New York

Hat tip to Dan Goldberg for the heads up. (also thanks to Amy Shefrin)

Yesterday I crunched some numbers and estimated that, assuming a full ACA repeal w/immediate effect and no replacement, roughly 800,000 New Yorkers would almost certainly lose their healthcare coverage, including:

  • ~129,000 highly-subsidized QHP enrollees,
  • ~380,000 Basic Health Plan enrollees, and
  • ~286,000 Medicaid expansion enrollees

However, according to a major press release from NY Governor Andrew Cuomo's office this morning, I massively underestimated the Medicaid total:

Over 2.7 Million New Yorkers Would Lose Coverage
Estimated State Budget Impact of $3.7 Billion
Counties Across New York Would Lose Over $595 Million in Direct Spending
New York Residents Would Lose $250 Million in Health Care Savings Tax Credits


New York is a little different: For one thing, they haven’t actually released any 2017 Open Enrollment data yet (other than a cryptic “55K enrolled over a 3-day period", which isn't very useful). They should be up to around 200K w/out auto-renewals by now. More significantly, they're one of only 2 states (Minnesota's the other) which features the ACA's Basic Health Plan. Unlike QHPs, which are divided into subsidized and unsubsidized enrollees, the BHP program is entirely dependent on ACA financing, so if the law is repealed, all BHP enrollees are kicked to the curb, just like Medicaid expansion enrollees would be.

Oof. I've been compiling a lot of charts and graphs the past week or so based on what I thought were the most comprehensive 2017 enrollment numbers available to date. The biggest data gaps are Vermont and New York, neither of which has released any enrollment data yet...or so I thought.

However, I somehow completely forgot this post from the thick of the original December 15th deadline:

In the past three days, more than 55,000 New Yorkers have enrolled or renewed coverage through NY State of Health. The Customer Service Center has answered more than 1,000,000 calls since the start of Open Enrollment on November 1 and an average of 46,000 calls a day this week. The NY State of Health website has also experienced high traffic reaching 12,000 users in peak hours.

...This is also the first time this enrollment period that NYSoH has released any actual enrollment data: 55,000 renewals + new signups. Unfortunately, that number only includes 12/12 - 12/ earlier numbers are included. Still, I'll take what I can get...

And New York makes it three:

NY State of Health Deadline Extended! New Yorkers Now Have Until December 17 to Enroll in or Renew Health Insurance Coverage Beginning January 1, 2017

High Enrollment Activity Prompts Deadline Extension

ALBANY, N.Y. (December 15, 2016) - NY State of Health, the state’s official health plan Marketplace today announced that the deadline to enroll or renew coverage for a health plan effective January 1 has been extended through December 17. The previous deadline was December 15. Consumers have two additional days to enroll in a plan with coverage starting January 1.

“NY State of Health is having the busiest open enrollment period yet and we want consumers to have a little more time to select a health plan for January 1, 2017.” said NY State of Health Executive Director, Donna Frescatore.

Thanks to Dan Goldberg for the heads up:

NY State of Health: The Official Health Plan Marketplace 2016 Open Enrollment Report August 2016

It's a whopping 64 pages long. Some of it is stuff like "how many people speaking Cambodian called the support lines?" (answer: 6) and the like, but there's also a whole bunch of handy data regarding actual healthcare policy/program enrollment in the Empire State. I don't mean to be ungrateful, as this is extremely comprehensive...but it would've been far more useful if the report had included data from the end of March (or even later), as opposed to cutting off at the end of the 2016 Open Enrollment period (January 31st). Due to attrition due to people who never pay their first premium, are denied policies for legal reasons (residency status, etc) and so on, only around 82% of the 272,000 people who selected QHPs in NY during OE3 were still actually enrolled as of two months later. A good 10-12% or so never paid in the first place and another 6-8% were kicked off involuntarily for one reason or another...none of which is reflected in this report.

Still, that aside, let's take a look!

Just as I'm wrapping up calculating the weighted average rate hikes requested in all 50 states, New York just became the second state (after Oregon) to release their approved rates:

Shout-out to Zachery Tracer for the heads up for this press release from the New York Dept. of Financial Services:


Thanks to Zachery Tracer (as well as Dan Goldberg & Cynthia Cox) for the heads up...

Well, now...this is about as cut & dry as it gets! They don't display the actual enrollment numbers for each carrier, but that's OK because the only real reason I need it in the first place is to weight the increases by market share...which the New York Dept. of Financial Services has helpfully already done!

And there you have it: A weighted average requested rate increase of 17.3% across the entire state's ACA-compliant individual market. Remember that NY never allowed transitional plans anyway, and there are likely only a handful of grandfathered plans left on the individual market, so this should cover well over 90% of the market.

