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Legislators cite flaws in NY health exchange
Question of the Day
ALBANY, N.Y. (AP) - State legislators cited problems Monday with the rollout of the federal health overhaul in New York, with constituents complaining about lost insurance coverage, higher premiums and confusion and limitations of medical networks.
Nearly 300,000 New Yorkers have been enrolled in private insurance or Medicaid since October with the average cost 53 percent lower than comparable individual insurance coverage, Donna Frescatore, executive director of the state’s new health marketplace, New York State of Health, testified at a Senate oversight hearing.
“The launch of NY State of Health has been an overwhelming success,” Frescatore said. “But implementing our state’s insurance marketplace is not a one-time task. It’s a continuous process of operational improvements, ongoing training, refining the products … and working one-on-one with consumers when they encounter difficulties or have questions.”
The marketplace, also called an exchange, was established under the federal health care law in an effort to extend coverage to 2.7 million uninsured New Yorkers.
State data show the exchange enrolled only about 76,000 uninsured so far with commercial or nonprofit carriers, and that others signed up for Medicaid or had insurance before, said Senate Health Committee Chairman Kemp Hannon, a Nassau County Republican.
He and other Republican senators cited problems like limited or inaccurate information and slow processing, with enrollees who didn’t immediately get insurance cards, have limited choices for providers and could get stuck with bills for out-of-network services.
“The biggest complaint is: ‘I can’t have the doctor I want,’” Sen. William Larkin said.
An estimated 100,000 New Yorkers lost coverage, including sole business proprietors who had insurance through group plans at chambers of commerce or professional associations or through the state’s Healthy NY program. A provision in the federal law was blamed for that forced change.
A panel of physicians testified about inaccurate information by insurers about which of them are in which networks, as well as lower payment rates for their services through the exchange insurance plans.
“The lack of information is incredible, and it’s going to result in bad patient care,” Hannon said.
Sen. Martin Golden, a Brooklyn Republican, said there’s an in issue with patients whose surgeons and hospitals may be in their networks, but anesthesiologists and others in the operating room are not, with patients getting stuck with their entire big bills.
Frescatore said all the plans are required to meet thresholds for adequate networks of doctors and hospitals, while the state requires out-of-network coverage for patients who have to seek emergency care or specialists unavailable from their networks. There’s a 10-day grace period for coverage from the date a patient receives an invoice for the first premium, and all 16 insurers have issued those invoices for those who signed up last year for coverage starting in January, she said.
So far, the separate state insurance exchange for small businesses with fewer than 50 employees has helped enroll more than 5,000 employees and dependents for coverage, Frescatore said. Among those who signed up for individual insurance so far in the main exchange, 30 percent are under 35 years old, 39 percent are between 36 and 54, and 31 percent are older than that, she said.
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