S.4639 (Krueger)/A.6780 (Simotas)


Director of Government Affairs


S.4639 (Krueger)/A.6780 (Simotas)


Expands “Qualifying Events” to Include Pregnancy



The Business Council opposes S.4639 (Krueger)/A.6780 (Simotas), which would allow pregnant woman to enroll in any insurance plan on the state health exchange at any time during a pregnancy regardless of existing enrollment rules.  While this bill is well intentioned, it ignores the fundamental principles and pillars of the federal Affordable Care Act (ACA) and would lead to the purchase of health insurance only as necessary.  The legislation would also have the unintended consequences of increasing costs to the state. 

The ACA is premised on a delicate balance of mandated benefits and mandated coverages to try to promote more universal coverage at affordable prices.  As such, public policy discourages people from purchasing insurance only when they need to use health benefits.  Creating incentives for people to enroll only when they have a health need, as done in this bill, poses a tremendous risk to the risk pool and affordability for  other plan participants.

Under the ACA, New Yorkers may enroll in health plans through the state's health insurance exchange during a designated open enrollment period, and during a special enrollment period if they experience a “qualifying event.” Qualifying events that trigger a special enrollment period include marriage, divorce, gaining citizenship, and birth, among others, which is similar to the circumstances that allow people with employer-sponsored insurance to change their coverage outside of open enrollment.

This legislation would add pregnancy to the list of qualifying events for a special enrollment period. This proposal is in total contrast with the decision of the federal Department of Health and Human Services to not include pregnancy as a qualifying life event for purposes of enrollment. This means that this bill amounts to a state-imposed insurance mandate, in excess of those required in the federal essential benefits menu, and must be paid for by state revenues – not federal money or premium dollars.  With so many new health coverage options now open for women, pregnant or not, now is clearly not the time to impose new coverage mandates for which there is no identified revenue source to pay.  

For these reasons, The Business Council respectfully opposes adoption of S.4639(Krueger)/A.6780(Simotas).