Wednesday, March 13, 2019

Loan And Insurance In New York

New York is a progressive state that embraced health care reform decades ahead of most of the rest of the country. The Affordable Care Act has smoothed out some rough edges in the New York insurance market, and since implementing Obamacare, the state has continued upon these improvements. In January 2017, prior to the inauguration of Donald Trump, New York Governor, Andrew Cuomo, announced that repealing the ACA would cause 2.7 million New Yorkers to lose their health insurance coverage.
Although Republican leaders spent 2017 attempting to repeal the ACA, most of their efforts fell short. All of the ACA repeal bills that were considered in 2017 failed to win enough support to pass, although the GOP tax bill, enacted in December 2017, did repeal the individual mandate penalty, starting in 2019 (there is still a penalty for being uninsured in 2018, which will be assessed on tax returns in early 2019, but there will not be a federal penalty for being uninsured starting in 2019).
A few states have implemented their own individual mandates for 2019 and beyond, although New York is not one of them. But Governor Cuomo took action in early 2017 to protect New York residents’ access to birth control and abortion coverage, regardless of the future of the ACA. The Governor also worked to ensure continued robust insurer participation in the individual market, and ongoing access to essential health benefits. Lawmakers once again considered a single-payer system during the 2018 legislative session — it passed the Assembly, but fell short in the Senate, just as it did in 2017.

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2019 exchange carriers

New York has a very robust individual health insurance market, with 12 carriers offering plans in the exchange, and two that offer plans only outside the exchange. All of them will continue to offer coverage for 2019, with average rate increases (before subsidies are applied) of 8.6 percent. (Details about approved average rate changes for each plan are available here). The following insurers offer individual-market plans in New York’s exchange:

Capital District Physicians Health Plan

Empire BlueCross and Empire Blue Cross Blue Shield

enrollment through January 31, 2019.

Louise Norris

Health insurance & health reform authority

December 16, 2018

Health insurance in New York

New York’s operates its own health exchange NY State of Health.

New York has long been a leader in health reform.

Twelve insurers are offering 2019 coverage through the state exchange.

Open enrollment for 2019 was extended through January 31, 2019. After that, residents would need a qualifying event to enroll in an ACA-compliant plan.

On average 2019 premiums have increased 8.6%

About 253,000 New York residents enrolled in 2018 QHPs through the state exchange.

Another 739,000 New Yorkers enrolled in the Essential Plan.

New York adopted Medicaid expansion in 2013. Medicaid enrollment has grown by 14% since 2013.

The state’s Health Republic CO-OP closed in 2015.

The state’s uninsured rate has dropped 47% since 2013.

New York does not allow the sale of short-term plans.

3.5 million New Yorkers are enrolled in Medicare.

New York overview: Taking advantage of all the ACA has to offer

New York has fully embraced the Affordable Care Act (ACA). The state expanded Medicaid, established its own health insurance exchange, and even created a Basic Health Program (BHP) for people who earn more than the Medicaid eligibility threshold, but not more than 200 percent of the poverty level. BHPs are allowed under the ACA, but only New York and Minnesota opted to create them.

New York’s health insurance marketplace

The health of New York’s state-based exchange, NY State of Health remains strong heading into 2019. The exchange has robust insurer participation, and premiums are still lower for 2019 than they were in 2013. (That’s not the case in most states, but New York had guaranteed-issue coverage long before the ACA, but without a mandate requiring people to buy coverage and without premium subsidies for middle-class enrollees. As a result, coverage was expensive in New York pre-2014.)

Enrollment in NY State of Health – including QHPs (private plans), the Essential Plan, Medicaid, and Child Health Plus – reached more than 4.3 million by the end of January 2018 (when open enrollment ended for QHPs). That was an increase of 700,000 over the prior year’s total enrollment.

In most of the United States, individual health insurance was medically underwritten prior to 2014, meaning that people with pre-existing conditions were often unable to purchase private coverage. But in New York, former Gov. Mario Cuomo signed a law in 1992 that required all policies in the state to be guaranteed issue, regardless of medical history. They also switched to a community rating system, with the same premiums charged for everyone, regardless of age.

Although the 1992 law was heralded by consumer advocates as a victory, it lacked two of the major market stabilization components that the ACA has now enacted. There were no open enrollment periods (people could buy coverage anytime they wanted), and there was no individual mandate, so people could wait until they were in need of care before purchasing health insurance.

