The State Senate concluded its session in late June without taking action on legislation to set the implementation of a NY Health Exchange in motion. They are not set to return to Albany until late September at the earliest. The absence of a governance structure and statutory authority has not stopped planners from proceeding with design elements which will have significant influence on the ultimate look and functionality of a health exchange. The Department of Health released a Health Benefit Funding Availability Solicitation on July 15, seeking to award a 4 year contract for the delivery of an operational system. The FAS also notes that it is the Department’s intent to award the successful bidder of this FAS the operational phase for the exchange.

The initial 30 day timeframe for interested parties to submit a bid to this 162 page document has been extended through September 6, 2011. The bid observes that “As an Early Innovator state, the target date for “Operational Readiness” of the NY-HX Solution is October 10, 2012, to facilitate re-use by other states.” NYS is not the only Early Innovator grantee to not pass authorizing exchange legislation; Kansas and Wisconsin legislative sessions ended without agreement on a bill and Oklahoma returned its EI grant to the federal government. Maryland has become a leader among states on exchange implementation – passing its legislation in April, appointing its 9 member board in May which held its first meeting in early June.

With an aggressive timeframe, and with state budget-provided authority to award without competitive bid, the Department of Health will proceed with designing and “building” a health exchange system that will likely anticipate policy decisions, rather than being informed by policy decisions related to the functionality needed for this customer interface.

Bill Hammond writes in his Daily News column - “Whenever state lawmakers mess around with the rules for health insurance, New Yorkers should hang on to their wallets.

The latest scheme out of the Legislature - meant to squash the growing use of mail-order pharmacies - is no exception. This proposed law does nothing to improve the quality or quantity of the drugs that people will get.”

To read more click here.

Rick Karlin writes in today’s Times Union - “Lawmakers at the end of the session displayed a rare degree of bipartisanship, especially in the narrowly divided Senate, where in the span of several hours Democrats and Republican came to together to pass a tax cap and a nationally heralded same-sex marriage law.

But cross-party cooperation has its limits, with Exhibit A being the abrupt dropping on Friday of legislation to create a Health Benefit Exchange, as called for in President Barack Obama’s health care overhaul.”

To read more click here.

Early this morning, negotiations concluded on the framework for the establishment of New York’s Health Exchange.  An analysis of the agreed-upon bill, which is expected to pass both houses of the Legislature today, can be found here.

Significantly, this agreed-upon bill preserves the role of the Legislature in making public policy by requiring the Exchange Board to seek statutory authority on issues such as selective contracting, standardizing benefits available through the exchange, etc. The Exchange in the agreed upon bill will be governed by a Board of 9 members, and will establish 5 regional advisory committees each with 5 members whose role will be to annually review and report on regional variations in the operation of the exchange.

The Board, once appointed, will have a very aggressive timetable to complete and report back to the Legislature and Governor by April 1, 2012 on twenty-two different policy areas.  These studies need not be stand-alone, and their completion may be delayed if federal rulemaking has not been released.

The Business Council believes this negotiated bill takes the proper approach in establishing the governance structure, identifying areas of policy upon which further study and data is required, and will allow for broad stakeholder input and participation.

Please feel free to Maggie if you have any questions.

The Business Council of New York State opposes this legislation which would permit health care providers, including physicians, to form unions for the purpose of collectively bargaining with health plans.

At a time when changes resulting from implementation of the federal Affordable Care Act will substantially alter the landscape of health care delivery, this is not the time to introduce state-specific authorization to permit health care providers to organize for the purpose of collectively bargaining with health plans. When the two largest payers in the country are Medicaid and Medicare, and neither reimburse health care providers at a sufficient level relative to providers’ true costs, a network of doctors collectively bargaining would likely seek to offset losses of Medicare and Medicaid revenue by charging more to privately insured patients – merely shifting costs rather than innovating and evaluating their own business practice models to wring efficiencies out of the system.

To read the bill memo in opposition click here.

