Much has been made recently about Howard Zemsky, the chief executive of Empire State Development, and his recent defense of Start-Up New York’s advertising campaign, which he said was “…paying dividends to New Yorkers in more intangible ways, including reversing…the state’s decades-old reputation as a place unfriendly to businesses.” Millions of dollars in advertising notwithstanding, we are very concerned with communications from other members of the administration, whose recent activities send a very chilling message to employers in New York.
In a recent letter regarding Anthem’s proposed acquisition of Cigna, Superintendent of Financial Services (DFS), Maria T. Vullo, took some unprecedented steps that highlighted the department’s inconsistent philosophies regarding the cost of healthcare in New York. Moreover, the letter sends a very strong and negative message to employers desiring to expand operations in New York, which is especially disconcerting given the significant longstanding economic presence these businesses already have in the state. Such actions should concern any of us trying to do business in New York.
As a representative of New York’s employers, I find it especially troubling that DFS dedicated much of their professed concern discussing the future market share of the commercial self-insured market. These are companies that opt to insure their employees out-of-pocket, rather than purchase insurance. Such insurance arrangements are typically entered into by sophisticated businesses in a very competitive and price sensitive market, and this is a market already regulated by the federal government through ERISA. While tensions between the state and the federal government over ERISA plans are not new, this letter signals a new attempt by a state agency to regulate employers in matters that fall far out of its jurisdiction.
Also deeply concerning is the DFS’ confusing logic on controlling the costs of healthcare for consumers in the state. DFS simply assumes that a carrier’s increased market share will somehow have a negative impact on the value-based payment model being promoted by the state, leading to higher costs for consumers, despite the fact that there is no evidence to support such an assumption.
This logic is flawed in several ways. The letter says that competition in the health insurance industry is needed so that providers (doctors, hospitals, etc.) can negotiate with various insurers to maximize their income. Perversely, this will naturally lead to an increase in health care premiums, an issue to which the DFS should be particularly sensitive. The fact that increasing the income of healthcare providers is not part of the mission of the Department of Financial Services aside, this statement simply misses the point. While the verdict on the cost-savings of the value-based payment model is not yet in, such a model never envisioned a marketplace where healthcare providers are given endless leverage to negotiate universally higher fees.
Further, the letter fully ignores the reality of healthcare provider mergers and acquisitions in the state. Last year alone there were 940 healthcare service transactions in New York, up from about 480 in 2010. This increase is at an unprecedented pace in New York; one which is likely to only accelerate. Numerous recent studies show that such mergers create upward pressure on healthcare costs. If the Department of Financial Services is concerned with the cost implications of diminished competition, why isn’t this side of the equation being considered?
Employers in New York are saddled with some of the very highest costs of doing business in the nation. Everything from property taxes to workers’ compensation costs to the price of health coverage. In order to change New York’s poor business reputation, we need more than advertisements; we need policies that work to lower these costs for employers. We need consistency in policy across the state’s many regulatory agencies and we need regulators that stay within the jurisdictional limits set by law. It’s time that all of New York’s regulating agencies get on board to building a better economy for all of us.