Over 3.6 million New Yorkers signed up for health insurance this year using the New York State of Health (NYSOH), the insurance marketplace created by the Affordable Care Act (ACA). This represents 18 percent of everyone in the state, and is nearly 800,000 more people than last year. Since NYSOH opened in 2013, the state’s rate of uninsured people has dropped from 10 percent to only five percent.
Before the ACA and NYSOH, fewer than 21,000 people bought individual insurance plans and the cheapest option cost over $1,000 a month. This year, over 240,000 people bought individual plans, and their average premium is almost 50 percent lower. The plans that those people purchased provide a standard set of benefits because of the ACA’s Essential Health Benefits, cost the same for everyone regardless of previous health problems, and came without any annual or lifetime limits on care. They also came with help for those whose premiums are still too high for their income – over half of the people who bought individual plans through NYSOH received tax credits, an average of $233 a month. Another 665,000 people used NYSOH to sign up for the Essential Plan, a low-cost option for those who do not qualify for Medicaid.
People signing up for health insurance using NYSOH also benefited from free assistance provided by Navigators, Facilitated Enrollers, and Certified Application Counselors. Navigators, who are trained and certified by the state, helped over 72,000 people and small businesses sign up for coverage. Their assistance is available in-person all across New York and in at least 43 different languages – you can find help in your own community by calling 888-614-5400.
 Peter Newell and Nikhita Thaper, “Affordable Care Act Brings New Life – and Covered Lives – to New York’s Individual Market,” United Hospital Fund, May 2016, https://www.uhfnyc.org/publications/881127.
Follow up from blog posted February 21, 2017
Yesterday afternoon, the Centers for Medicare and Medicaid Services (CMS) issued a final rule claiming to stabilize the Affordable Care Act insurance markets. In fact, it does just the opposite.
HCFANY and thousands of other consumer and provider groups submitted comments in opposition to the proposed version of the rule because many of its provisions would have harmed consumers. However, the rule was finalized largely as proposed.
The final rule reduces the open enrollment period for individual and small group health insurance plans from 13 weeks to just six weeks, which gives consumers significantly less time to shop around for and enroll in the best plan for them.
The final rule also decreases the allowable actuarial values for health plans at each metal level, which could reduce the advanced premium tax credits (APTCs) that help make health plans purchased through the Marketplace more affordable for moderate-income individuals and families. According to an analysis from the Center on Budget and Policy Priorities, even a 2 percent decrease in actuarial value could result in a $327 reduction in APTCs for an individual.
The final rule will make it more difficult for consumers to qualify for and enroll in health coverage through special enrollment periods, which could lead to gaps in coverage and deter enrollment.
Currently, it is unclear how this rule will affect New York because state officials are still studying it closely. Come back to HCFANY next week for more information.
The American Health Care Act, released late Monday and approved for a House vote by both necessary committees, guts Medicaid and threatens coverage for millions. You can help prevent this harmful bill from passing:
-Call your members of Congress at 866-426-2631 and tell them to say “no” to the American Health Care Act. You will be routed to the appropriate representative.
-Check out our resource page to keep up with the latest news and commentary about the bill.
Last week, the Centers for Medicare and Medicaid Services (CMS) issued a proposed rule for 2018. According to the press release, the proposed rule includes “reforms that are critical to stabilizing the individual and small group health insurance markets to help protect patients.”
However, many of the policy changes in the proposed rule would harm consumers. For example, a recent analysis from the non-partisan Center on Budget and Policy Priorities explains that the proposed rule would reduce the advanced premium tax credits that help make plans purchased through the Marketplace more affordable for moderate-income individuals in families.
According to the analysis, the proposed rule would result in lower tax credits because it lowers the actuarial value standards for “silver” level plans. This means that premiums and the percentage of costs covered by the insurer would decrease, but deductibles and copayments for consumers would increase. Under the Affordable Care Act, tax credits for consumers purchasing coverage through the Marketplace are calculated based on the second lowest cost silver plan. By allowing for lower value silver plans, the new rule would force consumers to pay more out of pocket to maintain their current level of coverage.
Furthermore, the CMS proposed rule also includes provisions to require consumers to provide supporting documentation for special enrollment periods before they can enroll in coverage. The proposed rule would also permit insurance companies to collect any missed premium payments before allowing consumers to re-enroll. Both of these changes could lead to gaps in coverage for consumers or deter enrollment.
Finally, the proposed rule would reduce the open enrollment period for individual and small group health insurance plans from 13 weeks to 6 weeks, which would give consumer significantly less time shop around for and enroll in the best plan for them.