Implementing Federal Health Care Reform
Health Insurance Exchange
Established by the Affordable Care Act, a health insurance exchange is an "insurance store" where individuals and small businesses can compare options and purchase coverage—online, through toll-free hotlines, and in person—as well as check eligibility for subsidies to reduce premiums and out-of-pocket costs.
2.1 million New Yorkers were enrolled in New York State of Health’s individual exchange during the second open enrollment period (which ended on February 28, 2015), including 415,000 individuals in Qualified Health Plans, 1.6 million in Medicaid, and 160,000 children in Child Health Plus.
3,708 small businesses in New York offered their employees insurance through New York’s Small Business Health Options Program and nearly 15,000 employees and their dependents enrolled.
An estimated total of $811 million in annualized tax credits were used to subsidize the cost of coverage for approximately three-quarters of the individuals enrolled in New York State of Health’s Qualified Health Plans during the second Open Enrollment period.
- Networks at the Nexus: Revisiting New York State’s Provider Network Standards and Protections
- HealthWatch: The Geography of Federal Medicaid Reform
- Building a More Effective Health Care System for Every New Yorker
- A Strategy for Expanding and Improving the Impact of the Medical Home Across New York City
- Value-Based Payment Models for Medicaid Child Health Services
Although insurance market reforms adopted in the 1990s and 2000s put New York a step ahead of most states, no policy issue has been more challenging than implementing the myriad and complex provisions of the Affordable Care Act, the landmark federal reform that provides meaningful premium and cost sharing subsidies for consumers through New York State of Health, the new insurance marketplace or “Exchange” created by New York, and establishes a new regulatory partnership between the federal government, states, and health plans, all built on an advanced IT system created from scratch. The Health Insurance Project produced a series of six timely analytic reports to assist policymakers in this enormous undertaking, focused on state discretion on the benefits that would be provided, the design of the Exchange, and how to best organize the new market.
After two years, the Affordable Care Act is having a very positive impact on New York, as the uninsured rate crept into single digits, driven by increased Medicaid enrollment, and a reinvigorated individual market. In addition to the coverage provisions, the Affordable Care Act encourages delivery system reforms that improve quality, reduce costs, and enhance the patient’s experience of care. Working in tandem with the Funds’ Medicaid Institute and Innovation Strategies initiatives, the Health Insurance Project provides a checklist for policymakers seeking to reach these goals by implementing payment reforms to replace fee-for-service methodologies that place providers at risk for the quality and cost-effectiveness, a change that raises a host of insurance regulatory issues. The Health Insurance Project will continue to focus on implementation issues facing state policymakers.
Resources for family caregivers and health care providers are available at our Next Step in Care website.