Despite Better-than-Expected Progress in Expanding Health Coverage, New York State Faces Obstacles in Signing up Remaining 1.1 Million Uninsured

Trump administration’s proposed “public charge” regulation could lead to significant disenrollment in Medicaid and Child Health Plus, even among citizens

NEW YORK, NEW YORK, August 20, 2019—New York State signed up more people than expected for health insurance under the Affordable Care Act (ACA) last year, but 1.1 million residents still lack coverage, and there are a number of potential obstacles that could make further progress difficult as the next sign-up period approaches, according to a HealthWatch brief released today by United Hospital Fund (UHF). 

Litigation and proposed federal regulations meant to eliminate or undercut the ACA have created an uncertain environment as the State gears up for the November 1 start of the 2020 open enrollment period. The “public charge” regulation just finalized by the Trump administration could also have a chilling effect, by requiring that income, health status, and the use of Medicaid and other non-cash benefits be considered when determining applications from immigrants for legal permanent resident status (green cards). “The new regulation could lead to significant disenrollment in Medicaid and Child Health Plus, even among children who are citizens,” the report warns. 

“Despite the uncertainties, New York is approaching the sign-up period with the wind at its back after a successful 2019 enrollment period,” said Peter Newell, director of UHF’s Health Insurance Project and author of the brief. “There is no shortage of ideas on how to cover the remaining uninsured in New York but moving the needle will depend on the commitment of policymakers to further progress and identify state resources to support coverage expansion, amid many competing demands.” 

The brief, Mile Marker or High-Water Mark? Tracking New York’s Progress in Covering the Uninsured, details several positive signs of progress in getting to universal coverage in New York. A recent federal survey estimated that New York’s uninsured rate for adults ages 18 to 64 was 6.8 percent at the end of 2018 (4.7 percent for all ages), compared with an uninsured rate of 13.7 percent for U.S. adults nationwide. 

The State Department of Financial Services reported that rates for individual coverage will increase an average of 6.8 percent in 2020, on top of an 8.6 percent average increase in 2019, much lower than the predicted increase of 23 to 25 percent projected in one analysis. And federal risk adjustment data for 2018 show that 32 states posted higher average premiums than New York (compared to 16 states in 2017), while 16 states had less stable or “sicker” individual markets than New York’s in 2018, compared with 10 states the year before.

About 638,000 of the 1.1 million New York residents who still lack coverage are eligible for Medicaid, Child Health Plus, or subsidies mandated by the ACA, according to one recent analysis. The remaining uninsured also include those who either have an income too high for assistance, are non-citizens, or don’t feel they can afford insurance even with subsidies. But, while the ACA provided important tools for expanding coverage, it is unlikely that there will be further assistance at the federal level. “It will be up to New York policymakers to determine if the current uninsured rate represents a mile marker on the road to universal coverage, or a high-water mark,” the report says. 

The brief can be downloaded from the UHF website here.

About 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. For more on our initiatives and programs please visit our website at and follow us on Twitter. 


Aug. 20, 2019
Health Insurance Project