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New York health insurance

New York took action to protect contraceptive coverage. Will the state implement an individual mandate to replace the federal one?

New York enrollment update

New York overview

The health of New York’s state-based exchange, NY State of Health remains strong heading into 2018. The exchange has robust insurer participation, and premiums are still lower in 2018 than they were in 2013 (that’s not the case in most states, but New York had guaranteed-issue coverage long before the ACA, but without a mandate requiring people to buy coverage; as a result, coverage was expensive in New York pre-2014).

Enrollment in NY State of Health — including QHPs (private plans), the Essential Plan, Medicaid, and Child Health Plus — reached more than 3.6 million by the end of January 2017 (when open enrollment ended for QHPs). That was an increase of 800,000 over the prior year’s total enrollment. And by mid-December 2017, total enrollment stood at nearly 4.2 million (2,871,000 on Medicaid, 229,000 on private individual plans, 364,000 on Child Health Plus, and 716,000 on the Essential Plan, New York’s Basic Health Program).

New York is a progressive state that embraced health care reform decades ahead of most of the rest of the country. The Affordable Care Act has smoothed out some rough edges in the New York insurance market, and since implementing Obamacare, the state has continued upon these improvements. In January 2017, prior to the inauguration of Donald Trump, New York Governor, Andrew Cuomo, announced that repealing the ACA would cause 2.7 million New Yorkers to lose their health insurance coverage.

Although Republican leaders spent 2017 attempting to repeal the ACA, most of their efforts fell short. All of the ACA repeal bills that were considered in 2017 failed to win enough support to pass, although the GOP tax bill, enacted in December 2017, did repeal the individual mandate penalty, starting in 2019 (there is still a penalty for being uninsured in 2018, which will be assessed on tax returns in early 2019, but there will not be a federal penalty for being uninsured starting in 2019).

Governor Cuomo took action in early 2017 to protect New York residents’ access to birth control and abortion coverage, regardless of the future of the ACA. And lawmakers once again considered a single-payer system during the 2017 legislative session — it passed in the Assembly, but fell short in the Senate.

It’s not yet clear whether New York will consider implementing a state-based individual mandate. The state has plenty of experience with the detrimental effects of having guaranteed-issue coverage without a mandate, although the limited enrollment windows that are now in place are helpful in terms of preventing a return to the death spiral situation that New York’s individual market was facing prior to the ACA.

New York health ratings

New York placed 13th in both the 2015 and 2016 editions of America’s Health Rankings, but moved up to 10th place in the 2017 edition. From 2012 to 2017, New York made the biggest gain of any state in the country under America’s Health Rankings, moving from 18th to 10th. And when the rankings began, in 1990, New York was ranked 40th. 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 3rd, respectively, and its per capita public health funding is 5th in the nation. And the state is ranked 6th in terms of obesity, and has the lowest rate of occupational deaths in the country. The 2017 edition of America’s Health Rankings puts New York 18th in the nation in terms of its uninsured rate, with Massachusetts at the top of the list (Massachusetts has had an individual mandate in place since 2006).

The Commonwealth Fund’s 2017 Scorecard on State Health System Performance rated New York 12th, up from 13th in 2015 and 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.

Commonwealth Fund’s 2015 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 more than 50 percent lower than pre-2014 rates, despite modest rate increases in 2015, 2016, and 2017.

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.

2018 exchange carriers

New York has a very robust individual health insurance market, and all but two carriers returned to New York’s exchange when open enrollment for 2018 coverage began on November 1, 2017. Affinity and CareConnect are no longer offering coverage, but 12 insurers continue to offer plans in the individual market via New York State of Health (details about approved average rate changes for each plan are available here):

  • Capital District Physicians Health Plan
  • Empire BlueCross and Empire Blue Cross Blue Shield
  • Excellus (Excellus Blue Cross Blue Shield in Central New York and Univera in Western New York)
  • Fidelis Care
  • Health Insurance Plan of Greater New York (EmblemHealth)
  • Healthfirst New York
  • HealthNow New York, Inc. (BlueShield of Northeastern New York, and BlueCross BlueShield of Western New York)
  • Independent Health
  • MetroPlus Health Plan
  • MVP Health Plan, Inc.
  • Oscar Insurance Corporation
  • United Healthcare of New York, Inc

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.

15 New York State of Health carriers offer plans under the state’s Basic Health Program. Also known as the “Essential Plan,” this coverage is for people with incomes up to 200 percent of the federal poverty level and does not include a deductible or premium. New York and Minnesota are the only states that have established BHPs.

New York enrollment in qualified health plans

Open enrollment for 2017 coverage ended on January 31, 2017 (just for qualified health plans; enrollment in Medicaid, Child Health Plus, and the Essential Plan continues year-round). On February 1, 2017, New York State of Health published an enrollment report, noting that January 31, 2017 was the busiest day they had ever had. Total enrollment through the exchange (including Medicaid, the Essential Plan, Child Health Plus, and private plans) reached more than 3.6 million by the end of January, which was an increase of 800,000 over the enrollment total at the end of the 2016 open enrollment period.

And for 2018 coverage, enrollment has continued to grow. By December 15, 2017, enrollment through NY State of Health stood at:

  • 229,000 people had enrolled in private health plans, aka QHPs. (total enrollment in QHPs stood at 242,880 when open enrollment for 2017 coverage ended; as of December 15, 2017, open enrollment still had six weeks remaining for 2018 coverage).
  • 716,000 people had enrolled in the Essential Plan (a Basic Health Program for people with income up to 200 percent of the poverty level)
  • 364,000 people had enrolled in Child Health Plus
  • 2,871,000 people had 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.

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 was 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.

Unlike many of the other CO-OPs that closed in 2015, Health Republic shut down at the end of November, instead of staying open until the end of the year. This meant that members had to select a new plan for December, and then also had to ensure they picked a plan for 2016 during open enrollment.

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 nine Republicans and 18 Democrats. Both McMahon and Arcuri were replaced by new Democrats in 2013.

In New York’s state legislature, there’s a strong Democratic majority in the House. Although the Senate also technically has a Democratic majority, nine Democrats caucus with the Republicans, including eight who belong to the Independent Democratic Conference (IDC). This has allowed Republicans to retain control of the state Senate, although the IDC members have signed on as co-sponsors of the legislation that would create a single-payer system in New York.

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.” He has continued with that support, moving ahead in January 2017 to implement regulations that protect contraceptive and abortion coverage at the state level, regardless of the future of the ACA under the Trump Administration.

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 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 (the Essential Plan) to residents with incomes up to 200 percent of the poverty level.

New York Medicaid/CHIP enrollment

Medicaid/CHIP enrollment in New York increased by nearly 13 percent from the fall of 2013 to December 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.

The addition of the Essential Plan in 2016 helped to smooth the transition between Medicaid and private health plans. People with income a little too high for Medicaid (139 percent to 200 percent of the federal poverty level) qualify for the Essential Plan instead of having to enroll in a subsidized private plan.

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.

New York health insurance resources

State-based health reform legislation

In 2014, New York lawmakers passed A.9205, the “Emergency Medical Services and Surprise Bills” law. This legislation took effect in 2015, and protects consumers in some circumstances from having to pay surprise balance bills when they’re treated by out-of-network providers at in-network facilities, or when they’re referred to an out-of-network provider by their in-network provider. A year later, the law was showing signs of being a “reasonable compromise” between competing interests of insurers, providers, and patients.

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

More New York coverage


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