Issue Brief: HCFANY Evaluation of UnitedHealth Reform Proposal

Posted December 7, 2009 by Amanda

In October 2007, the UnitedHealth Group issued a proposal to reform New York’s direct-pay and small-group markets. The direct-pay market is individual insurance coverage. The goal of the UnitedHealth proposal is to address the “death spiral” (see box below) or decline in enrollment. UnitedHealth attributes this decline to a lack of product flexibility, inadequate stop-loss pool funding, and by the introduction of the HealthyNY program onto the market.

HCFANY has reviewed the UnitedHealth proposal in relation to our 10 Standards for Quality, Affordable, Health Care for All. This is not a comprehensive proposal for universal health coverage.

The proposal is strongest in its use of the NYSHIP administrative structure, however it is unclear if the plan would preserve its comprehensive benefits or low-cost-sharing. Overall, it is difficult to evaluate this plan as it does not address several of the standards set forth by HCFANY.