Institute Forum
Costs and Coverage: Opportunities and Obstacles
in Health Reform for New York
With relatively generous public health insurance programs, New York may be in a better position than many states to implement changes mandated by the health reform law that Congress passed in March. Yet many questions remain regarding how the state and localities will accomplish implementation — including the issue of how they will pay for it, said speakers at a June 8 Rockefeller Institute public policy forum on “How Will New York Implement Health Reform?”
James Knickman, president and chief executive officer of the New York State Health Foundation, led the discussion with an overview of the changes required by the new law, as well as some challenges and opportunities those changes present to the state.
Knickman referred to the health reform law as “the largest opportunity ever” to expand insurance coverage for New Yorkers, with required expansion of the government’s Medicaid program, the establishment of insurance exchanges that offer affordable plans to residents of limited financial means, and billions of dollars in new federal funding to expand access to primary care. The greatest challenge, he said, will be in providing seamless care to New Yorkers who shift back and forth from being eligible for free coverage under Medicaid to needing to purchase their own insurance under the new law’s mandate for every American to have insurance coverage.
Knickman predicted at least 1.5 million New Yorkers will remain uninsured after implementation of the law, and that safety-net provisions such as community health centers will become increasingly important. Like the other speakers, he warned that too little has been done to restrain growth of health-care costs: “If we don’t manage costs, this is all going to fall apart,” he said.
Robert Doar, commissioner of the New York City Human Resources Administration, said that for health reform implementation to be effective, a single state or local agency must be identified to oversee changes. Otherwise, the goal of getting expanded services to more New Yorkers will get bogged down in bureaucratic red tape. Doar said reform provides opportunities for expanded access to prevention and wellness services, as well as for increased entry-level jobs in the health industry through federal grant programs. But he expressed concern that there is an inadequate supply of primary care physicians to meet what is likely to be an increased need for care, and disappointment in federal officials’ decision to exclude undocumented immigrants from the requirement to have insurance coverage.
Joseph D. Morelle, chair of the New York State Assembly's Standing Committee on Insurance, stressed the need to balance the desire for more comprehensive insurance coverage with the costs of that coverage. Mandating additional coverage on insurance policies drives up the cost of the coverage for insurance companies, which then pass those costs on to consumers.
"Making policies more comprehensive is wonderful, but if the offset is that it raises the cost of premiums and rates and makes it unaffordable to people on the bubble who are almost at the point of not being able to afford comprehensive coverage, then that is not a particularly reasonable, thoughtful, or appropriate, responsible thing to do," Morelle said.
The assemblyman and other speakers expressed concern over how the state will pay for health reform implementation in light of its own failing fiscal health. Morelle called for the federal government to support the state's costs of implementing the reforms.
Knickman expressed hope that the state would achieve savings through such reforms as the requirement for all individuals to carry insurance coverage. That mandate is intended to drive the average cost of coverage down for all residents — as more healthy people enter the insured population — and to encourage people to seek care earlier on in an illness, when treatments are less costly and more effective.
About the Rockefeller Institute of Government
The Nelson A. Rockefeller Institute of Government, the public policy research arm of the State University of New York, conducts fiscal and programmatic research on American state and local governments. It works closely with federal, state, and local government agencies nationally and in New York, and draws on the State University’s rich intellectual resources and on networks of public policy academic experts throughout the country.