Public Hearing Notice
Increasing Access to Health Insurance Coverage and Moving Toward Universal Healthcare Coverage: Defining the Goals and Identifying the Steps
At the direction of Governor Eliot Spitzer, the New York State Departments of Health (DOH) and Insurance (DOI) will conduct a series of public hearings to solicit input on the development of proposals for achieving health system reform, increasing access to health insurance coverage and moving toward universal healthcare coverage in New York. The Governor has articulated a multi-faceted charge to all participants in New York's health care system to work in partnership to meet the State's unique challenges:
"Our 'partnership for universal health coverage' will be based on a building-block approach that ensures access to affordable, high quality medical care for every single New Yorker, reduces the overwhelming and unsustainable cost of healthcare incurred by the public and the state, and avoids the significant implementation problems that have plagued other state efforts in this area," said Governor Spitzer. "This incremental effort will draw from the experiences of other states, but will ultimately result in a plan that is uniquely suited to New York's uninsured population and healthcare challenges." - Governor's Press Release of July 11, 2007
The Governor has made clear that reforming the health care system to make quality care more affordable is inextricably linked to expanding health insurance coverage and moving toward universal healthcare. As the Governor said earlier this year:
"… we will develop a plan for affordable, universal health insurance for all New Yorkers. To be clear, we cannot achieve this goal unless we first restructure our health care delivery system to lower health care costs. Otherwise, we will force an undue burden on families, businesses and government to cover the cost of universal coverage." - Governor's Health Care Speech, January, 2007
This hearing notice provides some basic information about the current state of health insurance coverage, health care costs and health care reforms in New York, sets forth the schedule of anticipated public hearings and contains questions that can be addressed at the public hearings. The list of questions is not exhaustive and participants in the hearings should feel free to provide in their oral remarks or prepared testimony any additional information they feel to be useful.
According to data from the 2006 Current Population Survey, close to 2.5 million New Yorkers are uninsured. Many of these uninsured New Yorkers work but cannot afford to purchase health insurance. Others, whether working or not, are eligible for public health insurance programs such as Medicaid, Child Health Plus and Family Health Plus, but are not enrolled in them.
Currently, New York State spends more per capita on health care than any other state in the nation, and our per enrollee spending for Medicaid is the highest or second-highest in the nation, more than double the amount expended by California. Medicaid is the largest item in the State budget. Despite this level of spending, recent studies by the federal Agency for Healthcare Research and Quality and the Commonwealth Fund rank New York State as average or worse on important quality indicators. The gap between New York's performance and those of the leading states represents diseases that could have been prevented or better managed, costs that could have been avoided and families that could have been insured.
New York has already begun to reform our health care delivery system and expand health insurance coverage in the State. Legislation passed this year contains key building blocks of Governor Spitzer's effort to increase access to coverage, improve the quality of health care and control health care costs, including: expansion of eligibility under Child Health Plus to 400 percent of the federal poverty level to make health coverage available to all 400,000 of New York's uninsured children; simplification of Medicaid enrollment to help ensure that those already eligible for health coverage receive and maintain coverage; expansion of the Family Health Plus program to allow employers to participate; reallocation of Medicaid spending to follow the patient and improve patient outcomes; and control of the growth rate of Medicaid spending from an annual average of 8 percent since 2001 to approximately 1 percent this year to promote the efficient delivery of healthcare services. These initiatives and accomplishments begin the essential restructuring of the State's health-care system to ensure that health care dollars are spent wisely for comprehensive coverage and high-quality, cost-effective care.
Additional information about health insurance trends, health system restructuring and Medicaid reform efforts in New York is available at partnership4coverage.ny.gov.
The hearings, which will be held between September and December 2007, will provide DOH and DOI with valuable information to assist in development of (i) a high-quality and cost-effective health care system, (ii) increased access to health insurance coverage and (iii) identifying what is required to create an effective and sustainable economic model for universal coverage. DOH and DOI are interested in proposals to increase the level of insurance coverage, improve the quality and efficiency of the health-care delivery system in New York, control the cost of health insurance and health care, distribute the cost of health insurance and care fairly and equitably, improve the State's economy and the competitiveness of its businesses, promote the economic viability of health care providers and determine ways to achieve universal coverage.
The Departments are seeking input from the general public, stakeholders in the health care system, academics and others with expertise in this area as well as legislative representatives. Testimony should address any or all of the following questions:
- What additional building blocks or incremental steps can be taken to increase access to health insurance in New York State?
- To what extent are the high costs of health care making health insurance unaffordable and universal coverage more difficult or impossible to achieve? What factors contribute to the especially high cost of health care in New York? How should these factors be addressed?
- What steps should be taken to improve quality and deliver cost-effective care? How do we eliminate unnecessary utilization of health services? How do we make providers more efficient? How do we move to a system of health-care financing where providers are rewarded for doing better rather than doing more? To what extent should payment be linked to outcomes?
- How can we make coverage more affordable and accessible to individuals and small businesses? How do we attract young and healthy individuals and small businesses to the insurance market? Should we expand the State's Healthy New York program?
- How should insurance risk be pooled? Should there be modifications to community rating/open enrollment? Should markets (i.e., individual, small group, large group) be combined? How do we make the pools big enough to maximize affordability? How do we stabilize the individual market (also known as the "direct pay" market)?
