A report released this month by the United Hospital Fund titled The Big Picture: Private and Public Health Insurance Markets in New York provides a comprehensive look at trends and share data for the state’s health insurance industry, e.g., four health plans — Excellus, WellPoint/Empire, United/Oxford and Emblem — control 80% of commercial group membership in the state. It also offers some insights into New York’s individual market — and something to think about when considering the potential fallout of national healthcare reform:
New York’s landmark Community Rating/Open Enrollment law, which governs the individual and Small Group markets, has weathered well for small employers and Healthy NY [a public-private program for individuals, sole proprietors and small groups] subscribers, but is badly broken for direct purchasers. While the market rules have preserved access to quality coverage for all individuals regardless of age, sex, health status, or occupation, a failed pooling mechanism and inadequate subsidies make the market unaffordable to many. In a sign of the uneasy co-existence of two rating systems — community rating and experience rating — gender and occupation still play a factor in experience-rated markets, in the rates paid by employer groups of between 51 and 150 employees…
The overriding picture that emerges in the commercial sector is that of a “stressed-out” market, reeling from years of double-digit premium increases. Increased cost-sharing, the chief tool that has emerged to blunt inexorable cost increases, is creating challenges for consumers, health care providers, and regulators. Even the most fundamental element of risk spreading — the employer group — has begun to fray, as cost-sharing helps offset premium increases for the whole group but shifts more costs to users of more services within the group.
Inadequate subsidies, a weak coverage mandate, guaranteed issue and community rating are all part of the Senate Finance Committee reform bill. So New York offers further proof that the SFC bill is only an incremental step on the road to more meaningful reform.
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