United Hospital Fund of New York

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.

UHF is undertaking the following activities: conducting a legal analysis of exchange governance; analyzing whether separate exchanges should be established for individuals and small businesses; identifying coverage rules and procedures to ensure seamless coverage for people whose eligibility for exchange subsidies or Medicaid coverage may change over time; assessing different operating models for the exchange; and convening roundtables to disseminate results of the analyses and discuss their findings.

Read the following grant reports associated with this grant:

• Two into One: Merging Markets and Exchanges under the Affordable Care Act
• Passive/Active: Defining the Role for a Health Benefit Exchange in the Interests of New Yorkers
• Coordinating Medicaid and the Exchange in New York State
• Building the Infrastructure for a New York Health Benefit Exchange: Key Decisions for State Policymakers