New Hampshire has 24 critical access hospitals.
"[Anthem is] building this exchange, the only one, and to keep costs down they are providing volume to 12 hospitals and cutting out 12," said Woodburn.
The exchange, part of the 2010 federal health care law commonly known as Obamacare, is aimed at increasing health care coverage and requiring those individuals currently without it to obtain it or face a federal tax penalty.
Small businesses with fewer than 50 employees are also required to purchase a plan for their employees or face a tax penalty. President Obama suspended implementation of "Employer Shared Responsibility" provisions on large employers (more than 50 workers) until 2015.
The insurance is to take effect Jan. 1.
Beginning Oct. 1, the state will roll out the New Hampshire Health Insurance Marketplace, the online exchange, where businesses and individuals can compare and purchase insurance plans.
The exchange will not impact those who will be covered through their employer.
While Anthem is the only carrier that has announced it will participate in the New Hampshire marketplace exchange for individuals in 2014, the New Hampshire Insurance Department does expect more carriers in 2015, said Jennifer Patterson, the department's legal counsel.
"In addition, we expect other plans will be available in the individual health insurance market outside the marketplace [exchange] in 2014, but people must use the [exchange] if they want access to tax credits and cost-sharing assistance available through the federal government," she said.
Harvard Pilgrim Health Care announced it will become a New Hampshire exchange participant beginning in 2015.
On July 31, the state insurance department submitted its recommendations to the federal government, but Anthem's specific plan and rate information is confidential under state regulations until the plans take effect Oct. 1, said Patterson.
The insurance carrier, however, could release details earlier if it wanted to, she said.
The New Hampshire marketplace exchange plan has been approved by the state and is now awaiting final federal approval, Anthem spokesman Chris Dugan said Wednesday.
Dugan declines to provide specifics, but did say Anthem will offer several products for consumers and the exchange will provide subsidies for individuals who can't currently afford insurance.
Anthem's plans are structured to be fully compliant with the federal law and offer all benefits mandated by the Affordable Health Care Act, he said.
"The plans also feature a select provider network which meets all New Hampshire network adequacy requirements and allows a price point that is approximately 25 percent lower than a product using a broad network," said Dugan.
Upon final approval by the federal government, Anthem will conduct an extensive outreach campaign to customers, informing them of options, providing details on available networks and including informational tools designed to help them make the best coverage decisions for themselves and their families, he said.
Through the federal health care law, the government's aim is to have lower out-of-pocket costs for consumers, said Dugan.
Details on how emergency care will work for those on the exchange and what will qualify as an emergency were not released.
Primary care also remains a concern.
As part of the federal law, an exchange provider must prove it is adequately covering an area.
But looking on a map to determine coverage versus driving in a car to a hospital are often different realities, particularly for some North Country residents, said Woodburn.
LRH CEO Warren West said he has concerns about Anthem being the only provider in the exchange.
"The ACA and the concept of the exchange is supposed to give patients more choices and in this state and it has not," said West. "I am very worried about the patients who have very limited opportunities in the North Country to get health care services."
West said he is even more concerned about where expectant mothers will deliver their babies, considering there aren't any hospitals in Coos County that do deliveries on the exchange.
Weeks Medical Center discontinued its birthing center in 2009, leaving LRH, not part of the exchange, with the only birthing center in the area.
In regard to a special exception, West said, "I have reached out to Anthem to see if we could be included in the network, especially in regard to our OB services. I have yet to hear back from them."
Currently, the New Hampshire Legislature is considering Medicaid expansion and West said he hopes the expansion moves forward so patients presently on charity care or free care can have access to Medicaid.
"That will help us to help them in the long run," he said.
Ammonoosuc Community Health Services has had a good relationship with Anthem and would be interested to see if it, too, can offer exchange capability at any one of its five delivery sites, said ACHS director Ed Shanshala.
Like Woodburn, Shanshala voiced concerns about long-distance driving for some exchange patients who can't get services at Weeks.
He also said some patients don't have transportation at all in the North Country, where the current ridership is insufficient to provide cost-effective transportation.
"I would be concerned about one site in Coos County, and Dartmouth is a good hike," said Shanshala.
Shanshala said the exchange is "all new to everybody and I'm trusting as people starting rolling it out we will evaluate it to make changes."
As the Oct. 1 nears, Weeks Medical Center has not done anything differently to prepare as Coos County's sole Anthem hospital, said Weeks CEO Scott Howe.
"The real challenge is it is unclear how many people will be impacted," said Howe.
The birthing center is the most significant thing Weeks doesn't have, he said.
"We are well-staffed with primary care physicians in the area," said Howe. "We have a well-rounded service for a rural area and most people can get everything else here."
Those who can't get everything, however, will be left to find it elsewhere, possibly driving past the North Country hospital they visited for years to a hospital as far away as Lebanon, and in some cases losing a day's pay to receive health services, said Woodburn.
"We will look for a special exception," said Woodburn. "These efficiency models just don't work across our population and geography that has 18 people per square mile."