Expanding Health Care Coverage

Grantee Name

Manhattan Institute for Policy Research

Funding Area

Expanding Health Care Coverage

Publication Date

July 2015

Grant Amount


Grant Date:

December 2010 – August 2011


The Affordable Care Act (ACA) required that residents in all 50 states have access to a health insurance exchange by 2014.

The exchanges created central marketplaces where individuals and employers can compare the benefit options and costs of all public and subsidized private insurance options available in their geographic area. Since the exchanges became fully operational in 2014, they have played a major role in the purchase of private health insurance by individuals across the United States. The ACA provided significant flexibility to states to design their own exchanges, but the exchanges needed to be ready to begin accepting applications by October 1, 2013.

In response to the quick pace of decision-making needed to shape the exchanges, NYHealth awarded Manhattan Institute for Policy Research (MI) a grant to examine ways to incorporate market-oriented and consumer choice-focused approaches into the design of New York State’s health insurance exchange.

Outcomes and Lessons Learned

Published report in April 2011, “Building a Market-Based Health-Insurance Exchange in New York.” Among the report’s major conclusions:

  • An overly restrictive exchange could diminish consumer choice and plan participation;
  • A market organizer framework for New York’s exchange, providing free flow of plan choice and competition, would lead to more customized insurance options and lower costs for consumers;
  • New York should encourage a range of cost-sharing and health insurance plan designs; and
  • The report received wide-ranging media attention and was disseminated to all members of the New York State Legislature.