The Big Picture

This NYHealth-funded United Hospital Fund report combines a detailed analysis of health plan enrollment and financial results with a comprehensive review of how New York’s health insurance markets actually work and are governed by key statutes and regulations.

More than 100 individuals were interviewed for The Big Picture, including current and former State regulators and agency officials, legislators, legislative and executive branch staff, lobbyists, agents, brokers, trade association officials, health plan executives, and consumers. The project team also reviewed health plan annual statements and multiple other data sources. Key findings include the following:

• Buyers in New York markets – individuals, businesses, and government – paid health plans more than $41.5 billion in premiums for coverage in 2006, the base year for the report. Four companies collected almost two-thirds of those premiums.
• Despite declining enrollment, commercial health plans experienced profitability from 2000 through 2006.
• With commercial enrollment declining, enrollment in State public programs grew, reflecting New York’s aggressive public program expansion.
• Premium increases for commercial coverage are driving an array of cost-sharing mechanisms, a trend with broad implications for consumers, providers, and regulators.