Consumers and Industry in Albany weigh in on NY’s Health Benefit Exchange

Posted September, 20 2012 by arianne

Guest Blogger, Bob Cohen,  Esq.; Policy Director, Citizen Action of New York

If there’s one thing that’s clear from yesterday’s meeting of the Capital District/Hudson Valley/Northern New York Health Benefit Exchange Regional Advisory Committee (RAC), it’s that the “devil is in the details” when it comes to building a strong pro-consumer health insurance Exchange.

The Governor’s Exchange Planning Team presented the Capital District RAC, one of 5 RACs set up under the Governor’s April Executive Order creating a Health Benefit Exchange in New York State, with a list of 8 issues to consider.  (Here’s the agenda and presentation summarizing the issues.) While the issues seem technical in many ways, how the State resolves them will in large part determine whether the Exchange meets its goal of providing truly comprehensive coverage to a million more New Yorkers.

Front and center at the meeting was which “benchmark plan” New York should select as a model for insurance plans inside and outside the Exchange – a decision that the State must make by September 30th.  While under the Affordable Care Act all plans must provide the same array of “essential health benefits,” there are serious differences between the Empire Plan recommended by HCFANY and the Oxford plans common in the small group market. HCFANY and its coalition members have pointed out that the Empire Plan has more generous service limits on a list of services like mental health, skilled nursing and home health care than those in other benchmark options. (Read HCFANY’s recent blog post on New York’s Essential Health Benefits. Here you can find HCFANY’s comments on the Essential Health Benefit Benchmark Plan options and a template letter.) Unfortunately, comments by the State Exchange Planning Team at the meeting left consumer representatives feeling that the State is leaning against the Empire Plan, making strong consumer advocacy on this issue critical.

Other areas gave consumer advocates more hope.  Troy Oeschner, a deputy superintendent at the Department of Financial Services, explained the importance of the Exchange standardizing the benefits offered to consumers.  Given the 15,000 separate plan offerings in the state today, it is virtually impossible for consumers to make informed choices.  At least at this meeting, the opposition by industry forces to the Basic Health Plan, a plan that would provide a low cost alternative for a half million New Yorkers, seemed muted.  Finally, although there are a number of knotty issues to be resolved in designing a state Navigator program before enrollment begins in October of 2013, at the meeting there seemed to be broad support for a system that includes the participation of community-based organizations, modeled on the Community Health Advocates program led by the Community Service Society.

Ultimately, whether we succeed on many of these issues will depend on whether the debates go beyond the world of health care “policy wonks.”  Keep checking these pages to see how you can get involved.