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New York health insurance

ACA fits Empire State’s progressive attitude toward reform

  • By
  • healthinsurance.org Contributor
  • September 26, 2016

New York is a progressive state, embracing healthcare reform decades ahead of most of the rest of the country. The ACA has smoothed out some rough edges in the New York insurance market, and since implementing Obamacare, the state has continued upon these improvements.

Find out how the NY State of Health, Medicaid expansion, the Essential Plan, and other programs have helped New York residents gain access to coverage, and see how the Empire State fares in national public health rankings. This guide offers a brief summery of health and health insurance in the state of New York.

New York health ratings

New York placed 13th the 2015 America’s Health Rankings, the most recent edition available. The state performs especially strong in measures related to access to care. Its numbers of primary care doctors and dentists per 100,000 people are 7th and 5th, respectively, and its per capita public health funding is 3rd in the nation. New York’s uninsured rate is also quite low. The state fares near the bottom when it comes to childhood immunizations and disparity in health status.

The Commonwealth Fund’s 2015 Scorecard on State Health System Performance also rated New York 13th (up from 19th in 2014) out of the 50 states and District of Columbia. While America’s Health Rankings showed the state has plenty of dentists, the Commonwealth Fund scorecard shows that adult New Yorkers skip annual dental visits more than the average person. The state performed well in other access-related dimensions, however, with lower-than-average uninsured rate, percentages of adults who skipped healthcare due to cost, and few at-risk adults who went without routine doctor visits.

New York’s scorecard includes additional details on how the ratings are calculated, analyzing a variety of factors and outcomes, including obesity, access to care, hospitalizations, infant mortality, and many others.

Trust for America’s Health has also summarized information on the prevalence of various illnesses, insurance coverage, access to healthcare providers, and socioeconomic indicators in New York. The specifics are available in the 2016 listing of Key Health Data About New York.

Within the state, health factors and outcomes vary from one county to another. This interactive map created by the Robert Wood Johnson Foundation shows how New York’s counties compare with one another. High- and low-ranking counties are scattered throughout the state, with no particular region outperforming the others.

How Obamacare has helped New York residents

In most of the United States, individual health insurance was medically underwritten prior to 2014, meaning that people with pre-existing conditions were often unable to purchase private coverage. But in New York, former Gov. Mario Cuomo signed a law in 1992 that required all policies in the state to be guaranteed issue, regardless of medical history. They also switched to a community rating system, with the same premiums charged for everyone, regardless of age.

Although the 1992 law was heralded by consumer advocates as a victory, it lacked two of the major market stabilization components that the ACA has now enacted. There were no open enrollment periods (people could buy coverage anytime they wanted), and there was no individual mandate, so people could wait until they were in need of care before purchasing health insurance.

Two decades later, health insurance premiums in New York were the highest in the nation, and coverage options were very limited, with few carriers choosing to participate in the market in New York.

The ACA brought much-needed changes to New York, keeping the guaranteed issue model (and in New York, coverage is still community-rated), but adding the vitally important individual mandate and open enrollment period. As a result, the rates that the state approved for 2014 were an average of 50 percent lower than 2013 rates, and that was before factoring in the subsidies that three quarters of the exchange enrollees received during the 2014 open enrollment period. Officials in NY noted that 2016 premiums continue to be nearly 50 percent lower than pre-2014 rates, despite modest rate increases in 2015 and 2016.

In 2013, about 12.6 percent of New York residents were uninsured. By mid-2014, six months after ACA implementation, that number had fallen by more than two percentage points, to 10.3 percent, and further to 8.6 percent by late-2015 (official US census data that was released in 2016 pegged both numbers a little lower: 10.7 percent uninsured in 2013, falling to 7.1 percent in 2015).

NY State of Health enrolled over a million people during the first open enrollment period, including Medicaid/CHIP as well as private plans. More than 80 percent of those people were previously uninsured.

2017 exchange carriers and rates

New York has a very robust individual health insurance market, and when 2017 open enrollment begins, all but one carrier will return to the New York’s exchange. WellCare will exit New York State of Health, leaving the following 14 carriers and average approved rate increases:

  • Affinity Health Plan, Inc. – 22.4 percent
  • Capital District Physicians Health Plan, Inc. – 13.9 percent
  • Empire HealthChoice HMO – 15.2 percent
  • Excellus Health Plan – 15.4 percent
  • Health Insurance Plan of Greater New York – 13.9 percent
  • Healthfirst PHSP – 7.4 percent
  • HealthNow New York – 8.7 percent
  • Independent Health Benefits Corporation –19.6 percent
  • Metro Plus Health Plan – 29.2 percent
  • MVP Health Plan – 6 percent
  • Fidelis Care New York – 11.6 percent
  • North Shore-LIJ CareConnect Insurance Company – 29.2 percent
  • Oscar – 19.6 percent
  • United Healthcare of New York – 28 percent

For 2014 and 2015, Freelancers Co-Op (Health Republic Insurance) also offered coverage through New York’s health insurance exchange. However, the ACA-created CO-OP ceased operations and terminated policies at the end of November 2015.

