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Thomas Raffio: Why Northeast Delta Dental is taking part in the NH ACA exchange

September 29. 2013 6:37PM

We are all entering the brave, new world of the Patient Protection and Affordable Care Act. There are many unknowns and few answers as to how the new Health Benefit Marketplaces (exchanges) will play out when they open for business tomorrow.

When the Affordable Care Act (ACA) passed in March of 2010, those who opposed it immediately vowed to repeal it. Medical and dental insurance companies then had a choice to make: assume the ACA will be fully implemented and prepare for it, or wait to see if it will be implemented and risk not being prepared for the exchanges come October of 2013. Northeast Delta Dental chose to confront our new reality, never believing that the ACA would go away.

We started preparing in 2010 for the ACA’s full implementation. We kept at it through the uncertainties caused by the related U.S. Supreme Court case and the 2012 presidential election. With the opening of the exchanges now upon us, we are as prepared as any carrier can be. We trust our years of preparation will serve us well. Along with other carriers offering products on the exchange, though, we may need to adapt as the government adjusts the roll-out of exchanges. We also may have to change the way we work together in the implementation of exchanges.

The establishment of the exchanges has been clouded by system delays and federal regulations that are too often ambiguous. But other purposes of the ACA are more clear: for example, its goals of improving our country’s health outcomes and reducing the cost of health care through reforms to health care and to the health care insurance markets. An emphasis on disease prevention and cost containment are two such market reforms. Northeast Delta Dental has a long history of promoting both of these.

By encouraging regular teeth cleanings and oral exams, as well as good home dental care, dentists have improved our collective oral health. Those efforts have helped to prevent dental disease before it starts and to control it if it already has. Likewise, dental benefit plan designs that cover 100 percent of the cost of those preventive dental services have created a financial incentive for patients to take good care of their teeth. Prevention avoids the more costly restorative work (fillings, crowns), only 50-80 percent of which is covered in a typical dental plan. This approach, one the ACA replicates in the health insurance market, has reduced the prevalence of cavities and their related care costs. This saves consumers money in the long run.

The ACA’s provisions are addressing the challenge of reducing health care costs. At the same time, Northeast Delta Dental has maintained our administrative costs at less than 10 percent of gross revenue over the past four years. This results in lower monthly premiums to our subscribers, who are increasingly looking for the best-designed plans to meet their personal budgets. Northeast Delta Dental’s emphasis on prevention and value-driven dental plans consumers want to purchase illustrates the outcomes supporters of the ACA hope to see mirrored in the health insurance markets.

Northeast Delta Dental took the plunge and opted to participate on the New Hampshire exchange. There are no guarantees that all the financial and human resources we have dedicated to that effort will benefit our company in the long run. We see the exchanges as part of the future health care system in which we need to operate. Everyone involved in the development of exchanges has experienced obstacles and hurdles. Along with that comes the opportunity to provide dental benefits to previously uncovered children and families. This, in and of itself, is a worthy goal.

Along with the medical and other dental carriers, as we approach the opening of the new insurance market, we will be holding our breath to see how it all unfolds. We will be watching to see if and how individuals and small employers take to the new, web-based marketplace. We will also see whether the very compressed timetable for implementing such a large effort is its undoing. On the other hand, that timetable may simply cause a slower rollout of a fully functioning system.

We are one of the larger employers in New Hampshire. Our success benefits our communities. As a non-profit organization, we contribute nearly $1 million annually to New Hampshire community organizations, including oral health initiatives to improve access to dental care. We fully intend to continue providing such support. We trust that wherever the market chips may fall as the ACA is fully implemented, Northeast Delta Dental’s long history of solid corporate citizenship and excellent customer service will carry us well into this brave, new world.

Thomas Raffio is President and CEO of Northeast Delta Dental.

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