Neither the Senate’s or the Governor’s bills contain clear conflict of interest provisions, which can create serious problems for the Exchange if either is adopted as is.

 The Exchange’s governing board will be in charge of heavy decisions on how health plans, providers, agents and brokers will interact with the Exchange.  Many of these decisions will determine the level of financial gains that these entities will end up getting. 

So, it makes no sense whatsoever to have insurance industry carriers, health care providers, agents, or brokers serving on the board.  Other states like California, Connecticut, Maryland, Vermont and Washington State have had no problem tackling this issue in their Exchange legislation. 

So why are New York’s lawmakers pushing back? Could it be that the insurance industry has lobbied so hard that they’ve actually convinced our lawmakers that they should be allowed to govern themselves on the Exchange AND be relied on to act in the best interests of consumers and small businesses? 

Malarky!

Pair this the Senate’s refusal to give the Exchange the authority to be an active purchaser with the power to negotiate with plans to achieve the best possible products at the best possible prices for enrollees, and we’ve got a load of shenanigans on our hands.

From the State’s perspective, and for consumers and small businesses, it makes no sense for us to not have a conflict-free governing board with the authority to selectively contract with plans.  This would mean more people would be covered under better plans, at better prices.  Good for public health, good for jobs, good for the economy.

Seven of the nine states with Exchange laws (Colorado and Oregon are the exceptions) permit active purchasing, as does the Hawaii legislation that is now before the Governor for approval.

What’s it not good for? Padding the pockets of insurance execs.  But, is that really who our Legislature is working for now? I’d like to think not.

 So here’s what we need to see:

• New York’s health insurance Exchange legislation must clearly prohibit anybody who could financially benefit from the decisions being made by the governing board of the Exchange, from serving on that board. Click here to read HCFANY’s Senate  Alert on the conflict of interest provisions.
• The Assembly needs to take a leadership role and urge that the final exchange legislation is strong, pro-consumer and pro-small business and  gives the state Exchange the authority to be an active purchaser.  Click here to read HCFANY’s Assembly Alert on the active purchaser provision.