New York state and its leaders are constantly faced by deadlines. Some deadlines have been met successfully, while others have been embarrassingly ignored in the past. A new set of challenges have been handed down to Albany, via the Washington D.C. universal health insurance edict. I have no intention of arguing the merits or weaknesses designed in the Patient Protection and Affordable Care Act (ACA), but merely wish to open up a larger discussion over insurance regulation as legislators begin discussing how New York is going to implement the federally required health insurance exchange by 2014. The exchange will be the place where New Yorkers will purchase their individual and small group health insurance plans.
Sure, it may seem that the 2014 deadline is a ways off, but we need to start working on the design of the exchange now. A few questions come to mind as I ponder the intricacies of this new challenge: How can we control health care costs to keep it affordable for New Yorkers and, ultimately, who or what would be in charge of the exchange?
If the goal of the ACA is to promote and ensure universal health insurance coverage, one must look at the underlying reasons as to why there are so many uninsured New Yorkers. The largest deterrent to buying health insurance is the high cost of premiums. In a little less than a decade (2001-10), there was a sharp decline of individuals enrolled in HMOs by about 97,000 individuals or 76 percent. Of uninsured New Yorkers, many are of a low-risk pool, young and relatively healthy.
We have a true opportunity to set this exchange up right by using competition and consumer choice to attract better and more varied health care coverage plans to accommodate a wider range of insured. New York should look into creating an exchange that acts as a clearinghouse of eligible plans and allows individuals to choose what is best for them. Not all insurance, premium or co-pay plans will fit every individual’s needs and preferences.
As it is now, the system predominantly serves high-need patients with little buffer to increasing care costs, due to certain New York state regulations, thus creating a costly unsustainable system and further keeping health care out of reach for most New Yorkers. Large cost fluctuations will be diminished by encouraging a diversified individual insurance pool.
If an open exchange system is established for New York, we face yet another question…who should be in charge?
Some have been throwing around the idea that the responsibility should lie with the state Department of Health (DOH). I think we should be careful, given DOH’s recent mandate debacle on summer day camps, requiring that all municipal run day camps devise a medical plan, hire an onsite nurse, and register with the state if kids happen to play common games like freeze tag, wiffle ball or red rover, for example.
Why not, instead, allow New York’s insurance exchange be led by a board of consumers, the very people that will have to contend with the Federal mandate of purchasing insurance. The board could be comprised of seniors, moms and dads, other adult individuals and small-business owners. Why not empower them to help direct a program that is, in essence, supposed to benefit them? Let’s keep seasoned bureaucrats out of the health care exchange, too, so the system doesn’t get weighed down by government red tape.
As always, if you have any questions or comments about insurance or any other state issue, please don’t hesitate to contact me at either my Johnstown office at (518) 762-6486, my Herkimer office at (315) 866-1632, or by email at butlerm@assembly.state.ny.us.