Yesterday, the NYS Senate released a letter written by Senate Majority Leader Dean Skelos (R) responding to Senate Minority Leader John Sampson’s (D) request that the Senate bring health insurance exchange legislation on to the floor.
Last year, New York’s exchange bill passed in the House, but never came to a vote in the Senate. At the time, Skelos had said that the Senate didn’t want to be seen as buying into “Obamacare.”
In yesterday’s letter, Skelos again pushed back. He gives several rationales for this.
One is a study that estimates the ACA could cost NY more than $65 billion for the Medicaid portion. The study he is referring to is from the conservative CATO Institute, and bases its numbers on people currently eligible for Medicaid, but not enrolled (the $65 billion number is supposed to reflect the total over 10 years). The idea is that the ACA’s individual mandate will prompt these folks to take up coverage they are already eligible for. Of course, CATO doesn’t dwell on the fact that these folks are free to enroll at any time, regardless of the ACA. In fact, the State already invests millions each year to boost enrollment among children and families eligible for Medicaid. Why? Because Medicaid is a cheap and efficient way to get people good health coverage, and the cost is split with the federal government. Its not clear why NY’s Senate Majority Leader would balk at the idea of actually fulfilling one of the State’s long-standing public health goals.
He also says that NY didn’t miss out on any cash by not passing a bill last year, perhaps implying that this will also be the case if we don’t this year either. Unfortunately, this is wrong. At this point, NY has received about $87 million under the ACA. But it’s eligible to get much more – provided it has exchange legislation in place by June 29, 2012. That deadline is as clear as day in the Grant application language. The amount is based on our state needs, which means a potential of hundreds of millions that will be lost if the Senate does not act.
There’s a couple of other reasons given, neither of which are any stronger. Lack of guidance on the Essential Health Benefits (EHB) is one. Yes, the State is still awaiting further guidance on that, but the comments submitted by the State on the EHB bulletin in no way indicate that the adoption of an exchange bill should hinge upon this issue.
Lastly, Skelos says it’s ok for NY to wait because HHS Secretary Sebelius recently said that it’s “appropriate” for us to do so. This is true, Sebelius did say this back in December. However, Secretary Sebelius did not choose to comment on the “appropriateness” of the consequences New Yorkers would face if we wait too long. Namely, missing out on millions in federal funds and having to pay to for an exchange out of state coffers if we so, or having to default to a one-size-fits-all federal exchange.
The truth of the matter is that New Yorkers simply can’t afford to wait. Health insurance on NY’s direct-pay market is now tipping past $12,000 per year for individuals and $24,000 per year for a family. This is just too expensive for normal folks. At the same time, the rate of employer-offered insurance continues to decline and every year the number of uninsured New Yorkers goes up. An insurance exchange will lower the rate of uninsurance by over 1 million, is estimated to bring down costs in the direct-pay market by 66%, and to lower small business costs by 22%. These aren’t just abstract numbers – this is food on the table. A full tank of gas. An electric bill that is no longer in arrears.
Senator Skelos’ letter is disappointing to read, but hopefully it does not reflect the intent of the entire Senate majority. New York needs strong leaders who will look past partisan divides and work together to do what’s right for the state. Time is running short. Let’s hope the Senate comes through for New York.