Today is the deadline for individuals to sign up for health care coverage through the Affordable Care Act in order to get coverage by Jan. 1. So far, New York state’s experience with this groundbreaking change in the way Americans get health care coverage has been generally positive.
Todd Muscatello is a Vice President for Sales at Blue Cross Blue Shield in Syracuse. As someone who deals in the vagaries of health insurance every day, he says he's glad he lives in New York state.
"New York state is ahead of most of the rest of the country in terms of getting this exchange up and running," Muscatello said.
He’s impressed, especially considering the amount of time the state had to create the exchange website or marketplace for health insurance policies, called New York State of Health.
"Our folks work with that website every day," Muscatello said. "And it’s got its ups and downs. But for the most part it’s working. My peers across the country who have to work with the federal exchange experience more challenges, so New York state’s done all right.”
The other good thing about living in New York state, when it comes to the Affordable Care Act, is that premium rates aren’t soaring as in other states and may go down for many people. Part of that comes from the rules and regulations we sometimes complain about coming from Albany.
“New York state is much more of a regulated and a rich benefit state," Muscatello said. "Community ratings have been around for a long time. The all inclusive approach. "Because of that the policies were closer to, if not already at, what was mandated through health care reform versus other states where the premium increases that you read in the paper were much more sticker shock.”
State officials say there has been an uptick in people completing applications and enrolling in plans as today’s deadline approached, including a 34 percent jump in applications from the first week in December compared to the second week in December. Lisa Sbrana, counsel for New York State of Health, says there is an average daily enrollment of 4,500 individuals.
“We’re seeing a good mix of enrollees across age groups, and continue to look forward to releasing more data as it comes," Sbrana said. "It’s so fluid at this point, that we see that we’ll probably be releasing that in the next month or so."
She says New Yorkers have been looking for help in making decisions, with more than 300,000 calls to the state’s call center since it opened in October. The 6,000 trained assisters who offer face to face advice have been busy, like Brian Vanbenschoten, a community navigator for ACR Health in Syracuse. He says many people have never really read the fine print of their insurance policy and often get confused by some of the insurance terminology, which can be different from one insurance company to another.
"We’re not here to make that selection for them obviously," Vanbenschoten said. "That final decision comes down to them. But getting that clarity and getting all that information and having it explained that makes sense to everybody is hugely valuable."
While officials say the state exchanges are working well now, there are some concerns for the future. For one thing, the prices that the insurance companies are charging now are nothing more than an educated guess, based on a projection of who will sign up. Muscatello says because the rates for 2015 are based on a rating process that happens in early 2014, the insurance companies still won’t have good information on who is using their product. So those rates won’t stabilize for another couple of years.
"It’s kind of an anxious time because you have a product out there that you hope is priced right, but you really don’t know and probably won’t know for a couple of years,” Muscatello said.
And for physicians, there are questions; particularly about the pressure on primary care physicians. Onondaga County Medical Society president Dr. David Halleran expects there to be access issues. He also worries that the number of primary care doctors won’t be rising anytime soon.
"Nowadays I think people have a hard time being a primary care doctor because of all the regulation, the low reimbursement and just the high debt of getting out of medical school," Halleran said.
While today is the deadline to sign up for insurance and have it available Jan. 1, people will have until March 31 to sign up and avoid the fine for not having insurance. The Affordable Care Act requires nearly all Americans to have health insurance next year or pay $95 or one percent of their income, whichever is greater.