They also included the Small Group market, which I take note of when available but don't really track nearly as closely as the indy market:

I get a lot of ACA and healthcare-related email, as you might imagine. Sometimes it's a hot tip about some breaking news story or wonky report being released. Sometimes it's a clarification or correction of something I just posted from an industry insider wanting to clear the record. Sometimes it's a borderline illiterate Ted Cruz supporter complaining about how Cruz is shaking supporters down for cash or trash-talking his opponents. Sometimes it's an anti-ACA advocate arguing a point with me. Sometimes it's a scam artist trying to hustle me.

And then there's this:

Submitted on Monday, April 11, 2016 - 11:36am

Name: "Bob"*


New York offers new Special enrollment period (SEP) victims of domestic violence.

Can you believe that ? This is just going to increase cost for everyone on the state exchange !

*Not his real name.

OK, a couple of things:

Thanks to Richard Mayhew for the head's up:

ALBANY, N.Y. (AP) — The state's health exchange expects to enroll more than 470,000 New Yorkers in its new low-cost option for coverage this year.

Testifying at an Assembly hearing this week, exchange Executive Director Donna Frescatore said New York chose to participate with the Essential Plan. The plan is an option under the federal Affordable Care Act starting in 2016.

It's aimed at adults who don't qualify for Medicaid but have been unable to afford private coverage.

The Essential Plan has no annual deductible before insurance begins paying medical bills.

Premiums are free for those with incomes at or below 150 percent of the federal poverty level.

At long last, the New York State of Health exchange has released their final 2016 Open Enrollment Period data! (thanks to Dan Goldberg for the heads up)

Actually, two of the data points (private QHPs and BHP enrollment) aren't very different from what I already knew. However, there's some interesting news on the Medicaid & Child Health Plus side:

Rate of Uninsured Drops to Lowest Level in Decades

ALBANY, N.Y. (February 23, 2016) - NY State of Health, the state’s official health plan Marketplace, today announced more than 2.8 million people have signed up for health insurance as of  January 31, 2016, the end of the 2016 open enrollment period.  Since the Marketplace opened in 2013, the number of uninsured New Yorkers has declined by nearly 850,000. According to recently released data by the Centers for Disease Control and Prevention, the rate of uninsured declined from 10 percent to 5 percent between 2013 and September 2015 and is at its lowest level in decades.

On the one hand, I'm kicking myself for not noticing this red flag when the final 2016 Open Enrollment numbers were released last week. On the other hand, I was trying to absorb, analyze and compile a lot of data at the time, so I should cut myself a bit of slack for missing it.

When the numbers were announced, one figure which seemed surprisingly high was that New York (which still hasn't actually released their final numbers yet) apparently enrolled around 400,000 people in their new ACA-created Basic Health Plan (BHP)...and that 300,000 of these folks had supposedly shifted to the BHP program from existing exchange QHP policies.

This did seem surprisingly high to me; I had assumed that instead of NY's QHP total going up around 25% (as I was expecting in most other states), it would stay essentially flat, with the cannibalization by BHPs essentially cancelling out the 100,000 new QHP enrollees I was expecting. 300K making the move was 3x as many as I was expecting. However, in the flurry of other data to crunch, I let this slip by me.

THIS JUST IN...the first official NY State of Health enrollment update (thanks to Dan Goldberg for the tip):

More than 2.7 million New Yorkers currently enrolled in coverage through NY State of Health • New Yorkers must enroll by January 31 for 2016 Coverage

ALBANY, N.Y. (January 25, 2016) – NY State of Health, the State’s official health plan Marketplace, is encouraging uninsured New Yorkers to learn about affordable health coverage options and enroll in a plan by January 31, 2016. To date, more than 2.7 million people are enrolled in health insurance through NY State of Health, including 1.9 million enrolled in Medicaid, and 827,000 enrolled in non-Medicaid coverage. This includes 210,000 children enrolled in Child Health Plus; 260,000 individuals enrolled in a Qualified Health Plan and 356,000 people in the new Essential Plan, a new and more affordable option for lower income New Yorkers.

One of the more obscure provisions of the ACA is the ability/funding for states to set up something called a "Basic Health Plan" for residents who are low income, but not that low income; it's sort of a "Medicaid Plus" program, in a way; here's the Kaiser Family Foundation's explanation:

The Patient Protection and Affordable Care Act (ACA) gives states the option to implement a Basic Health Program (BHP) that covers low-income residents through state-contracting plans outside the health insurance marketplace, rather than qualified health plans (QHPs). In March 2014, the Centers for Medicare & Medicaid Services (CMS) issued final regulations on the requirements for a BHP and the methodology for calculating federal payments to states. States can choose to implement BHP beginning in 2015.

If you look at the State-By-State OE3 enrollment breakdown, you'll notice that there are still 4 blank fields all the way down at the bottom, plus a special note regarding California: