Expanding Health Care Coverage


United Hospital Fund

Funding Area

Expanding Health Care Coverage


September 1, 2011

This United Hospital Fund (UHF) report, supported by NYHealth, focuses on two discretionary decisions for New York involving the State’s new health benefit exchange: first, merging the exchanges for individuals and small businesses, and second, merging the individual and small group markets.

The report notes that maintaining separate individual and Small Group exchanges would bring a single-minded focus on the different needs of individual and small business customers, but would increase costs, create redundancies, and complicate coordination. Merging the insurance market segments is a far more complex issue, and the report highlights how a series of interrelated state policy decisions could reshape the markets. The report also underscores the uncertainty created by the mix of new incentives and penalties that consumers and businesses will face as they make decisions.

Examining different estimates of the size and relative health status of the newly insured and the current individual and Small Group markets, the report presents estimates of premium changes based on the combined experience of individuals and groups. Given federal guidance yet to come, important state policy determinations to be made, and uncertain insurance market dynamics, the timing of a merger is a related issue for policymakers to consider.

This report is the third 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 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.