Data Analysis on Coverage in Public and Private Health Insurance Markets
The Big Picture is a series of yearly reports that provide an unprecedented portrait of New York’s commercial, self-funded, and publicly funded markets (the latter for children and for Medicaid and Medicare recipients accessing care though health plans). See the latest installment.
Over 375,000 more New Yorkers gained coverage in 2014, according to the Census Bureau’s American Community Survey for 2014, as the uninsured rate declined from 10.7 to 8.7 percent.
629,217 New Yorkers—over a third of the uninsured—were identified as “not a citizen” in the 2014 American Community Survey. Since most of these individuals will not be eligible for the State’s insurance exchange or public program enrollment, the lack of coverage for this population remains a pressing State policy question.
13.6 percent of New Yorkers between 19 and 25 years of age—270,000 people—were uninsured in 2014. Strategies to continue targeting this population would reduce the uninsured further—and premium rates—since the relatively good claims experience of this population would be blended with that of older New Yorkers in the individual market.
314,513 uninsured New Yorkers lived in households with incomes of $100,000 and above in 2014. Rising individual mandate assessments under the Affordable Care Act taking effect next year may cause some of these individuals to purchase coverage, but learning more about the reasons this group remained uncovered would be useful. Some may be ineligible to purchase coverage through the State’s insurance exchange due to unaffordable employer coverage, a problem known as the “family glitch.”
Under the Affordable Care Act Medicaid expansion, all eligible New Yorkers earning less than 138 percent of the federal poverty level ($16,243 a year for an individual) are able to enroll in the state’s Medicaid program. But despite a sharp increase in Medicaid enrollment—1.6 million enrolled in Medicaid through the State’s insurance exchange—more than 587,000 New Yorkers at this income level were uninsured in 2014. Many of these individuals could be ineligible for Medicaid due to their citizenship status, but many appear to be eligible but uninsured, suggesting the need for focused outreach.
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A hallmark of the Health Insurance Project is the analysis of data on the distribution of coverage, and financial, enrollment, and regulatory filings for health plans operating in New York’s public and private insurance markets. These analyses and related convening activities have aided the effort to expand and improve coverage, identify emerging regulatory issues, and inform and spur consensus around important policy decisions. Analysis of federal uninsurance surveys undertaken early on in partnership with the Urban Institute, for example, identified the uninsured population as mainly full-time workers at small businesses without coverage through their employer and New Yorkers eligible for public programs but uninsured—the latter, a finding that fueled efforts to improve the enrollment and recertification processes. A more recent analysis highlighted geographic areas across the state where the uninsured are concentrated.
For the past decade, the Health Insurance Project’s Big Picture series has provided detailed snapshots of public and private insurance markets, highlighting important health plan enrollment and financial data. These reports have charted the decline in fully insured employer-sponsored coverage, the growing role of health plans created to serve public programs, the importance of Medicare Advantage business to health plans’ bottom lines, the dwindling market for commercial individual coverage, and the pace of consolidation among insurers. Analysis of other health plan regulatory filings revealed important differences between provider networks for public programs and commercial coverage, and how increased cost sharing designs affect consumers in the small group market.
The latest edition of the Big Picture, the sixth in all, features health plan data from 2014, allowing an analysis of the impact of the Affordable Care Act on New York’s public and private insurance markets, as well as some thoughts on work to be done as the implementation of the Affordable Care Act moves into its critical third year.
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