Democrat and Chronicle
Albany
Cara Matthews
ALBANY — Gov. Andrew Cuomo submitted legislation Monday that would set up a health care exchange to comply with the federal Affordable Care Act.
Like the Senate Republicans’ bill, which came out last week, the governor’s bill would set up a public authority to administer the exchange, or marketplace. But Cuomo’s legislation would authorize the exchange to negotiate benefits on behalf of consumers andsmall businesses, and the Senate bill would not.
Small businesses and individuals that don’t have health insurance will buy benefits through the exchange, which has to be operating on or before Jan. 1, 2014. They will be able to look for plans online or call a toll-free number. The federal government will determine by Jan. 1, 2013, if a state is qualified to run an exchange.
Cuomo said his bill would set up a “centralized, customer-service oriented marketplace” where people and small groups will be able to choose from an array of qualified health plans and obtain decisions on eligibility and subsidies. There are roughly 2.7 million uninsured New Yorkers.
The exchange would establish the minimum requirements insurers would have to meet and set up procedures for certification, recertification and decertification of health plans, and it would assign ratings to each plan based on quality and price.
“We think the governor’s bill is a great bill that would really protect consumers,” said Jessica Wisneski, legislative director for Citizen Action New York.
If the exchange didn’t have the authority to negotiate, people would not get “good quality, affordable plans,” and the number of health plans available could overwhelm then, she said.
The New York Health Plan Association, which comprises 25 health plans, doesn’t think the exchange should have negotiating authority, said Leslie Moran, senior vice president.
“It essentially creates another regulatory level and we have concerns about that,” she said.
If the Web portal and navigator are set up correctly, people could set specific search parameters and get a list of plans that meet their criteria, Moran said. That way, they wouldn’t “feel overly bombarded with choices that don’t apply to their needs,” she said.
The governor’s bill would require that the board study how to support itself when federal funding is exhausted and allow the exchange to charge user fees. There is no authority in the Senate bill to tax or impose assessments.
“This is a dynamic, flexible proposal that will protect consumers and help bring down the cost of health care for families, businesses, and taxpayers,” Cuomo said in a statement.
Health care advocates and groups have urged state officials to move forward with legislation as soon as possible so New York can get the maximum federal planning grant available. Federal funds will support the planning, implementation and operation of the exchange through December 2014. New York has already received a total of $28 million.
“We are looking at a really short timeframe here,” Moran said.
Under Cuomo’s proposal, a board of directors would oversee the authority. The state insurance superintendent, health commissioner and Medicaid director would be ex officio members of the board. The board would have an 18-member advisory committee whose mission would include taking into account regional variations in the availability of health insurance coverage.
The Senate bill would set up an 11-member governing board of directors and regional advisory committees. It would prohibit any general fund money from being used to finance the exchange. The public authority would have to study a number of policy issues and submit a report to the Legislature by 2011 Dec. 31.
“The bill establishes a solid foundation, adhering to all of the necessary requirements to receive federal funding, as we continue to craft the final details of a state exchange,” Senate Insurance Committee Chairman James Seward, R-Milford, Otsego County, said in releasing the bill.
Health care advocates said they were disappointed that neither bill includes the strong protections against conflicts of interest that they have been seeking.
The U.S. Department of Health and Human Services will set up exchanges for states that don’t do so on their own.
