- Assemblyman Fred W. Thiele, Jr
. (I, D, WF-Sag Harbor) announced the Assembly
passed legislation he supported that establishes the
New York Health Benefit Exchange in compliance with the federal Patient Protection and Affordable Care Act, which was signed into law by President Barack Obama
last year (A.8514). The legislation has the support of the governor and the Senate.
The Assembly's legislation allows New York to establish and operate its own health insurance exchange - a centralized marketplace that will provide consumers and small businesses with access to a variety of health care plans from different insurance providers and determine eligibility for and provide enrollment in public health plans. The legislation directs the exchange to present comparative plan information on available plans and consumer assistance to consumers through an Internet website, a toll-free telephone hotline and in person.
"For New Yorkers who don't receive health insurance through their employers or are still struggling to find work in this tough economy, trying to get reasonably priced, quality health care can be a daunting task," Assemblyman Thiele said. "This legislation follows the federal health care reform law to enhance access to quality care, while potentially reducing the cost to businesses and taxpayers."
By establishing an exchange in New York, this legislation facilitates the purchase and sale of individual and small employer health insurance and provides individuals with access to public health coverage. The functions of the exchange also:
• Provide for enrollment periods that are in the best interests of qualified individuals and employers.
• Make available an electronic calculator to determine the actual cost of coverage for consumers after the application of any federal premium tax credit and cost-sharing reductions.
• Establish a navigator grant program in order to provide funds to organizations to conduct public education and awareness programs, distribute fair and impartial information and other consumer services.
• Ensure compliance with federal requirements regarding plan certification, oversight and benefit standards.
In order to provide individuals with the best health care possible, this legislation establishes multiple advisory committees to represent the regional interests of health care consumers, small businesses, health care providers and insurers. These committees will collect their findings and provide advice to the Board of Directors on how to meet the needs of consumers in each region, Thiele added.
"The input of our local health officials is crucial for the exchange, as they best understand the needs and interests of our communities," Assemblyman Thiele said. "With their presence on the committees, regional variations such as the availability of health insurance coverage and other issues will be addressed more efficiently."
Additionally, this legislation establishes the minimum requirements an insurer should meet to be considered for participation, and implements procedures with respect to the certification and oversight of qualified health plans.
Under this measure, the exchange will be required to conduct studies, with reports due to the governor and Legislature by April 1, 2012, on various aspects of operating the exchange including:
• The role of the exchange in decreasing health disparities, including disparities on the basis of race and ethnicity.
• The advantages and disadvantages of the exchange serving as an active purchaser, a selective contractor or a clearinghouse of insurance.
• Offering benefits within the exchange beyond essential benefits required by federal regulation.
• Offering benefits to Medicaid
-eligible populations beyond federal benchmark benefits.
• The anticipated annual operating expenses of the exchange and the options for generating funding for the ongoing operation and self-sufficiency of the exchange.
"Access to health care is a fundamental right for everyone, not just to those individuals who can afford it," Thiele said. "It is essential that during this economic downturn, we help our families get the quality care they need and deserve."