Two decades later, health insurance premiums in New York were the highest in the nation, and coverage options were very limited, with few carriers choosing to participate in the market in New York.

The ACA brought much-needed changes to New York, keeping the guaranteed issue model (and in New York, coverage is still community-rated), but adding the vitally important individual mandate, limited enrollment period, and premium subsidies to make coverage affordable for middle class enrollees. As a result, the rates that the state approved for 2014 were an average of 50 percent lower than 2013 rates, and that was before factoring in the subsidies that 60 percent of New York State of health’s QHP enrollees receive (QHP stands for qualified health plan, which is another word for the private health plans offered for sale in the exchange, as opposed to Medicaid, the Essential Plan, and Child Health Plus). Officials in NY noted that 2018 premiums continue to be more than 50 percent lower than pre-2014 rates, despite modest rate increases each year.

In 2013, about 10.7 percent of New York residents were uninsured, according to US Census data. By 2017, that number had fallen by nearly half, to 5.7 percent. At that point, the average uninsured rate across the US was 8.7 percent, and just 13 states had uninsured rates lower than New York’s.

NY State of Health enrolled more than 4.3 million people during the open enrollment period for 2018 coverage, including enrollments in the Essential Plan, Child Health Plus, Medicaid, and individual qualified health plans.  Enrollments continue year-round for Medicaid, Child Health Plus, and the Essential Plan.

New York’s lawmakers and the Affordable Care Act

In 2010, New York’s U.S. senators (Democrats Kirsten Gillibrand and Charles Schumer) both voted yes on the ACA. In the U.S. House, 24 Democrats voted yes, while two Republicans and two Democrats (Michael McMahon and Michael Arcuri) voted no. Schumer and Gillibrand are still in the Senate. Both McMahon and Arcuri were replaced by new Democrats in 2013. The U.S. House delegation from New York currently consists of nine Republicans and 17 Democrats, with one vacant seat. We have a summary of how each of them has voted on key health care reform legislation.

In New York’s state legislature, there’s a strong Democratic majority in the House. Although the Senate also technically has a Democratic majority, nine Democrats caucus with the Republicans, including eight who belong to the Independent Democratic Conference (IDC). This has allowed Republicans to retain control of the state Senate, although the IDC members have signed on as co-sponsors of the legislation that would create a single-payer system in New York.

Democratic Governor Andrew Cuomo is an ardent supporter of the ACA, saying in 2012, “We look forward to continuing to work together with the Obama administration to ensure accessible, quality care for all New Yorkers.” He has continued with that support, moving ahead in January 2017 to implement regulations that protect contraceptive and abortion coverage at the state level, regardless of the future of the ACA under the Trump Administration.

The state has been fully on-board with ACA implementation from the start, opting for a state-run exchange (NY State of Health) and expanding Medicaid to cover residents with incomes up to 138 percent of poverty. The state was also only the second in the nation (after Minnesota) to implement the ACA’s provision to create a Basic Health Program, extending very low-cost health insurance (the Essential Plan) to residents with incomes up to 200 percent of the poverty level.

Medicare enrollment in New York

New York Medicare Medicare enrollment reached nearly 3.6 million enrollees in 2018 – almost 18 percent of the state’s population, which is consistent with the percentage of people enrolled in Medicare nationwide. As of 2016, about 85 percent of New York Medicare recipients qualify for coverage based on age alone, while the remaining 15 percent were on Medicare due to disability.

When it comes to spending, Original Medicare per-beneficiary spending in New York averaged $9,670 in 2016. That’s above  the national average spending of $9,533.

Those who want additional benefits beyond what original Medicare offers can choose a Medicare Advantage plan instead of traditional coverage. In New York, 38 percent of Medicare recipients had Medicare Advantage plans as of 2017.

Medicare Part D plans are also an option for Medicare beneficiaries who want to stand-alone prescription drug coverage. In 2018, nearly 1.5 million New York beneficiaries had a stand-alone Rx plan.

New York health insurance resources

Community Health Advocates

State-based health reform legislation

In 2014, New York lawmakers passed A.9205, the “Emergency Medical Services and Surprise Bills” law. This legislation took effect in 2015, and protects consumers in some circumstances from having to pay surprise balance bills when they’re treated by out-of-network providers at in-network facilities, or when they’re referred to an out-of-network provider by their in-network provider. A year later, the law was showing signs of being a “reasonable compromise” between competing interests of insurers, providers, and patients.