send our thoughts and prayers to Gary’s loved ones during this difficult time.  Please accept our deepest sympathies.

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How would you assess the first year of the Affordable Care Act’s Performance?

With several technological issues of the Health Insurance Marketplace (exchange) rollout, frustration mounted as visitors to the website for Maine and New Hampshire and the Vermont Health Connect website for Vermont were hampered from enrolling in health coverage. Eventually, most of the technological glitches were addressed and nearly eight million Americans enrolled in coverage through the exchanges. In all three states, Northeast Delta Dental offered Stand Alone Dental Benefit (SADB) Plans. More than 4,500 people enrolled in these plans and now have access to dental coverage through Northeast Delta Dental for 2014.

Let’s review our journey to date and then explore likely outcomes related to the procurement of medical and dental coverage. Open enrollment for 2014 was scheduled to begin October 15, 2013. Vermont, running its own exchange, was on schedule. The federal exchanges in Maine and New Hampshire were delayed by a month. However, when the exchanges were made available to individuals (SHOP exchanges were scheduled to be functional in the fall of 2015), there were many challenges. Vermont Health Connect had several technical glitches, and the federal exchanges for Maine and New Hampshire were not able to handle the volume of users and crashed. Even individuals that were able to enroll online were not confident that they successfully obtained health coverage.

Once the exchanges became functional, more than 40,000 individuals in Maine and New Hampshire and more than 38,000 in Vermont enrolled. Of these a vast majority received some form of subsidy through the exchanges.

Among those satisfied with their non-Affordable Care Act (ACA) compliant medical plans, there was a scramble to renew their existing plans known as ‘grandmothered plans’ in order to avoid a change in health coverage. The government recognized the need for action and sanctioned the ‘grandmother plans’ through a ‘transitional relief’ program for certain medical plans. This enabled the plans to remain ‘as is,’ many until 2016. This did not affect SADB Plans at all.

Now, confidence is high that an individual can utilize the exchanges to obtain coverage. Although some technological issues persist, such as mid-term changes in family enrollment, the new ‘normal’ is that enrollment can be confirmed in a timely manner, and the necessary information and payment will be properly transferred from the exchange to the carrier. Northeast Delta Dental has collaborated with the exchange operators to address any “blips” and we do not anticipate significant future challenges.

Anthem was the only medical carrier participating on the exchange in New Hampshire in 2014. At least four new carriers, Harvard Pilgrim, Maine Community Health Options (Maine based co-op), Assurant Health, and Minuteman Health (Massachusetts based co-op) have applied to the New Hampshire Insurance Department (NHID) for consideration to include their plans on the exchange for the 2015 enrollment period. They are waiting for approval from the NHID and Health and Human Services. Northeast Delta Dental offered the only SADB Plan for the 2014 rollout; however, other dental insurance carriers have applied and are waiting for 2015 approval.

Small Business Health Options Program (SHOP) exchange implementation is expected to be functional this fall for 2015 plans for employers with fewer than 50 full-time equivalent employees in Maine and New Hampshire. However, employees will not be able to take advantage of full ‘employee choice’ (a choice of multiple plans at the same metal level) until at least the 2016 plans. For 2015, small group employers in Vermont will continue to directly enroll with carriers for ACA “exchange certified” small group plans offered through Vermont Health Connect.

The government is now working on an automatic renewal and reenrollment plan for 2015. The proposed rule was posted on July 1, and public comments were accepted until July 28. After reviewing feedback, the government will publish a final rule and guidance. In the interim, testing of the auto-renewal technology requirements continues.

A recent ruling by a Washington, DC court cast doubt on whether or not federal exchanges can offer subsidies for health coverage. The administration is going to appeal that decision. Meanwhile, the decision has been stayed, which means at the moment the subsidies for many people in New Hampshire and Maine will stay in place.
Vermont is a state run exchange and would not be affected by the ruling because subsidies for state run exchanges are specifically mandated by the ACA.

In summary, as long as Congress and the administration resist compromise and fail to identify solutions to the unintended consequences of the ACA, barriers to a smooth, successful implementation will continue to exist, inhibiting the ACA from fully achieving its original goals of:

    • Improving the affordability of health insurance
    • Significantly decreasing the number or people who don’t have health insurance
    • Reducing the cost of health care in the United States

Northeast Delta Dental will continue to update you on the many challenges and associated solutions of the ACA.

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