State-run Affordable Care Act health coverage program in works

As other states begin setting up health insurance exchanges required under the Affordable Care Act, many are turning to Massachusetts which pioneered the online health insurance marketplace. AP video. (Jan. 24)

State health department officials are putting together a "health benefit exchange" that in less than four months is to offer New Yorkers a marketplace to buy lower-cost health insurance as part of the federal Affordable Care Act.

While officials are confident they will meet the Oct. 1 deadline for enrollment to get under way, advocates and others supportive of the state's efforts are anxious.

"They are working long hours and there are a lot of complexities outside of their control," said Gwen O'Shea, president of the Health & Welfare Council of Long Island. "Some pieces of the ACA have clarity and some don't. I don't know how you take that complex framework and overlay it on to New York, which already has a broken system."


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A keystone of the Affordable Care Act is the requirement that every state offer a health insurance exchange to expand coverage to individuals, families and businesses with 50 or fewer employees who are uninsured or underinsured.

A report by the Urban Institute, a nonpartisan economic policy research group, projected that of the 2.5 million uninsured New Yorkers, about 1.1 million -- including about 150,000 of more than 272,000 uninsured Long Islanders -- are expected to enroll.

On July 15, the state will reveal some details of approved plans. Enrollment will be through a website or with help from trained "navigators" on the phone or at designated sites. Coverage is to start Jan. 1.

The exchange is funded through 2014 entirely by $340 million New York received from the federal government. After that, it must be financially self-sustaining.

New York is one of 17 states to set up its own exchange; the remaining states elected not to. The federal government will run exchanges in those states that do not set up their own.

The state is one of three to establish its exchange through executive order. The Republican-controlled State Senate for more than a year blocked moves authorizing the exchange to avoid taking any action on President Barack Obama's Affordable Care Act. So last April, Gov. Andrew M. Cuomo, a Democrat, issued an order placing it within the Department of Health. That department is working closely with the Department of Financial Services, which regulates insurers and approves insurance premium rates.

Exchange executive director Donna Frescatore said she was confident they would meet the deadline.

"We will be open and accepting applications on Oct. 1," she said.

O'Shea and Kevin Dahill, chief executive of the Nassau-Suffolk Hospital Council, are members of a regional advisory committee that met with Frescatore and her staff in Manhattan on May 30. Dahill said the meeting was the "most robust" to date, but he was still concerned that so few New Yorkers know anything about the exchange just months before enrollment is to begin.

"The average person doesn't know anything about this stuff. It's pretty imminent and it's a big change," Dahill said.

New York's exchange could put the state on a national stage, said Elisabeth Benjamin, vice president of the Community Service Society of New York, an advocacy group for low-income New Yorkers. The state may be the only one that will offer "one-stop shopping" for both commercial and government health insurance, such as Medicaid, said Benjamin, also a member of the advisory group.

One major piece -- how many insurers will participate and whether the plans they offer will be more affordable -- should become clearer on July 15, when the state will reveal which insurance plans have been approved, the geographic areas they will cover, services they will offer and rates.

Leslie Moran, a spokeswoman for the New York Health Plan Association, said insurers view the exchange as a new market -- but one with potential pitfalls.

"The fear is that to make the plans cheaper, they [state officials] will artificially keep the rates down," Moran said, and that could cause some insurers to not participate.

Once details of the plans are known, the state will also begin training hundreds of "navigators" to assist people online and in person. Most small businesses get their insurance from brokers who also will be trained to assist employers through continuing education courses.

 

New York Health Benefit Exchange

 

What is it?

The exchange is a marketplace to help people shop for and enroll in health insurance coverage.

Who can use it?

Uninsured or underinsured individuals, families and small businesses will be able to compare commercial insurance options, calculate costs and select coverage online, in person, over the phone or by mail. The Exchange will also help people check eligibility for programs like Medicaid.

When does it start?

Insurance coverage can be purchased through the exchange starting in October and will be effective Jan. 1, 2014.

Source: New York State Department of Health

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