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 370,058 people had effectuated private plan coverage through the New York exchange as of June 2015. In addition, Medicaid/CHIP enrollment in New York grew by 763,458 people from 2013 to June 2015.
But a wide range of issues play a role in the overall health of a state’s residents. For residents of New York, there are numerous factors that could impact health outcomes and that might be of interest in terms of the state’s approach to healthcare and healthcare reform. Here’s a summary:
Carriers in the individual market
New York has a very robust individual health insurance market. There are 17 carriers, and 16 of them participate in New York State of Health, the state-run exchange (this will decrease by one at the end of 2015, when Health Republic CO-OP closes its doors):
- Affinity Health Plan, Inc.
- Capital District Physicians Health Plan, Inc.
- Health Insurance Plan of Greater New York (EmblemHealth)
- Empire BlueCross and Empire Blue Cross Blue Shield
- Excellus (Excellus Blue Cross Blue Shield in Central NY and Univera in Western NY)
- Fidelis Care (NY State Catholic Health Plan)
- Freelancers Co-Op (Health Republic Insurance) – the CO-OP will cease operations at the end of 2015.
- Healthfirst New York
- HealthNow New York, Inc. (Blue Shield of NENY; Blue Cross Blue Shield of Western NY)
- Independent Health
- MetroPlus Health Plan (Market Plus)
- MVP Health Plan, Inc.
- North Shore LIJ
- Oscar Insurance Corporation
- Oxford OHP (off-exchange only)
- United Healthcare of New York, Inc. (United, Oxford)
New York health ratings
The Commonwealth Fund’s 2014 Scorecard on State Health System Performance rated New York 19th out of the 50 states and District of Columbia – down one spot from 18th in 2009. New York’s Scorecard includes 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..
America’s Health Rankings placed New York a little higher – at 15th – in 2013. The state has a relatively low prevalence of suicide, tobacco use, and obesity, which boosts their overall rating. They also have plenty of primary care doctors and dentists, and high per capita public health funding.
But New York also has its challenges, including a low high school graduation rate, low immunization coverage, and a high percentage of children living in poverty – a quarter of the state’s children currently live in poverty, up from about 20 percent five years ago.
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 2014 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.
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.
How did the ACA help 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 Governor 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 8.3 percent by mid-2015 (official US census data that was released in 2015 pegged both numbers a little lower: 10.7 percent uninsured in 2013, falling to 8.7 percent in 2014, but with no 2015 data available). NY State of Health enrolled over a million people during the first open enrollment period, including Medicaid/CHIP as well as private plans. And more than 80 percent of those people were previously uninsured.
New York enrollment in QHPs
There are a total of 15 carriers in the New York exchange (Health Republic is no longer offering coverage). Not all carriers issue plans in all areas, but more than half of the state’s counties have at least five different carriers offering plans in 2014, and six carriers expanded their coverage area in 2015.
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. But they struggled financially, and in September 2015, state and federal regulators shut down the CO-OP (enrollees will be able to transition to other carriers during open enrollment, and their CO-OP coverage will remain in force until the end of 2015).
By June 2015, 370,058 people had effectuated (in-force) private plan coverage through the New York exchange – the sixth highest total in the country. About 71 percent of them received premium subsidies averaging about $226 per month.
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.
New York Medicaid/CHIP enrollment
Medicaid/CHIP enrollment in New York increased by 763,458 people from the fall of 2013 to June 2015. The state’s acceptance of federal funding to expand Medicaid eligibility to 138 percent of poverty has played a significant role in the NY’s Obamacare success.
(The ACA called for Medicaid expansion nationwide, but in 2012 the Supreme Court ruled that states could opt out, and 20 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 Medicaid year-round, so total enrollment has continued to increase, further lowering the uninsured rate in New York.
State-based health reform legislation
The 2014 legislative session was a very busy one for lawmakers working to improve numerous aspects of the healthcare system in New York. Here’s a summary of recent New York bills related to healthcare reform: