Regional Advisory Committees – Cuomo Administration Appears to be Coalescing Around Key Issues Affecting Consumers

Posted September, 26 2012 by arianne

The fifth Exchange Regional Advisory Committee meeting scheduled for this month was held in a packed room in New York City yesterday.  The Administration’s presentation can be found here and you can watch the webcast by visiting the RAC home page.

It appears that the Cuomo Administration has consolidated its thinking on key consumer issues.  Here’s an update about the issues and why they matter.

Market Merger.  The Cuomo Administration has determined that there may not be time to modify New York’s insurance law to merge the individual and small group markets. The individual market will include sole proprietors and the smallest of small businesses, who will be better off with merged markets. The United Hospital Fund indicates that merging the individual and small group markets would significantly benefit individuals by reducing the cost of coverage as much as 38%, but would have a small percentage increase for small businesses in the group market.

It appears the State is leaning towards not merging the individual and small group markets.

Premium Aggregation.  This is a fancy term for who sends the bills.  The most consumer friendly way to bill people for their insurance would be to have the Exchange issue uniform billing notices and collect premiums for consumer using it to get coverage.  If the Exchange collected the premiums, a family could just send in one check, even when members of the family are enrolled in different plans.  However, insurance companies want to continue to issue their own notices and bills, which can be confusing for consumers.

It appears the State is leaning towards leaving the billing notices up to individual insurance companies.

Risk Adjustment.  This is another complicated policy issue that affects consumers because it affects the way our risk is carried across insurance carriers in the market.  In New York, we have long had two separate risk adjustment mechanisms:  “Reg 146” for the commercial carriers and “CRGs” for the public carriers.  The State’s consultants, Wakely Acutarial, had recommended that we consolidate and simply use one risk adjustment mechanism, CRGs, across both markets.  Advocates especially liked this option because it meant that the proposed Basic Health Plan, if adopted by New York, could include both commercial and public carriers, thereby increasing choice for consumers. Instead, insurance companies are arguing for the federal risk adjustment mechanism.

It appears the State is leaning towards the federal risk adjustment mechanism.

Essential Health Benefits.  The EHB will be the basic benefit package offered by plans inside and outside of the Exchange, and in a Basic Health Plan if New York adopts this option.  Consumers, including HCFANY, have urged the State to offer the civil-service Empire Plan level of coverage, which has more comprehensive coverage than the alternative Oxford Small Group plan.  Insurance companies, small businesses groups and others argue the Empire plan would be too expensive and that the incremental price increase would cause more consumers to opt for the lowest-level Exchange Bronze plan.  The State will officially decide on Friday, but we wouldn’t bet the family farm on the Empire Plan, ironically covering those very same decision-makers.

It appears the State is leaning towards the Oxford Small Group plan for the EHB package.