Exchange 2015 Plan Invitation

Contact: Lev Ginsburg

March 4, 2014

Donna Frescatore
Executive Director of the New York Health Benefit Exchange
New York State Department of Health
Corning Tower
Albany, NY  12237

Dear Ms. Frescatore,

Thank you for the opportunity to comment and share my thoughts on some of the proposed changes for the health plan invitation for New York’s marketplace for 2015.  On behalf of the Business Council’s more than 2,500 members – businesses large and small all across the state – I wish to submit the following comments.

We congratulate the Department of Health and the staff at the New York State of Health for their good work in developing and rolling out New York’s Exchange.  New York’s Exchange infrastructure and user interface is perhaps the very best in the nation and has been described by some media outlets as, “one of few Obamacare success stories.” While, it remains unclear how many small businesses in New York have utilized the Exchange, it is clear that New York did a fine job in its creation.

As the state’s leading business organization we are keenly aware of the fact that New York employers overwhelmingly identify employee health care as their top cost-of-doing business concern.  The implementation of the ACA has upped the ante, so to speak, on the unease of employers about their health care costs and has raised serious questions, especially among small businesses, about their ability to meet current and looming government mandates while staying competitive.  As recently as this morning, the federal government is announcing another delay in a part of the ACA implementation.

Given the unease, uncertainty and the transitional nature of the healthcare environment, we are very concerned with the proposal voiced in the recent Regional Advisory Committee webinar, that New York State of Health will be mandating out-of-network benefits for health plans in 2015.

Employers and employees want and need choice in the health insurance market both on and off of the Exchange.  A healthy market with a variety of coverage options is the only way to ensure that New Yorkers can purchase insurance that fits both their health care needs and their budgets.  Mandates add both cost and inflexibility to plans, raising prices and limiting variety of plans at the same time.  In the case of a mandated out-of-network benefit, it has been estimated that the price of premiums could rise by almost thirty percent. 

With over one million expected enrollees on the Exchange over the next two years, controlling costs and fostering choice for employers and employees throughout the state should be the highest priority.  Respectfully, any attempt to mandate all health insurers to offer coverage for all health care provided by out-of-network providers on the Exchange would be in direct conflict with the goal of affordability, resulting in increased premiums overall and the serious weakening of existing provider networks. 

New York State of Health has been operational for less than six month and 2014 enrollment doesn’t end for another four weeks.  Such a minimal window of time is hardly enough for health plans to truly begin to assess existing products and make any real calculations based on experience of existing Exchange products.  Given the newness of the Exchange and many of the products therein, it is premature to begin making major modifications to the market, especially one with the potential to dramatically raise premiums for consumers. 

The work that you have done in building, rolling out and operating New York State of Health is a stand-out in the nation.  Enrollment numbers continue to increase and hundreds of thousands of New Yorkers now have quality health insurance that they did not have before.  Now is not the time to implement new and very costly mandates on consumers just entering the market.  Therefore, The Business Council opposes any new mandate for out-of-network coverage on private insurance on the Exchange as unnecessary and extremely expensive for New York consumers.  Thank you again for the opportunity to submit comments.

My Best,
Lev Ginsburg, Esq.