The Assembly passed legislation this evening that would create the New York Health Benefit Exchange and bring the state into compliance with the federal Affordable Care Act. The vote was 82-44, with some opponents saying they oppose the federal law and think it could be overturned. The Senate has not yet passed the bill.
All states have to set up exchanges by 2014 to give individuals and small groups a place to find affordable health insurance, including public health coverage. Those that don’t create their own will have the U.S. Department of Health and Human Services do it for them. And people who don’t purchase health insurance will be subject to fines. There are roughly 2.7 million uninsured New Yorkers.
“No one should have to live without affordable, quality health insurance,” Assembly Speaker Sheldon Silver, D-Manhattan, said in a statement. “The New York Health Benefit Exchange will provide many New Yorkers with the vital health insurance coverage they deserve. The benefits of this program are very promising, and my colleagues and I look forward to working with Governor Cuomo and the Senate to ensure its successful implementation.”
The exchange would be set up as a public authority with a board of directors. It would be advised by regional advisory committees to represent health-care consumers, small businesses, health-care providers, labor unions and health insurers. The authority would have oversight of health plans in the exchange. It would have to set up a website and provide a toll-free hotline and in-person appointments.
The public authority would be required to study a number of issues and report to the governor, including how it can become self-sustaining by Jan. 1, 2015; the advantages and disadvantages of serving as an active purchaser with the authority to negotiate, a selective contractor or as a clearinghouse of insurance; and merging the individual and small-employer markets for rating purposes.
By setting up the structure of the exchange now, New York would be eligible for millions of dollars in federal funding to plan, implement and operate the exchange until December 2014.
“I am very pleased that we were able to reach an agreement to establish the New York Benefit Health Exchange, which I hope will become a comprehensive, effective and lasting way to ensure the availability of healthcare insurance for all of our residents,” said Assembly Insurance Committee Chairman Joseph Morelle, D-Irondequoit, Monroe County. “This new and unique approach to health insurance will offer consumers choices and flexibility, and utilizes competitive market forces to maintain healthcare quality while keeping costs affordable.”
The American Cancer Society and AARP criticized aspects of the legislation. Lois Wagh Aronstein, AARP New York state director, said it does not include explicit language to prohibit conflicts of interest for board members. It does not provide the exchange to be an active purchaser with participating health plans.
“With this authority, the Exchange could use its considerable market power and certification authority to limit Exchange participation only to plans with a high level of quality and value for the beneficiaries,” she said in a statement.
Blair Horner, vice president for advocacy of the American Cancer Society of New York and New Jersey, said the exchanges success “hinges on a governing board acting exclusively in the interest of the individuals and small businesses that will purchase health insurance through it.
“The legislation does not explicitly prohibit participation on the board of those who have ‘financial skin in the game.’ As he considers legislative nominations and makes appointments to the exchange board, Gov. (Andrew) Cuomo must ensure that no member has a financial conflict of interest,” he said.