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Recommendations for the New York Health Benefit Exchange

Building a Forward-looking Insurance Exchange in

New York StateIn the coming period, policy makers, providers and the State government will be

directing their attention to the design and establishment of an Insurance Exchange. Westrongly support incorporating into the New York State Exchange features that will

encourage the highest quality, most readily affordable coverage and, as well, facilitate

movement toward a simplified, more efficient, more broadly inclusive health care system.

Following are some steps New York could take in creating such a forward-looking

exchange:

Administrative Streamlining: Create a single application process for all types of subsidized or public coverage

that can be easily understood by all state residents. Unify and simplify the administration of health care benefits. Create a unified,

simplified administrative process for all insurers within the exchange, including benefit

management, billing, and other functions based on standardized sets of systems and rules.

Expand this unification to the administration of claims, so as to achieve, ultimately, a

simplified system that will benefit both patients and providers. Integrate private insurance and public programs within the exchange. Work

towards improving transition among existing programs, including the federal tax subsidy

under the ACA, Medicare, Medicaid, Child Health Plus and Family Health Plus, as

peoples eligibility changes, to use the Exchange to create a true continuum of coveragefor exchange purchasers.

High Quality, Affordable Care: Set high standards by promoting affordable, high-quality coverage with

comprehensive and standardized benefits with the widest possible provider

networks. Our exchange should counter the likelihood that plans under the Affordable

Care Act (ACA) will have high deductibles and co-pays (that is, low actuarial values) by

seeking and approving only the highest quality, most affordable plans. Broaden risk-sharing. Create a single, statewide exchange, operated by the State

itself, so as to spread risk as widely as possible and incorporate as many plans and users

as possible. Then require, through new legislation, that all individual and small group

insurance be sold through the exchange. Combine both types of coverage into a single

pool. Offera true state-run public plan. Start with the Basic Health Plan provided under

the ACA for low-income residents, and then incorporate other public plans to compete

with inefficient, profit-oriented, private insurers. Include robust risk adjustment

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mechanisms to ensure that the exchange provides a level playing field for public and

private plans.

Meeting the Needs of All New Yorkers: Make the exchange as immigrant-friendly as possible. State law recognizes the

importance of immigrants, and immigrant health, to our state. Provide, through the

exchange, access and support for all immigrants that Federal law, so far, does notprovide. Facilitate consumer engagement through the exchange. Use the exchange to help

consumers deal with the complexity of the multi-payer health insurance market and help

consumers obtain the most comprehensive, affordable insurance possible. New York

should invest in a robust network of community-based Navigators and a strong

independent Consumer Assistance Program.These steps will position New York State to move forward toward the simplified,

efficient, high quality health care system that its residents deserve.

ENDORSING ORGANIZATIONS (List in Formation):

Bronx Health Link

Children's Defense Fund-NY

Citizen Action of New York

Committee of Interns and Residents SEIU

Community Service Society

Doctors Council SEIU

Doctors for America-NY

Empire Justice CenterGreater NYC for Change

Health Care for All New York

Healthcare-NOW! NYC

Hunger Action Network of New York State

Jobs with Justice, Long Island Chapter

Long Island Coalition for a National Health Program

Long Island Council of Churches

Make the Road New York

Metro New York Health Care for All Campaign

National MS Society

National Physicians Alliance-New YorkNew York Immigration Coalition

New York State Nurses Association

New Yorkers for Accessible Health Coverage

NY MS CAN

Physicians for a National Health Program-NY Metro

Public Health Association of New York City

Raising Women's Voices-NY

Rekindling Reform