Talkin’ bout insurance rates

My Files

The New York State Department of Financial Services is currently reviewing insurance companies’ rates for the coming year, 2015. Overall this year, 11 insurers asked for rate increases and four asked for decreases. You can read insurer rate applications here. Members of the public have the chance to comment on the rates. HCFANY recently submitted seven letters about these plans:

Aetna Health

Empire HealthChoice

Excellus Health Plan

Health Republic Insurance of New York

Metro Plus Health Plan

Oscar Insurance Corporation

United Healthcare

2014 insurance rates on NY State of Health, our State’s health plan Marketplace, declined by 53%. These affordable rates were an important reason for the enrollment of over one million New Yorkers. The Department of Financial Services has an important role in ensuring that health plan rate increases are in line with actual medical cost changes, and that rates remain as affordable as possible for consumers.

HCFANY’s comments first discuss the broader context that the Department should consider and then additional specific carrier issues. In addressing the broader context, HCFANY notes:

  1. Health care costs have been rising at slower rates for the past several years, and have been under 10% for the last 12, according to National Health Expenditures data. The California Marketplace held health insurers to a maximum 4.2% increase for 2015.
  2. It’s reasonable to expect the 2015 risk pool will be healthier than 2014, because less healthy consumers are likely to have already enrolled.
  3. The ACA “risk” programs should mean lower risk for insurers and lower prices for consumers. The ACA includes special programs – risk adjustment, risk corridor, and reinsurance programs – to compensate insurers for any increased risk they take on as a result of new enrollees. The programs were designed specifically to ensure stable insurance rates for consumers.
  4. Insurers should have lower administrative costs as a result of the ACA. Significant money and energy is being put into marketing and outreach for health insurance because of the ACA, which means insurers can spend less time and money marketing their products.

The Department of Financial Services should post the final rates sometime in the early fall.

keep calm_know you're covered

Guest post: Jessie Kavanagh, Health Policy Intern at Community Service Society of New York

Last week, a 3-judge panel of the U.S. Court of Appeals for the District of Columbia ruled 2-1 that states using the federally-facilitated marketplace (healthcare.gov) cannot offer government subsidies to their residents. The same day, a 4th U.S. Circuit Court of Appeals in Virginia unanimously came to the opposite conclusion– that the states using the federal marketplace should be able to offer subsidies.

What to make of this conflict? Regardless of the disagreement, the bottom line for New Yorkers is simple: the decisions have no immediate impact on New Yorkers’ eligibility for the ACA tax credits and subsidies.

The main issue in these cases concerns the language in the ACA regarding the subsidies. The language states that subsidies are only available “through an exchange [aka marketplace] established by the state.” The U.S. Court of Appeals for the DC Circuit argued that this language means subsidies should be available only to people who enroll through a state-based marketplace. However, the 4th Circuit Court said that the law was ambiguous, and that the IRS was entitled to its interpretation that the federal marketplace acts as a state’s marketplace, and therefore all states can offer subsidies to their residents.

Ultimately, the ACA was written with the intent to make insurance more affordable for all Americans. And, it seems to be working. In New York, 3 out of 4 enrollees in commercial Qualified Health Plans during open enrollment- or 274,247 New Yorkers – were eligible for tax credits that made insurance more affordable.

 

Leon_Anna_enroll

Navigator Leon McIntosh helps New Yorker Anna enroll

We all know finding the right health insurance plan can be complicated and overwhelming – even with the launch of the insurance marketplaces offering one-stop shopping under the ACA. One of the most exciting features of the ACA is the establishment of assister programs to help people enroll (e.g. Navigators and Certified Application Counselors). A new survey from Kaiser Family Foundation shows just how effective these groups were during the first open enrollment period.

According to the survey, administered to directors of assister programs around the country:

28,000 assisters helped 10.6 million people apply for coverage and financial assistance.

States with State-based Marketplaces, like New York, had a much higher ratio of assisters to uninsured and helped two times as many people relative to the uninsured population when compared to states with a Federally-facilitated Marketplace. Our own NY State of Health‘s recent enrollment report shows that 643 Navigators and nearly 4,000 Certified Application Counselors helped over 413,000 New Yorkers enroll in coverage. That’s nearly half of enrollees.

Most consumers who sought help applying for coverage were uninsured and had limited health insurance literacy.

The vast majority of programs reported that consumers seeking help had a limited understanding of the ACA and struggled with basic health insurance terms, like “deductible.” As a result, assistance took time – between one to two hours in most cases.

Nearly all assister programs have been “re-contacted” by consumers with post-enrollment problems, including questions about how coverage works.

Questions from consumers don’t stop at enrollment. However, assister programs are not trained on post-enrollment issues, and in many cases don’t have funding that allows them to provide this type of assistance. Instead, the ACA established Consumer Assistance Programs (CAPs) to provide these services, but these programs haven’t received federal funding since 2012. Luckily, New York legislators recently approved $2.5 million in the 2014-2015 budget for the State’s CAP, Community Health Advocates (CHA). Thanks to the funding, CHA will be able to provide more robust hotline and in-person services through community-based organizations in the coming months.

disparities_report

Guest post:
Bob Cohen, Policy Director, Citizen Action of New York/Public Policy and Education Fund;
Theo Oshiro, Deputy Director, Make the Road New York

New York took a big leap forward in enrolling nearly a million New Yorkers in health coverage during the first open enrollment period under the ACA that ended in March, but we still have a lot to do to ensure that all New Yorkers, including traditionally excluded communities, fully benefit from the federal law. This is the simple message of a new “white paper” released in June by two HCFANY partners, the Public Policy and Education Fund and Make the Road New York, in conjunction with the Alliance for a Just Society, a national network for research, policy and organizing.

The report, Addressing Health Disparities Through the Marketplace: An Action Agenda for New York State of Health,” applauds NY State of Health for a number of steps it has already taken, like easing enrollment in emergency Medicaid. The white paper establishes a broad agenda with 11 recommendations for further actions by NYSOH and the Legislature. For example, the report recommends a greater focus on outreach aimed at reaching diverse communities through steps like stronger targeting of ethnic media and reexamining current restrictions on navigators on contacting New Yorkers in their homes. It suggests that public numerical targets be set for enrollment of groups like immigrants and people of color, that NYSOH move forward aggressively with translating its website into languages other than English, stronger enforcement of requirements that health plans develop clear strategies to address health disparities, and the establishment of  a stakeholder task force focused on the reduction of disparities.