The Big Picture IV: New York’s Private and Public Insurance Markets and the Affordable Care Act

This NYHealth-funded United Hospital Fund report, “The Big Picture IV,” provides an analysis of key findings and trends in New York State’s private health insurance markets and public health insurance programs. It is part of a series by the United Hospital Fund offering a comprehensive review of New York’s commercial, Medicare, Medicaid, and self-funded insurance markets.

The report provides a detailed snapshot of enrollment and financial trends, notes implications of the Affordable Care Act (ACA) for New York’s health insurance market, and previews some important policy and regulatory questions for the future. Among the key findings for New York:

• Private health plans in the commercial market realized nearly a 50% gain in net income, to $1.3 billion from 2009 to 2010, despite declining enrollment.
• Certain plans contracted to provide coverage for low-income beneficiaries of public health programs, called PrePaid Health Services Plans (PHSPs), saw a jump in total premiums of more than 20% from 2009 to 2010.
• New York State’s Department of Financial Services approved health insurance premium rate increases averaging 7.6% for 2012.
• In 2010, 44% of private sector employees were covered by self-insured plans, where a limited number of Affordable Care Act provisions apply.
• While the exact number of New Yorkers covered by plans in the small group market is unknown, the report identifies 1.9 million individuals covered by small group commercial plans in 2010.
• Although only approximately 26,000 individuals are enrolled in New York State’s private commercial individual market, the report estimates that the Affordable Care Act will push those numbers to 850,000 individuals starting in 2014.
• In New York City Medicaid managed care is typically provided by PHSPs, but in upstate regions commercial plans dominate in offering Medicaid coverage. As a result, non-New York City residents may benefit from more seamless transitions from Medicaid into commercially run Exchange plans as their income and eligibility changes.