Why is this Topic Important to Wealth Managers? This blogticle presents discussion related to the Affordable Care Act with regards to the establishment of state health insurance exchanges. The information is provided to wealth managers to keep them informed on the health insurance law changes which will begin to appear so that they may better prepare clients.
New York Governor Andrew M. Cuomo announced earlier this week that he has submitted a Governor’s program bill that would establish a new Health Benefit Exchange in order to comply with the Affordable Care Act passed by Congress and signed into law by President Barack Obama in 2010.
The Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act are collectively referred to as the Affordable Care Act, and include a number of policies intended to help physicians, hospitals, and other caregivers improve the safety and quality of patient care and make health care more affordable. The idea is by focusing on the needs of patients and linking payments to outcomes, delivery system reforms should help improve the health of individuals and communities and slow national health care cost growth. 
New York has made the decision to operate its own exchange, rather than have the federal government operate one for the state, given the complexity and diversity of the insurance market in New York.
“This legislation would fulfill New York’s commitment to the federal government to set up a health benefit exchange that will enhance access to affordable quality health care for all New Yorkers,” Governor Cuomo said. “This is a dynamic and flexible proposal that will protect consumers and help bring down the cost of health care for families, businesses, and taxpayers.”
The purpose of the proposed legislation is to establish a single Exchange in New York – a centralized, customer-service oriented marketplace where individuals and small groups will be able to purchase qualified health plans, receive eligibility and subsidy determinations, and be enrolled in a range of coverage options, including public health coverage programs.
The Exchange will make available health plans, including certain qualified dental plans, to individuals and employers beginning on or before January 1, 2014. Under this proposed legislation, the Exchange will establish the minimum requirements an insurer shall meet to be considered for participation in the Exchange and will implement procedures for the certification, recertification, and decertification of health plans as qualified health plans. The Exchange will also assign ratings to qualified health plans offered through the Exchange on the basis of relative quality and price, in accordance with the Affordable Care Act.
In addition, the Exchange will include a Small Business Health Options Program (SHOP), which will assist small employers in facilitating the enrollment of their employees in qualified health plans offered in the group market.
While the Federal law requires each Exchange to be “self-sustaining” by January 1, 2015, federal funds will support the planning, implementation, and operation of the Exchange through December 2014. New York has already been selected to receive funding under an Early Innovator Grant ($27 million) and an Exchange Planning Grant ($1 million).
The bill also provides critical protections meant to assist individuals in using the Exchange. For example, the bill provides that the Exchange will operate a toll-free telephone line to assist consumers and an Internet website containing standardized comparative information on qualified health plans. The website will also feature a calculator allowing individuals to determine the actual cost of coverage. The bill also requires the Exchange to establish a program to award grants to entities to serve as “navigators” to help educate consumers and facilitate enrollment.
With the enactment of this legislation, assuming other applicable criteria are met, New York will qualify to apply for additional federal funding to support Exchange planning and establishment through December 31, 2014.
Next week’s blogticles will discuss important planning aspects of 2011.
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 See Public Law 111-148; Pub. L. 111-152.