Expanding Health Care Coverage


United Hospital Fund

Funding Area

Expanding Health Care Coverage


December 1, 2011


This United Hospital Fund (UHF) report, supported by NYHealth, examines the roles New York’s health benefit exchange should play, ranging from a passive market organizer model that relies on the free market alone to determine the quantity and scope of offerings, to an active purchaser model that would use leverage to get the best prices through a competitive procurement.

The report looks at the advantages and disadvantages of each model and highlights how two core exchange activities—selecting the health plans that will participate in the exchange and selecting the products available for purchase—are affected by unique features of New York’s insurance market and regulatory framework. The report concludes with a discussion of the policy options in the passive/active framework under the various exchange models.

This report is the fourth in a series of reports focused on New York’s health insurance exchanges. The first report examined the initial set of governance and organizational choices for states in designing their exchanges. The second report examined the organizational improvements necessary to successfully integrate the State’s Medicaid program into the Exchange. The third report focused on two discretionary decisions for New York involving the Exchange: merging the exchanges for individuals and small businesses and merging the individual and small group markets. The fourth report explored the roles the Exchange should play, ranging from a passive market organizer model to an active purchaser. The fifth report examined the various plan options that will serve as a benchmark plan for implementing the essential health benefits rule required for all individual and small group policies. The sixth report looked at the extent of public and private health insurance plans’ provider networks and current State standards and processes for determining the adequacy of these networks.