Several New York State of Health exchange carriers will offer plans related to the Basic Health Program. Also known as the “Essential Plan,” this coverage is for people with incomes up to 150 percent of the federal poverty level and does not include a deductible or premium. New York and Minnesota are the only states that have received federal approval for their BHPs so far.

New York enrollment in qualified health plans

Of NY State of Health’s 15 carriers in 2016, Fidelis Care had the largest market share with 26 percent of exchange enrollees. Empire BCBS, Oscar, MetroPlus and Healthfirst each had 10 percent. Those five carriers accounted for two-thirds of the market share, with the other third spread out across the remaining carriers.

By January 2016, there were more than 2.8 million people enrolled in coverage through NY State of Health.

  • 271,964 were enrolled in in qualified health plans(QHPs) – effectuated enrollment stood at 224,014 on March 31
  • 379,559 were enrolled in the state’s Essential Plan, which became available in 2016
  • 215,380 were enrolled in Child Health Plus
  • 1,966,920 were enrolled in Medicaid

New York’s QHP enrollment numbers dropped in 2016, which was due in part to the Essential Plan becoming available. The Essential Plan also reduced the percentage of QHP enrollees who received premiums subsidies, dropping from 70 percent in 2015 to 55 percent in 2016.

In late 2013, the Kaiser Family Foundation estimated that 1,264,000 residents in New York would be potential customers for the exchange, and that 779,000 of them would be eligible for premium subsidies

Health Republic CO-OP

One of the available plans during the first two open enrollment periods was an ACA-created Consumer Oriented and Operated Plan (CO-OP). Under the ACA, the federal government awarded $2 billion in start-up funding to CO-OPs in 22 states. In New York, the CO-OP is Freelancers Health Service Corporation (also known as Health Republic), which received $174 million in federal funding. The CO-OP was highly successful in terms of enrollments, garnering about 20 percent of the individual market in New York in both 2014 and 2015. However, they struggled financially, and in September 2015, state and federal regulators shut down the CO-OP.

New York and the Affordable Care Act

In 2010, New York’s U.S. senators (Democrats Kirsten Gillibrand and Charles Schumer) both voted yes on the ACA. In the U.S. House, 24 Democrats voted yes, while two Republicans and two Democrats (Michael McMahon and Michael Arcuri) voted no. Schumer and Gillibrand are still in the Senate. The U.S. House delegation from New York currently consists of eight Republicans and 17 Democrats. Both McMahon and Arcuri were replaced by new Democrats in 2013.

New York’s state legislature also has a strong Democratic majority, and Democratic Governor Andrew Cuomo is an ardent supporter of the law, saying in 2012, “We look forward to continuing to work together with the Obama administration to ensure accessible, quality care for all New Yorkers.”

The state has been fully on-board with ACA implementation from the start, opting for a state-run exchange (NY State of Health) and expanding Medicaid to cover all of the state’s legal residents with incomes up to 138 percent of poverty. The state is also only the second in the nation (after Minnesota) to implement the ACA’s provision to create a Basic Health Program, extending very low-cost health insurance to residents with incomes up to 200 percent of the poverty level.

New York Medicaid/CHIP enrollment

Medicaid/CHIP enrollment in New York increased 13 percent from the fall of 2013 to June 2016. The state’s acceptance of federal funding to expand Medicaid eligibility to 138 percent of poverty has played a significant role in the New York’s Obamacare success.

The ACA called for Medicaid expansion nationwide, but in 2012 the Supreme Court ruled that states could opt out, and 19 states have not yet moved forward with any type of Medicaid expansion.

During the first open enrollment period, the Kaiser Family Foundation estimated that about 43 percent of the 2.2 million non-elderly uninsured residents in New York would be eligible for Medicaid or CHIP under the expanded eligibility guidelines created by the ACA. Eligible applicants can enroll in New York Medicaid year-round, so total enrollment has continued to increase, further lowering the uninsured rate in New York.

Medicare enrollment in New York

New York Medicare enrollment reached more than 3.3 million enrollees in 2015 — roughly 17 percent of the state’s population, which is consistent with the percentage of people enrolled in Medicare nationwide. As of 2013, about 84 percent of New York Medicare recipients qualify for coverage based on age alone, while the remaining 16 percent are on Medicare due to disability.

In 2009, New York ranked 3rd in overall annual Medicare spending with $34.1 billion. 2014 data show the state spends $8,938 per enrollee each year – just below the national average spending of $8,970.

Those who want additional benefits beyond what original Medicare offers can choose a Medicare Advantage plan instead of traditional coverage. In New York, 37 percent of Medicare recipients make this choice compared with 31 percent of all Medicare recipients.

Medicare Part D plans are also an option for Medicare beneficiaries who want to stand-alone prescription drug coverage. 42 percent of New York Medicare enrollees have a stand-alone Rx plan; nationally, 45 percent of all Medicare enrollees have this coverage.

State-based health reform legislation

Here’s a summary of recent New York bills related to healthcare reform: