From Health Affairs, an informative article on the development of NY’s health insurance exchange- a key provision of Federal healthcare reform:
New York is a deep-blue state that Barack Obama won with 62 percent of the vote in both 2008 and 2012. Even so, the state’s Republican-controlled Senate balked twice at approving a central feature of President Obama’s signature health care reform law: a state health insurance exchange.
As a result, Democratic Gov. Andrew Cuomo had to issue an executive order in April 2012 to establish the New York Health Benefit Exchange. “Establishing the health exchange will bring true competition into the health care marketplace, driving down costs across the state,” Cuomo said in a written statement when he issued the order.1
The Affordable Care Act requires an exchange in every state. New York, Rhode Island, and Kentucky are the only states that have established their new federally approved health insurance market by executive order. Thirteen others, plus the District of Columbia, have done so through legislation; Utah is awaiting federal approval of its legislatively created exchange. The remaining thirty-three states declined to set up an exchange on their own; as a result, in those states the federal government will run an exchange by itself or in partnership with the state.
Governor Cuomo’s executive order came nearly a year after the New York legislature’s failure to pass legislation. The delay has pushed the Empire State hard up against the deadlines for implementing the health insurance marketplace, which require starting enrollment on October 1, 2013, and coverage on January 1, 2014. Yet, unlike many other states that are struggling to meet the quickly approaching deadlines, New York has the support of nearly all stakeholders, including Republican Senate leaders, as it works to establish a state-run exchange. Since the executive order was issued, the state has by most accounts moved efficiently to get enrollment started on time.
“New York is doing the best job one can expect given all the challenges,” says New York Senate Health Committee chair Kemp Hannon (R–Nassau County), who in 2011 backed the bipartisan bill to create an exchange that didn’t pass. “I haven’t heard anyone griping,” he adds. “But we’re building something entirely new, and even Amazon had growing pains at the beginning.”
The law’s proponents say it’s crucial for proreform states like New York, California, Maryland, and Oregon to have their exchanges up and running, enrolling people on October 1. Their success would demonstrate that the Affordable Care Act is working and would quiet critics like Sen. Max Baucus (D-MT), who recently warned of a “huge train wreck coming down” on exchange implementation.2 President Obama acknowledged that launching the exchanges is “a big, complicated piece of business.”3
Nationally, the state exchanges are expected to serve as a key mechanism in extending health coverage to an estimated twenty-seven million uninsured Americans by 2016 and in fostering competition that will curb health care cost growth. Nearly 1.6 million New Yorkers are projected to access coverage through the state’s exchange.
“There are a lot of eyes on New York,” says Donna Frescatore, a Cuomo health policy adviser and former state Medicaid director whom the governor appointed executive director of the exchange last July. “We’re a large state, and we have the opportunity to significantly reduce the number of uninsured. There are a lot of very interested folks rightfully asking us good questions…” (For full article click here)