SUBJECT:

Consolidation in the health insurance industry in New York and across the nation is transforming health insurance markets and the health care system. Over 12 million New Yorkers today get their health care from plans which were involved in a merger, acquisition or some other type of affiliation agreement in just the past three years. Consolidation has also resulted in shifts in market share.

The Committees are interested in exploring the impact that this consolidation has on patients' access to health care services and the ability of health care providers (both institutional and non-institutional) to fairly negotiate contractual relationships with health plans. Specifically, witnesses may direct their testimony (but need not limit it) to the following points:

• The state Insurance Department (SID) has approved over a dozen mergers or acquisitions of health plans in the last few years without conducting a single public hearing. Should the state Insurance Law's Holding Company Act be amended to require public hearings on merger applications? The recent SID approval of the HIP/GHI affiliation includes premium increase protections for enrollees and rate protections for providers. Why weren't these protections included in previous merger ap-provals issued by the SID?

• To what extent has health industry consolidation resulted in a health plan or group of health plans dominating a market within New York State.

• What impact do health plans with significant market share in a region have on delivery and access to health care services, control of health care decision-making (utilization review) and the ability of providers to care for their patients?

• What regulatory or legislative changes should be considered to ease the turmoil that has become all too common in the contracting process and to ensure that health care providers are able to negotiate fair agreements with health plans that minimize disruption for patients and providers and preserve important community services? For example: regulatory procedures of the state Department of Health (DOH) and SID; use of so-called "evergreen" contracts between plans and providers and "all products" clauses; rules for contract termination; procedures for execution of contracts by pro-viders and health plans; authorizing providers to collectively negotiate with health plans; strength-ening anti-trust laws or enforcement.

Persons wishing to present testimony or attend should complete the hearing reply form below and return as indicated as soon as possible, but no later than November 16 for the Syracuse hearing or November 27 for the New York City hearing. It is important that the form be fully completed and re-turned so that persons may be notified in the event of emergency postponement or cancellation.

Oral testimony will be limited to ten minutes in length. All testimony is under oath. In prepar-ing the order of witnesses, the Committees will attempt to accommodate individual requests to speak at particular times in view of special circumstances. This request should be made on the reply form or communicated to Committee staff as soon as possible. Ten copies of any written statement should be submitted at the hearing registration table.

In order to meet the needs of those who may have a disability, the New York State Assembly, in accordance with its policy of non-discrimination on the basis of disability, as well as the Americans with Disabilities Act (ADA), has made its facilities and services available to all individuals with dis-abilities. For individuals with disabilities, accommodations will be provided, upon reasonable request, to afford such individuals access and admission to Assembly facilities and activities.

Questions about this hearing may be directed to Richard Conti of the Assembly Health Com-mittee staff at 518-455-4941, contir2@assembly.state.ny.us, or Peter Newell of the Assembly Insur-ance Committee staff at 518-455-5676, newellp@assembly.state.ny.us.

Consolidation in the Health Insurance Industry - Public Hearing Reply Form

Respond by November 16 for the Syracuse hearing or November 27 for the New York City hearing.
Mail to: Assembly Committee on Health, 822 Legislative Office Building, Albany, NY 12248
Or fax to: 518-455-5939