While we haven’t seen all the fine print, HCFANY is delighted to report that this year’s budget deal includes important protections for New York’s health insurance consumers.  The new budget deal includes:

  • Co-premium assistance for people between 138-150% of poverty (people with children that are currently eligible for Family Health Plus ).  Those who enroll in the Exchange with Silver-level plans will pay no premiums.  This measure is NOT conditional on federal financial participation.
  • Protection for people who currently have out-of-network coverage in the individual market.  These consumers will have the option to pay for a Platinum-level plan on the Exchange with an out-of-network rider and be “risk pooled” with the rest of the State’s individual market.
  • A requirement for SDOH to create a workgroup to study whether New York should adopt a Basic Health Plan
  • Fair consumer protections on the State’s new Navigator program
  • Funding for consumer assistance for New York’s health insurance consumers through Community Health Advocates
  • Still waiting details on Medicaid budget, but it looks like most optional benefits have been saved….

A special thanks to everyone who added their names to our sign-on letter, called the Governor’s office, and worked hard to get these important consumer protections. These budget victories would not be possible without you!!!

Stay tuned for more on the budget!



Yes folks, it's the Hoover Dam!

A press release issued by Governor Cuomo’s office yesterday announced that New Yorkers will save over $500 million on health insurance premiums this year thanks to the Department of Financial Services’ (DFS) utilization of the State’s prior approval law.  As you may remember, New York’s 2010 prior approval law allows DFS officials to review insurance rate increases before they go into effect and scale them back if they are too high.

Health insurers had requested overall increases averaging around 12.4%, which were then cut down to an average of 7.5% by DFS.  Rate increases for small group plans will increase an average of 9.5%, down from the average 15.7% increase requested by the insurance plans.  Prior to passage of the prior approval law, annual premium rate increases averaged 14%.

These modest increases stand out at a time when many states are experiencing double-digit increases in premiums.  For example, an article in Saturday’s New York Times notes that states like Florida and Ohio have seen rates rise by as much as 20%, with similar rate increases proposed in California.

The Affordable Care Act requires states to review any proposed rate increases above 10%, however New York is one of 37 states which allows state officials to deny excessive rate increases (an issue that is explored further in the Times article).

So, thanks again to our Senate Democrats who really championed this issue back in 2010 and made savings like this possible today.  We appreciate the work you do!!!

See below for a breakdown of the average requested rate increase and what the DFS ended up actually approving.  For the full list of increases by insurance plans, see the Governor’s press release.


Health Insurance Market Segment
Total Number
of Members Affected
Requested Annual Rate Increase (Weighted Average)
Approved Annual Rate Increase (Weighted Average)
Reduction by DFS
Individual, direct-pay
Small Group
Large Group
Medicare Supplement

Click here to read the Governor’s press release.

Click here to read the NYTimes article, titled “Health Insurers Raise Some Rates by Double Digits.”



On Monday, October 1, New York State selected the benefits of the State’s largest small group plan, Oxford EPO, as the Essential Health Benefits (EHB) benchmark plan.

The state also outlined the coverage areas in which the Oxford plan’s benefits will be supplemented to meet ACA requirements:

  • Pediatric dental/vision coverage – NYS will supplement the Oxford plan’s benefits with the current pediatric dental/vision benefits offered through NY’s CHIP coverage.
  • Habilitative services – will have parity with rehabilitative services.
  • Mental health/substance abuse parity – benefit limits in the Oxford plan will be removed.
  • Annual/lifetime dollar limits – quantitative limits will be substituted when further federal guidance is available.

As we explained in our August 13 post, the selected benchmark EHB will apply to all non-grandfathered plans both inside and outside the State Health Insurance Exchange (the Exchange), as well as the benefits included in a Basic Health Plan, if New York implements such a plan.

In our written comments to the State, HCFANY urged the State to select the New York State Employee Plans’ Empire Plan, which has more comprehensive benefits than the Oxford plan. Among other differences, the Empire Plan covers adult dental care, and covers some services (like physical therapy and speech therapy) according to medical necessity rather than limiting those services to a set number of visits.

The State balanced value to consumers and small business employees of the more comprehensive benefits with the predicted additional cost these benefits would add to premiums. According to Milliman, the consultant that studied the EHB benchmark options for the State, selecting the Empire Plan would add $15 more to monthly premiums than selecting the Oxford plan would. The complete report by Milliman on EHB is available here.

The State received extensive feedback, including 60 written comments from the public.  Some of the comments, like this comment from the Hemophilia Association of New York, urged the State to select the Empire Plan because consumers need comprehensive coverage. Others, including this comment from the New York State Conference of Blue Cross and Blue Shield Plans urged the State to select an Oxford plan to keep premiums lower.

Input at the Regional Advisory Committees was similarly mixed, with stakeholders including carriers and small business advocates urging the State to keep premiums low, and stakeholders including consumer advocates urging the State to choose a more comprehensive benefit package.

While consumer advocates are disappointed in the State’s decision, there are some consolations for consumers:

  • The EHB will serve as a floor, not a ceiling, for benefits offered by individual and small group plans in New York.
  • The EHB will raise the floor for many New York consumers, including consumers who currently have coverage through Healthy NY plans.
  • Benefits that are not covered by the EHB, like adult dental, will be available through more comprehensive plans or coverage riders.
  • The EHB decision may be revisited for 2016.

HHS will offer the public one more opportunity to comment on this decision through a Notice of Proposed Rulemaking. We will keep you posted about opportunities to comment at that time.

Today, the Kaiser Family Foundation and Health Research & Educational Trust (HRET) released the 2012 Employer Health Benefits Survey. Thanks to the Affordable Care Act (ACA), in 2012, premium increases are at an all time low and workers are getting more affordable benefits from their employers. The survey found that employer-sponsored family health coverage reached $15,745, an increase of 4 percent from last year. Workers pay, on average, $4,316 toward the cost of their coverage.

Fewer plans are considered grandfathered in 2012 than in 2011 (48% down from 56%), resulting in more workers benefiting from preventive care with no co-pays and access to an external appeals process, keys provisions of the ACA that have been implemented for non-grandfathered plans.  For plans to remain grandfathered, employers must not make significant changes to their plans to reduce benefits or increase employee costs.

According to the survey, 2.9 million young adults are currently enrolled on their parent’s coverage because of the dependent coverage for children up to age 26 provision in the ACA. This provision has largely contributed to the decline in the percentage of uninsured adults ages 19-25 over the past year, from 33.9% to 27.9%.

Unfortunately, the survey showed that workers with coverage at lower-wage firms (where at least 35 percent of workers earn $24,000 or less a year) may fare worse with some employer-sponsored health benefits than workers at higher-wage firms (where at least 35 percent of their workers earn $55,000 or more a year).

  • Workers at lower-wage firms on average pay $1,000 more each year for family coverage than workers at higher-wage firms.
  • Workers at lower-wage firms are more likely to face high deductibles than those at higher-wage firms.
  • Large employers are more likely than small ones to allow workers to pay their share of premiums with pre-tax income (91 percent, compared to 41 percent) and to contribute pre-tax dollars to Flexible Spending Accounts (76 percent, compared to 17 percent).

As states and the feds continue to implement the provisions of the ACA, workers will reap the benefits through their employer-sponsored coverage. We look forward to the 2014 survey, when many more substantial provisions of the ACA will be in effect. For the impatient in the audience, tomorrow the U.S. Census Bureau will release its Report on Health Insurance Coverage on 2011.