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NY health insurance enrollments exceed last year's numbers

Enrollment for health insurance on the state insurance marketplace has already exceeded last year’s figures as the Jan. 31 deadline approaches, state health officials said.

More than 4.6 million New Yorkers have enrolled in policies offered on the New York State of Health marketplace, including an 11 percent rise in the number of Medicaid enrollees and a seven percent rise for both the Essential Plan and for qualified health plans.

Of those opting for private health plans, 58 percent qualify for financial assistance in the form of subsidies and tax credits.

The surging enrollment — which includes new customers as well as people re-enrolling in their plans — contrasts with the estimated four percent enrollment decline in the federal marketplace utilized by 39 states. Last year the Trump administration shortened the enrollment period on Healthcare.gov from 90 to 45 days, and slashed its advertising budget.

In New York, however, the enrollment period for its state-run marketplace runs for three months, and outreach efforts include community-based “navigators” to assist people in choosing a plan. So far,  more than 260,500 New Yorkers have enrolled in qualified health plans -- from insurance companies that have been qualified by the state to offer their products in the marketplace -- and 773,300  in the state’s affordable Essential Plan for moderate-income New Yorkers.

 “Higher enrollment shows ongoing consumer demand for the affordable, quality health plans offered by the marketplace,” said NY State of Health executive director Donna Frescatore. “With the Jan. 31 deadline quickly approaching, we encourage anyone who needs coverage for 2019 to enroll now.”

The marketplaces were created under the Affordable Care Act of 2010, which also enacted a host of other changes to the nation’s health care delivery system. It provided subsidies for moderate-income families, expanded Medicaid eligibility in states that agreed to it, required equal treatment for customers no matter their prior health conditions or age, allowed parents to keep children on their health plans up to age 26, and mandated that insurance plans cover a range of essential benefits.

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It also imposed an individual mandate requiring everyone to buy insurance or pay a tax penalty.

That mandate ended Jan. 1, a consequence of the then Republican-led Congress removing the tax penalty in its tax package of December 2017. A lower court judge in Texas ruled recently that the loss of the individual mandate meant the entire ACA was unconstitutional, although the ACA remains in effect while that decision is under appeal.

In response, Gov. Andrew M. Cuomo has pledged to propose legislation codifying various ACA protections and to preserve its marketplace. However, if federal funding is cut off, the state would have to use state taxpayer funds to maintain subsidies and its popular Essential Plan.

Health policy expert Sara Collins of the Commonwealth Fund in New York City said the ACA’s extensive reach into the nation’s health care system meant ending it would be “massively disruptive,” and not just to the ACA marketplaces.

“If tax credits were to go away, it would be very hard to maintain the marketplaces as they are," she said. "That’s what makes it affordable and states would have to come up with the funding . . .  it would be very expensive to do.”

While many plans are still expensive for many consumers in the individual marketplace, premiums did fall when the marketplaces opened; rate increases are regulated and subsidies help many afford insurance who otherwise would be priced out.

The percentage of New Yorkers without coverage fell from 10 percent to under five percent of state residents under the ACA, according to state figures. In the previous enrollment period, 4,332,393 New Yorkers enrolled in coverage through the NY State of Health’s Individual marketplace, including 253,102 in QHPs with and without financial assistance, 738,851 in the Essential Plan (EP), 2,965,863 in Medicaid, and 374,577 in Child Health Plus (CHP). CHP is funded under separate legislation.

County enrollment figures for 2019 are not yet available. Janine Logan, a spokeswoman for the Nassau-Suffolk Hospital Association, one of three local groups certified to help people enroll, said that so far the agency has assisted more than 3,000 Long Islanders enroll in individual and family plans. While Medicaid and Essential Plan enrollments have risen, compared  with the same time last year, Qualified Health Plan enrollment fell.

Conceding that policies may be too expensive for some families  that earn too much to qualify for subsidies, she said, “Some do walk out, saying they can’t afford it. The enrollers are running them through a lot of different scenarios, spending more time than they have in the past . . . ”

So far, she said, 51 percent have enrolled in Medicaid, compared  with 48 percent last year, 17 percent in the Essential Plan, compared  with 16 percent, and 12 percent in qualified or commercial plans, compared  with 15 percent. The group will host an open house to assist last-minute enrollees on Jan. 30 and 31, from 5 to 8 p.m., at 1383 Veterans Memorial Hwy., Suite 26, in Hauppauge.

Elizabeth Ryden Benjamin, vice president of health initiatives at the Community Service Society, applauded the state’s move to enact state legislation codifying ACA protections. “It’s a smart consumer protection regime and the state is smart to codify it,” she said.

However, she said she would like the state to extend coverage to immigrants left out of coverage under the ACA, and to enact a state premium assistance program – as California is proposing – to assist moderate-income families earn too much to get subsidies but not enough to afford insurance.

“Only one million are left uninsured in New York State,” she said. Of them, a third are eligible for Medicaid, but fail to sign up, a third are immigrants ineligible under ACA rules, and a third have incomes just over the eligibility line for subsidies, or 200 percent of the poverty line.

“People are suffering now, people who need help now,” she said, estimating a premium assistance program would cost several hundred million dollars, which she called “a rounding error in terms of our state health care budget."

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