While nearly a million New Yorkers enrolled in coverage via the state’s new “New York State of Health” health benefits exchange marketplace during the recently completed “open enrollment” period that ended on April 15 (approximately 70% of whom were formerly uninsured), that still leaves 1.5 million New Yorkers without coverage in place. “Anytime enrollment” is still possible for adults eligible for Medicaid (up to 138% of the Federal Poverty Level (FPL), approximately $15,000 for an individual, or $42,000 for a family of four), for children living in families up to 400% FPL (approximately $92,000 for a family of four), and for individuals and families who experience a special life event that qualifies them for a 60-day “special enrollment period” (see full list at www.nystateofhealth.ny.gov.) And of course, the next general open enrollment period will begin on Nov. 15th.
What do we do about the still uninsured until then?
In the short-term, we can refer them to the various safety net providers in our communities, such as public hospitals, community health centers, and other such entities. And we’ll need to support those entities from any funding cuts, and ideally push to beef them up so they can adequately address the task at hand.
In the longer term of course, projections from the Congressional Budget Office when the Affordable Care Act (ACA) was enacted 4 years ago indicated that the ACA would only cover about 30+ million nationwide of the country’s 50 million uninsured. The ACA only goes so far.
For those who get coverage under the ACA, major problems need to be addressed. These include making the coverage much more affordable to use concerning deductibles and co-pays, particularly for those of modest income just above Medicaid eligibility, and broadening out the very narrow provider networks that many plans have, which also could include the ability to go out-of-network when needed.
All that may be well and good enough in the short term. However, what can we do in the longer term to bring true universal health care to New York and America? The ACA has a solution for that too.
Starting in 2017, options become available to states to “go a different way” from the ACA as long as they meet the overall coverage goals of the law. (After all, the ACA is a floor, not a ceiling, for states.) This opportunity offers states the possibility of moving toward fully universal insurance programs that would cover all residents. Vermont is pursuing such an approach from the start as it implements the ACA, moving toward a public-administered, publicly-funded program under a “single-payer” approach.
The “New York Health” bill here in New York (A. 5389-A / S. 2078-A), sponsored by Assembly Health Committee chair Richard Gottfried and Senator Bill Perkins, is modeled on the Vermont approach, adapted to the specifics of our state’s insurance system. Advocates for this bill are pushing hard to obtain additional co-sponsors for it in both houses of the Legislature, and are hoping for a one-house vote in the Assembly before the end of this year’s session in late June.