1.2 Million New Yorkers Projected to Gain Coverage Under Federal Health Care Reform

August 13, 2010 (New York) – Federal health reform could expand health care coverage for an estimated 1.2 million people in New York State who are currently uninsured, a new analysis released today by the New York State Health Foundation (NYSHealth) has found.

The report, entitled “Implementing Federal Health Care Reform: A Roadmap for New York State” and prepared by Patricia Boozang, Melinda Dutton and Alice Lam of Manatt Health Solutions and NYSHealth Visiting Fellow Deborah Bachrach, reviews and analyzes the key provisions of the Federal reform law, known as the Affordable Care Act (ACA). It then projects the unique implications that each provision of the law holds for New York, and identifies the tasks and hurdles that State government and other stakeholders must confront when implementing reform.

“Health care reform is an unprecedented opportunity to provide affordable health care to the majority of New Yorkers, and we cannot let this moment slip by,” said James R. Knickman, President and CEO of NYSHealth. “The number of New Yorkers who gain coverage through the Federal law will largely depend on how successfully the reforms are implemented.”

“Now that health reform is the law of the land, much of the responsibility for implementation falls to the states,” said Patricia Boozang of Manatt Health Solutions. “The implementation challenges facing states are daunting, complex, and occur during a time of fiscal constraint. This roadmap will help New York make the most of the opportunities before it.”

There are currently 2.6 million uninsured children and non-elderly adults in New York State; ACA makes a large majority of them eligible for coverage. The report estimates that up to 440,000 individuals who are currently eligible for Medicaid but unenrolled may sign up because of enhanced outreach. Up to another 70,000 individuals will be made newly eligible for and enroll in Medicaid. Approximately 570,000 people are expected to use tax subsidies to purchase insurance through an exchange (a marketplace to connect consumers and employers to insurers), and an estimated 80,000 are likely to purchase coverage through an exchange without Federal subsidies.

While the ACA will dramatically increase the number of insured New Yorkers, some individuals will be left behind and remain uninsured. Because ACA does not extend coverage to undocumented immigrants, an estimated 400,000 undocumented and uninsured immigrants may remain uncovered. Further, because New York already has more generous Medicaid eligibility levels than most states, a smaller proportion of New Yorkers will be made newly eligible for Medicaid by ACA in comparison with other states. If outreach and enrollment efforts fall short, people who are currently eligible for—but not enrolled—in Medicaid could still not enroll.

“New York has long been a leader among states in expanding health insurance coverage, and Federal reform opens up a scale of opportunity that we’ve never seen before to achieve something resembling universal coverage,” said David Sandman, Senior Vice President of NYSHealth. “The rubber meets the road at the state level, and New York can again lead the nation down a path to successful implementation.”

The report concludes that health care reform will require an overhaul of the State’s existing regulatory and delivery infrastructure. Some of New York’s existing regulations will have to be repealed; new health and insurance guidelines will have to be drawn up and issued; and significant new infrastructure and administrative systems will have to be created. Some of the specific tasks identified in the report that the State government and other stakeholders must undertake include:

Creating the Exchange(s): Federal reform calls for the creation of state-based insurance exchanges, and many questions must be addressed before New York can successfully implement an exchange, including whether to create one exchange or multiple exchanges; what entity or entities will run the exchange(s); and which insurers will be allowed to participate.

Expanding Access to Care: New York State must increase primary care capacity to prepare for an influx of newly-insured people who will seek care. It will be equally important to preserve a strong safety net for those New Yorkers who remain uninsured.

Reforming the Payment and Delivery System: Federal reform enables New York to pursue lower costs and better outcomes through new care and payment models. Careful planning and execution will be needed to synch these models with care providers across the State.

“Health reform means more than expanding coverage,” said Deborah Bachrach, Visiting Fellow at NYSHealth. “The State has the opportunity to reform its payment and delivery systems and ensure that all New Yorkers have access to care that is affordable and effective.”

Please click here to download the full report and please click here to view an implemenation timeline.

The New York State Health Foundation is a private Foundation dedicated to improving the health of all New Yorkers. NYSHealth has a three-part mission: expanding health insurance coverage, increasing access to high-quality health care services, and improving public and community health by educating New Yorkers about health issues and empowering communities to address them. It was established with charitable funds from the privatization of Empire Blue Cross/Blue Shield.