Health Care & Health Insurance Committee Update

April 27, 2011

Health Exchanges On the Agenda

As the states grapple with implementing laws to carry out the vision for health exchanges, as anticipated in the federal health care reform law, active stakeholder meetings continue in Albany.

Last week Governor Cuomo convened a stakeholder meeting designed to elicit feedback from the over 100 attendees on areas they feel important for an exchange to address.  A copy of the powerpoint used to guide this discussion can be found here. Of particular note, are slides 5 and 7 for what they do not say. Slide 5 focuses on a principle set forth that the exchange must be consumer-oriented, with an explanatory bullet that it must "attract" businesses. The notion that the exchange must serve businesses was not widely discussed nor did the heavily-represented consumer interests at this meeting seem to embrace the notion that small businesses are an intended customer of the exchange, not an ancillary supply chain to it. Slide 7 speaks to a principle that the exchange "must work." What caught my attention is the lack of an explanatory bullet underneath this slide that the exchange, by federal statute, must be sustainable. This will become key as the model for building an exchange is designed, because much of the audience comment at this particular stakeholder meeting was seeking the state as an active purchaser, aggressively using its aggregate purchasing power to drive down costs, while wishing for a product design that knew few if any limitations. There was little discussion on the role of currently state-subsidized products including Healthy NY and Family Health Plus-Employer Buy In, nor any discussion on what happens if the exchange becomes unsustainable.

The Governor's lead on the health exchanges did reference that the Governor's team is looking strongly at the National Association of Insurance Commissioner's model legislation on how to design an exchange. A copy of that report can be found here

Many stakeholders are weighing in with broad policy statements on what is important to their interests in a New York exchange. Issues important to the Business Council were included in a recent Connect article which can be found here. The Manhattan Institute recently published a paper on building a market-based exchange which can be found here. Others weighing in include the National Association of Health Underwriters, Citizens Action, and entities representing special populations including the disabled, women's health issues, those battling cancer, and those with chronic diseases.