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Expanding the Family Health Plus Employer Buy-In: A Potential Solution for Making Health Insurance Affordable for Small Businesses in New York State

  • By: NYSHealth
  • Date: August 2014
  • Priority Area: Expanding Health Care Coverage
  • Type: Grant Outcome Reports
  • Category: Grant Outcome Report
  • Document: Download
  • Grantee Name: Community Service Society of New York

Overview

Increases in employer-based health insurance premiums have led to declines in health insurance uptake and coverage among low-wage workers. New York sought to address this problem by offering a hybrid public-private health insurance program. In 2007, the New York State Legislature enacted legislation that allowed employers and union benefit funds to purchase Family Health Plus (FHP) coverage for their employees. Pilot implementation of the new Family Health Plus Employer Buy-In program (FHP EBI) began in 2008. In 2009, the New York State Department of Health (NYSDOH) announced its intention to expand the program statewide to all employers regardless of size, type, or revenue level, but premium rates proved to be too high for employers, thereby hindering expansion. In 2009, the New York State Health Foundation (NYSHealth) awarded a $210,000 grant to the Community Service Society of New York (CSS) to analyze critical design and implementation issues for FHP EBI and provide actionable recommendations to resolve program challenges and barriers.

Grant Goals

Under this grant, CSS set out to achieve the following:

  • Conduct a national review of public-private hybrid and premium assistance programs to develop recommendations on FHP EBI program design;
  • Identify improvements in the program’s implementation through analysis of eligibility and implementation issues, and conducting interviews with policy stakeholders; and
  • Publish a paper on its recommendations to resolve challenges in FHP EBI program implementation.

Grant Outcomes

CSS achieved the following outcomes:

  • Conducted a national review of public-private hybrid and premium assistance programs implemented in other states and in New York;
  • Partnered with Gorman Actuarial to conduct an independent actuarial analysis of premium setting, based on various insurance taxes, fees, assessments, mandated benefits, and employer groups;
  • Completed an analysis of eligibility and implementation issues, such as application and determination processes, employee coverage transitions, and consumer assistance;
  • Conducted interviews with State officials and other policy stakeholders to gather early lessons from the initial experience; and
  • Published its findings and recommendations in a report, “Expanding Affordable Coverage for Low-Waged Workers: Fixing the Family Health Plus Employer Buy-In.”

In August 2010, NYSDOH released its revised premium rate analysis, which was higher than anticipated by most stakeholders. To address this issue, NYSHealth awarded CSS an additional grant to work with Gorman Actuarial to better understand the analysis and provide feedback to the State. The recommendations offered by CSS and Gorman Actuarial lowered the premium rate by nearly $100 for an individual per month in New York City.

Grantee Information

Download Grant Outcomes Report