A new report provides an analysis of enrollment and financial data on New York’s individual health insurance market—before and after the rollout of the Affordable Care Act—showing how New York’s implementation breathed new life into the individual market. It also highlights some key steps necessary to sustain that improvement and factors that could undercut these gains. In 2014, new enrollment, participation in health plans that primarily offer coverage through public insurance programs, more competitive pricing, a better risk pool, and a federal reinsurance program resulted in an average individual New York premium of $430.97.
In addition, health plans reported big drops in expenses per member for hospital/medical care and drugs. Yet larger enrollment (from 136,000 in 2013 to 441,000 in 2014) and an apparently healthier risk pool did not translate to positive net income for most health plans in 2014, according to the report. Eight licensees reported underwriting gains for individual coverage (totaling $70 million), while 18 licensees posted losses totaling $169 million.
Affordable Care Act Brings New Life—and Covered Lives—to New York’s Individual Market also examines the steps necessary to sustain New York’s improvements in the individual insurance market, focusing on three areas: the stability of the risk pool, expanding coverage to the remaining eligible but uninsured, and continued premium affordability. The report concludes that the affordability of coverage is the single biggest challenge facing the market, and it is inextricably linked to maintaining a healthier risk pool. The report is available at the link below. This work was supported by The New York Community Trust (New York, NY).