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United Hospital Fund

Implementing Health Reform: Immediate Issues and Options in Designing New York’s Insurance Exchange

Federal health care reform mandates that each state establish a health insurance exchange or participate in a federally facilitated exchange, which will serve as a central marketplace where individuals and employers can access all public and subsidized private insurance options.

Expanding Health Care Coverage

Grantee Name

United Hospital Fund

Funding Area

Expanding Health Care Coverage

Publication Date

July 2013

Grant Amount

$496,000

Grant Date:

October 6, 2010 – February 3, 2012

Print

Federal health care reform mandates that each state establish a health insurance exchange or participate in a federally facilitated exchange, which will serve as a central marketplace where individuals and employers can access all public and subsidized private insurance options.

Exchanges are key linchpins to the successful implementation of health reform. If the exchanges function as planned, they will expand coverage, improve the quality of coverage, and potentially reduce health care costs. Currently, federal reform law provides few parameters to shape the structure of these exchanges, leaving substantial design decisions up to individual states’ jurisdiction. New York State has faced many critical and complex choices in establishing a successful Exchange.

In 2011, the New York Health Foundation awarded a grant to United Hospital Fund to inform the immediate design decisions confronting the State. These decisions affected the outcomes of the Exchange related to its ability to provide affordable, sustainable coverage.

Outcomes and Lessons Learned

  • Conducted an extensive literature review and legal analysis of Exchange governance;
  • Interviewed key stakeholders;
  • Assessed different operating models;
  • Identified coverage rules and procedures;
  • Analyzed census data;
  • Produced six reports; and
  • Convened three roundtables to present findings to stakeholders.

Based on its research and stakeholder input, United Hospital Fund produced a series of six analytic papers focused on discrete questions related to establishing New York’s Exchange. These papers offered an informed and balanced analysis that explored both sides of every issue, and provided guidance on policy choices. New York State featured these reports prominently in communications with public and federal officials, and the publications were cited by the State as resources for the public. In addition, the work was used by the Governor in changing budget bill language.

Read the six reports related to this grant:

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