Quietly, Pioneering UHF Work Helps Ensure Access to Care

As a critical component of physical, mental, and financial well-being, health insurance has, for decades, been the focus of UHF research and analysis—work substantially informing the development of coverage-related State policies that have made New York a national leader in ensuring access to care. Under the Affordable Care Act, New York's efforts to achieve near-universal coverage have gained additional traction, with the proportion of uninsured in the state decreasing from over 10 percent to approximately 5 percent: that's almost 1 million New Yorkers gaining coverage. But the latest data, and new federal policies, suggest a reversal of this great achievement may be on the horizon—making UHF's continued focus on coverage more important than ever.

UHF's coverage and access work—through its Health Insurance Project and Medicaid Institute—is unique in its dedication to in-depth analysis and its ability to bring together a broad range of stakeholders and influencers, highlight policy areas requiring attention, provide vital data and technical assistance, and work directly with State and City agencies on issues ranging from payment reforms that promote more effective care to improved delivery of services for high-need populations.

This work has contributed to some of New York's notable successes in both private and public coverage. UHF played an important role, for example, by informing the development of New York State of Health, the Affordable Care Act “exchange” or marketplace that has been a major contributor to coverage increases in the state. In addition to streamlining the application process for individual insurance, Medicaid, and Child Health Plus, the exchange also facilitated an immensely successful roll-out of the State's Essential Plan for individuals with incomes above Medicaid levels but below $49,200 (for a family of 4). The Essential Plan now provides coverage to more than 735,000 New Yorkers, with free or $20-per-month premiums and minimal co-pays related to participant income.

Another important UHF priority has been New York's Medicaid program, providing comprehensive services for 6 million low-income New Yorkers, including those with disabilities and those in need of long-term services and supports. Despite substantial enrollment growth, per-person costs have been kept in check, helping the program stay within a State-imposed global budget cap. Through a contract with the State Department of Health, UHF has provided valuable support to the program—playing a leadership role, for example, in efforts to ensure its long-term sustainability by analyzing broad program trends and specific policies in practice, and supporting the State in developing a children's agenda that includes value-based payment targeted to children's needs and UHF-authored policies for the First 1,000 Days on Medicaid initiative.

UHF also provided important tools for the fight to maintain the federal Children's Health Insurance Program—known in New York as Child Health Plus—that covers more than 375,000 young New Yorkers and more than 6.4 million children across the nation. Foreseeing the impending struggle in Congress on reauthorization of the program as part of broader budget negotiations when fiscal crisis loomed in late 2017 and early 2018, UHF created a series of data briefs and commentaries that explained the scope and importance of coverage for children. That information gave nonprofit organizations and government officials alike ample ammunition to support their ultimately successful advocacy for continuing this vital program.

Despite these advances, there are signs of trouble. Rate proposals for the 2019 individual market featured a weighted average increase of 24 percent, almost half of which is associated with Congress eliminating the Affordable Care Act's individual mandate penalty—a rise in premiums that may dissuade many New Yorkers from purchasing coverage. Recent Gallup survey data also suggest the uninsured rate may already be on the rise, and UHF's December 2017 data brief on the small group market found an alarming decrease in enrollees, from 1.7 million in 2007 to 1.1 million in 2016.

The small group market is especially important to watch given recent federal rules making it easier for small businesses and self-employed individuals to band together to form what are known as Association Health Plans. In March 2018 UHF made strong comments on the then-proposed rules, outlining the potential risks of these plans to New York's coverage gains (e.g., skimming healthy patients and raising small group premiums that are already the second highest in the nation), then followed up, in June, with a detailed analysis that is informing the State's response to the final rule. New York will now be joining at least one other state in filing suit against the federal government “to safeguard the protections under the Affordable Care Act and ensure that all families and small businesses have access to quality, affordable health care.”

Shedding light on specific challenges and providing a solid foundation for problem solving are hallmarks of UHF's work. “Although there are some clouds on the horizon, it is rewarding to work in a state dedicated to maintaining a robust health insurance market that provides comprehensive, affordable coverage,” says Peter Newell, UHF's Health Insurance Project director. “Our work not only analyzes the result of health insurance policy, but also greatly informs its behind-the-scenes design and implementation.”

Adds Chad Shearer, UHF's vice president for policy and Medicaid Institute director, “While much of the health policy world has turned its focus to other issues, UHF remains steadfastly dedicated to analysis that encourages the preservation and continued expansion of high-quality, affordable health insurance coverage. Other health issues may be more popular in the current headline-grabbing culture, but they become moot if people don't have coverage that provides access to needed services.