Cara Matthews writes on Lohud.com - “Gov. Andrew Cuomo submitted legislation Monday that would set up a health-care exchange to comply with the federal Affordable Care Act.

Like 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 and small businesses, and the Senate bill would not.

Small businesses and individuals that don’t have health insurance will purchase 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.”

Judith Messina writes in Crain’s New York Business (subscription-based) - “In the three years that Elizabeth Crowell has offered health insurance to employees at her Brooklyn antiques shops, she’s weathered two rate hikes, of 20% and 25%, on her Empire Blue Cross plan. She is bracing for renewal in November, when she will learn whether she’s in for another steep increase in 2012.

“It’s the only cost in my business that’s unmanageable,” said Ms. Crowell. Last year, she spent $25,500 on coverage for her four-person family and the two full-time employees at her two shops, both called Sterling Place…

New York is determining how to structure its exchange. Key matters and questions include naming or creating a governing body to supervise the exchange, and whether that body will vet offerings; if there will be a single exchange for the whole state or several regional ones; and if the small business and individual markets should be merged.
Many New Yorkers support the idea of an exchange but differ on some major points.

A large number of consumer groups, for example, want the exchange to be an active purchaser, negotiating and determining who can sell what. Small businesses, on the other hand, want flexibility and the widest possible choice, and largely oppose the active-purchaser role.

“We think it will limit choice and competition,” says Margaret Moree, director of federal affairs for the Business Council of New York State.

The only decision New York must make now concerns the governing body. It lags other states, 20 of which have enacted legislation or have it in the works. The choice must be made and approved by the Legislature by June 20, the end of its session, in order for New York to be eligible for millions in federal grants to help establish the marketplace.”

To read more click here.

“Senate Health Committee Chairman Kemp Hannon, R-Nassau County, and Senate Insurance Committee Chairman James Seward, R-Milford, Otsego County, announced this morning that they have introduced legislation that would set up New York’s health-insurance exchange, a requirement under the federal Affordable Care Act.” writes Cara Matthews on LoHud.com.

“The legislation is a first step in advancing a health insurance exchange that will ensure affordable and accessible coverage that meets the unique insurance needs of all New Yorkers,” Seward said in a statement. “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.”

Each state has to set up an exchange, or marketplace, for small employers and individuals to buy health insurance by Jan. 1, 2014. New York will be eligible for tens of millions of dollars in federal grants if it adopts a bill before the end of the legislative session June 20. Drafts of the Senate legislation and Gov. Andrew Cuomo’s bill have been circulating. The governor’s administration has not officially submitted its proposal.

The Legislature and governor should have the authority to make all “significant” policy decisions, not the exchange, Heather Briccetti, acting president and CEO of council, said in a statement. “It would be a mistake to act too quickly and lock the state into an exchange structure and process that will not work for small businesses moving forward. That is why The Business Council urges the Governor and legislature to do no harm in adopting exchange legislation,” she said.”

To read more click here.

Cara Matthews writes on pressconnects.com - “With days left in the legislative session, lawmakers have yet to take any action on setting up a health insurance exchange, a requirement under the federal Affordable Care Act.

Each state has to set up an exchange, or marketplace, where small employers and individuals whose employers don’t provide coverage, or who can’t afford the employer plans, can purchase insurance. About 2.7 million New Yorkers are uninsured.

Although the exchange doesn’t have to be in place until Jan. 1, 2014, there is a lot of planning involved in setting it up, and health care advocates are urging New York to move forward quickly.

There are six scheduled days left in the legislative session, which ends June 20.”

To read more click here.

“Medical malpractice premiums for physicians in different regions of the state can vary as much as five times the amount paid between regions and the difference can exceed $100,000 for some specialties, according to an analysis issued today by Excellus BlueCross BlueShield.” write Leva Doyle in the Ithaca Journal.

“”Medical malpractice rates for upstate New York physicians are considerably less than those in downstate regions and are similar to the amounts paid by physicians in states that report the lowest premium rates in the country,” said Arthur Vercillo, M.D., regional president, Excellus BlueCross BlueShield.”

To read more click here.