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New York Health Benefit Exchange Legislation

June 27, 2011
By Stephanie West

This legislation passed in the Assembly will create the New York Health Benefit Exchange which will ensure that affordable health coverage is available for residents and small business owners who need it.

The bill (A.8514) would bring New York State into compliance with the federal Affordable Care Act which requires the establishment of healthcare exchanges to make it easier and more affordable for individuals and small businesses to obtain health coverage. The exchanges also must provide eligible individuals with access to public health coverage.

“No one should have to live without affordable, quality health insurance,” said Silver (D-Manhattan). “The New York Health Benefit Exchange will provide many New Yorkers with the vital health insurance coverage they deserve. The benefits of this program are very promising, and my colleagues and I look forward to working with Governor Cuomo and the Senate to ensure its successful implementation.”

“The Exchange will revolutionize the way people enroll in public health plans like Medicaid, Child Health Plus and Family Health Plus,” said Gottfried (D-Manhattan).  “Instead of time-wasting trips to the ‘welfare office,’ there will be a statewide, online, streamlined system for enrolling and renewing enrollment, to make it much easier and more efficient for New Yorkers to get the health coverage to which they are entitled.  People without computers will be able to access one at a community organization, health care provider or public library to enroll.  We tend to think of the exchange as a way to buy commercial health insurance, but there will be millions more people accessing the exchange for public health coverage.”

The measure would require the Exchange to make possible the sale of qualified health and dental plans, to provide information to help consumers compare insurance plans through the exchange and to enroll eligible individuals in the appropriate public and private health plans.

The functions and obligations of the New York Health Benefit Exchange are established in the legislation, which aims to address the approximately 2.7 million New Yorkers who are uninsured. The bill would:

• establish the Exchange as a public benefit corporation containing a board of directors with expertise in various aspects of healthcare and health coverage;

• enact tough ethics standards for business and professional activities of Exchange directors, officers and employees;

• set up regional advisory committees to represent the interests of healthcare consumers, small businesses, healthcare providers, labor organizations and health insurers; and

• require the Exchange to certify and provide oversight to its various health plans as well as publicly disclose all fees and payments.

The Exchange also would be mandated to comply with all federal operational standards, reporting requirements and other duties called for by the Secretary of Health and Human Services, and to provide:

• consumer assistance for individuals and small business owners through the Internet, a toll free telephone hotline and in person appointments, beginning on January 1, 2014;

• an electronic calculator to help consumers determine the actual cost of health coverage after the federal premium tax credit and cost sharing reductions; and

• funding for organizations to conduct public education and awareness programs for the distribution of fair and impartial information to consumers.

Under the bill, the Exchange would be obligated to prepare a report for the governor and legislature by April 1, 2012 about its various operations and policies, and include recommendations on matters such as:

• how it can become self-sustaining by the January 1, 2015 deadline, when federal funding ends;

• the advantages and disadvantages of the Exchange serving as an active purchaser, a selective contractor or a clearinghouse of insurance;

• merging the individual and small employer markets for rating purposes;

• offering benefits to Medicaid eligible populations beyond the federal benchmark; and

• its impact on the Healthy New York and Family Health Plus Programs.

In addition, the measure calls for a study on the role of the Exchange in decreasing disparities in access to and the cost of health coverage based, for instance, on race or ethnicity.

While the federal Affordable Care Act requires the exchanges to be operational by January 2014, federal funding is available to the states for the planning, implementation and operation of the exchanges until December 2014.  New York could be eligible for the maximum federal funding award, depending on how soon the New York Health Benefit Exchange is in place.

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