Achieving Quality, Affordable Health Insurance for All New Yorkers: An Analysis of Reform Options

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Posted to Web: July 24, 2009
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Under contract to the State of New York, researchers conducted in-depth micro-simulation analyses of four types of health care reforms being considered for state implementation: a single payer public health insurance option, Assembly Member Gottfried’s New York Health Plus proposal that provides an option for all New Yorkers to enroll in Family Health plus, public-private hybrid options that simplify and expand existing public programs and reform private health insurance, and a market-based option that relies on regulatory flexibility and tax credits. The cost and coverage implications of state reform options falling into these four categories are presented in this report.


New York’s recent governors have made state health care reform a high priority. State-of-the-State addresses by both Governor Spitzer and Governor Paterson have emphasized the need for quality, affordable health coverage for all residents, recognizing that fundamental reforms would be required to expand coverage to the millions of uninsured New Yorkers. These administrations assembled internal working groups, held a series of town hall meetings on the topic, and issued a request for proposals (RFP) for analysis of health care reform options, contracting with and working closely with TUrban Institute’s Health Policy Center to perform that analysis. The RFP specified the approaches to be analyzed and included multiple criteria for analysis which are fully detailed in Section 6. Analysis of each proposal was required to include: its cost to government, employers and consumers; the extent to which it reduces barriers to coverage and advances the goal of universal coverage; the impact on the business community; the impact on the provider community; and the impact on scope of benefits, quality of care and consumer choice. This report reflects the work product produced under those auspices.

Support for health care reform at the state level has also come from members of the Legislature. For example, Assembly Member Richard Gottfried has introduced his own reform proposal, as has a group of legislators.

New York has a number of advantages relative to other states in pursuing state-based reforms. The rate of uninsurance among the non-elderly population (less than 65 years of age) is modestly below the national average – 15.4 percent in New York compared to 17.5 percent in the nation as a whole. While the overall uninsurance rate in New York is only about 2 percentage points below the national rate, its strong commitment to public coverage has made the state’s uninsurance rate among the low-income population more than 6 percentage points lower than the national average. Nineteen and a half percent of the state’s non-elderly are covered by Medicaid or the Children’s Health Insurance Program (CHIP).

Yet, as is true across the country, rising health care costs in New York have put increasing financial pressure on the privately insured and state budgets. Per capita personal health care spending in New York, across all payers, was $6,535 in 2004, the most recent year available. This spending level places New York among the five highest health care spending states in the country.

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