- What are the possible funding sources for increased access to coverage? How do we effectively and equitably maximize these sources? Given the budget gaps the State faces in coming years, what is the role of State fiscal policy in supporting access to coverage? How do competing state fiscal objectives balance with various proposals or options? How does the State assure itself that the proposals to increase access to coverage are cost effective and balance within the overall state budget?
- What role should the federal government play in assisting New York? Where might the State seek financial support from the federal government? Are there proposals that are national in scope that we should be aware of or support?
- What role does federal preemption under ERISA play?
- Is increased regulation of insurer premiums, profits and business practices appropriate and necessary? Should the State follow proposals in other states to increase the minimum amount that health plans must pay toward claims (i.e., the minimum medical loss ratio), or would this diminish the ability of health plans to support various health care programs through assessments on premiums?
- How do we make sure that everyone who is eligible for public health insurance programs is enrolled in them? Should we expand public health insurance programs like Family Health Plus? If yes, how should they be expanded? If subsidies at reduced levels are provided to families with higher incomes than are currently eligible, how do we assure that individuals opt into coverage? If no, what other mechanisms should we use to expand coverage? How do we ensure that public coverage does not "crowd out" private coverage?
- Given that the State's Medicaid Program is the most expensive in the nation, what steps can be taken to control costs and make service delivery more cost effective to fiscally accommodate all persons eligible for public programs once they are properly enrolled?
- How do we make coverage affordable for those at lower income levels? Should government subsidize private coverage for those who have too much income to qualify for the public programs but who cannot afford other coverage? If yes, how? Are direct premium subsidies best or would reinsurance mechanisms designed to reduce premiums be better? If no, what other mechanisms should we use to expand coverage to those at lower income levels?
- What level of benefits should be provided? Should benefit levels be standardized across public programs, private programs or both public and private programs? Should a comprehensive range of benefit options be available? What is the right balance between comprehensiveness and affordability?
- What level of consumer cost-sharing is appropriate? What role does personal responsibility have in containing future health care costs? Are high-deductible health plans a reasonable alternative for certain sectors of the population?
- What standards or measurements should be used to determine how much an individual should contribute toward coverage (e.g., a percentage of income or a household budget)? Should all costs, such as co-payments or co-insurance, be considered or only premiums?
- What should an individual's responsibility be for obtaining and maintaining insurance coverage? Do we need an individual mandate?
- What responsibility should employers have for providing coverage to their employees? How should we encourage businesses to offer coverage? Should a fee be imposed on employers that don't offer insurance? How? If yes, what impact might such a requirement have on New York State's economy and employment in the state?
- How do we retain employer participation, if public programs expand?
- What are the advantages and disadvantages of a single-payer model of universal coverage? Of a multiple-payer model? Do both models promote effective cost controls, administrative efficiencies, and high-quality care?
- How do we address the health-care needs of adult undocumented immigrants? If coverage options are extended to adult undocumented immigrants, will they opt in?
- Will provider subsidies for indigent care continue to be necessary?
- How should health insurance be regulated in New York? Should oversight by both the Health and Insurance Departments continue? Should there be a single regulatory authority? Are regulatory reforms needed to provide more effective oversight and consistency in regulatory requirements across all types of health insurers?
- Is there a role for an entity that acts as an insurance exchange or clearinghouse? Should that role be limited to simply acting as a facilitator that directs consumers to insurers, or should it have broader authority to negotiate rates? If so, what, if any, parameters should be placed on how such negotiations are conducted?
The Public Hearing Schedule
|September 5, 2007||10 a.m.||Glens Falls Civic Center
Glens Falls, NY
|October 3, 2007||10 a.m.||Erie County Community College
121 Ellicott Street
|October 10, 2007||3 p.m.||Call-in Hearing|
|October 30, 2007||9 a.m.||New Yorker Hotel
481 8th Avenue (corner of 34th and 8th)
New York, NY
|November 2, 2007||9 a.m.||New Yorker Hotel
481 8th Avenue (corner of 34th and 8th)
New York, NY
|November 13, 2007||10 a.m.||Onondaga Community College
|November 26, 2007||10 a.m.||Monroe Community College
Room Monroe B
R. Thomas Flynn Campus Center
|December 5, 2007||10 a.m.||SUNY College at Old Westbury
Old Westbury, NY
Requirements for Public Hearing Participation
All individuals planning to attend a hearing or call the phone hearing must pre-register with the New York State Department of Health or the New York State Department of Insurance. To pre-register, please contact:Ms. Cindy Esterby
Office of Health Insurance Programs
New York State Department of Health
Corning Tower Bldg., Room 1483
Empire State Plaza
Albany, New York 12237
(518) 474-5737 Ms. Deborah Greer
New York State Insurance Department
One Commerce Plaza
Albany, NY 12257
All speakers are required to provide six (6) written copies of their testimony to be presented at the hearing and an electronic copy that can be uploaded onto the Partnership for Coverage Web site. The paper copies of the testimony must be provided to Department staff on the date of the hearing being attended and the electronic copy must be emailed to email@example.com on the date of the hearing. Individuals who are unable to attend may submit written comments to the address noted above and electronic comments to the email address above.
For further information, please contact the individuals listed above.