United Hospital Fund Report Takes a Fresh Look at New York's Resuscitated Individual Health Insurance Market

Release Date: 05.26.2016
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A new United Hospital Fund report provides an analysis of enrollment and financial data on New York’s individual health insurance market—before and after the rollout of the Affordable Care Act—showing how New York’s implementation breathed new life into the individual market. The report also highlights some key steps necessary to sustain that improvement and factors that could undercut these gains.

The report notes that, prior to the Affordable Care Act, a dwindling number of enrollees in the individual health insurance market were able to afford monthly premiums, which typically exceeded $1,000. By contrast, in 2014, new enrollment, participation in health plans that primarily offer coverage through public insurance programs, more competitive pricing, a better risk pool, and a federal reinsurance program resulted in an average individual New York premium of $430.97. In addition, health plans also reported big drops in expenses per member for hospital/medical care and drugs in 2014.

Yet larger enrollment (from 136,000 in 2013 to 441,000 in 2014) and an apparently healthier risk pool did not translate to positive net income for most health plans in 2014, according to the report. Eight licensees reported underwriting gains for individual coverage (totaling $70 million), while 18 licensees (including the three new health plans debuting in 2014) posted losses (totaling $169 million).

Affordable Care Act Brings New Life—and Covered Lives—to New York’s Individual Market also examines the steps necessary to sustain New York’s improvements in the individual insurance market, focusing on three areas: the stability of the risk pool, expanding coverage to the remaining eligible but uninsured, and continued premium affordability. The report concludes that the affordability of coverage is the single biggest challenge facing the market, and it is inextricably linked to maintaining a healthier risk pool.

“As the public debate gets more pointed during this election year, it’s important to take a fresh look at the impact of the Affordable Care Act in New York,” said Jim Tallon, president of United Hospital Fund. “In 2013, it would have been hard to imagine an uninsurance rate of under 6 percent, which is where we in New York are today. But sustaining and building upon this progress won’t be easy. Clearly, a sustained focus on the affordability of premiums will be important.”

Affordable Care Act Brings New Life—and Covered Lives—to New York’s Individual Market is the third in a series of snapshot reports highlighting specific issues related to the Affordable Care Act, as a complement to the forthcoming Big Picture chartbook on health plan enrollment and financial results in New York’s private and public insurance markets. Written by Peter Newell, director of the Health Insurance Project, and Nikhita Thaper, research assistant, the report is available from UHF’s website at http://www.uhfnyc.org/publications/881127.

Support for this work was provided by the New York Community Trust.

About the United Hospital Fund: United Hospital Fund works to build a more effective health care system for every New Yorker. An independent, nonprofit organization, we analyze public policy to inform decision-makers, find common ground among diverse stakeholders, and develop and support innovative programs that improve the quality, accessibility, affordability, and experience of patient care.

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