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The Big Picture

An unprecedented portrait of New York State's commercial, self-funded, and publicly funded markets for children and for Medicaid and Medicare recipients receiving care from private insurers, The Big Picture is an important new tool for health care leaders and policymakers, establishing the context for some of the major decisions ahead.

Fact Check

Buyers in New York State's health insurance markets—individuals, businesses, and government—paid health plans over $41.5 billion in premiums for insurance coverage in 2006; in a sign of increasing consolidation, the four largest plans in the state collected nearly two-thirds of those premiums.  Despite declining commercial enrollment, seven major health plans earned a total of over $1.6 billion in profits.  Reflecting both shrinking business coverage and New York's commitment to expanding affordable coverage, enrollment in New York's trio of public managed care programs—Medicaid Managed Care, Family Health Plus, and Child Health Plus—exceeded enrollment in the commercial Direct Pay and Small Group markets by almost 1 million covered lives.

An estimated 10 million New Yorkers get health coverage through their employers — about half through insurance policies and the remainder through various self-insurance arrangements.  Understanding the dynamics of the various segments of the private market will be critical to the next stage of health care reform.  The Fund has undertaken a number of projects to explore these markets and provide a solid base from which policymakers can analyze future options.

Comprehensive Market Portrait

While annual statements filed by insurers and additional information from the state Department of Health provides some data, there hasn’t been a single source of detailed, cogent, statistical analysis of these markets. Now, an intensive Fund study has yielded just such information. The Big Picture: Private and Public Health Insurance Markets in New York combines statistical analysis of health plan enrollment and financial data—providing a rich portrait of the buyers and sellers of coverage, benefits, premiums, and expenses—with a review of key laws and regulations that underpin the markets. It also highlights major market features such as the Empire Plan, New York’s remarkable health insurance program for 1.25 million public employees, dependents, and retirees.

By describing how our health insurance markets work and how they got there, The Big Picture informs the discussion of “what’s next” at this critical juncture for health care reform, in New York and throughout the nation. The Fund’s work behind this report continues, and updates will be produced as new data emerge.

Helping New Yorkers Keep their Coverage

With the state and the nation in the grips of a deep recession, over a half-million New Yorkers were receiving unemployment insurance benefits as 2009 began, and tens of thousands of workers were filing new claims each week. With employer-sponsored health insurance covering about two-thirds of the state’s workers, many of the newly jobless are losing their health coverage as well. To address this problem, the Fund has published Hard Times and Health Insurance: Staying Covered When You Lose Your Job.

This clearly written consumer guide presents practical advice on state and federal protections and how to exercise them: COBRA, and the new subsidies provided in the federal stimulus package; private insurance coverage; state public programs; and other forms of financial assistance and available help. The guide has already been updated several times, and new information will be added as coverage options change.

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