Both houses of the legislature advanced their separate budget plans this week. As part of its plan, the New York State Assembly included the governor’s proposal to create a health exchange. The health exchange is the mechanism through which New Yorkers lacking health insurance, as well as small businesses, could obtain coverage. According to the US Census, nearly 3 million New Yorkers lack health insurance.
A health exchange would be empowered by the state to negotiate with health insurers to offer affordable, high quality insurance to those who need it. The concept of a health exchange is not new. The state of Massachusetts created one in 2006 and now has over 98 percent of its residents covered by health insurance.
However, the New York State Senate did not include the health exchange in its budget. Without agreement between the houses, the exchange will not become law.
Why is the Senate Majority opposed? Hard to say. In June, the same Republican leadership negotiated an agreement to create a health exchange only to have the deal blow up due to opposition members of their conference influenced by the tea party. Despite the fact that there were enough votes to pass the exchange legislation, the leadership chose not to seek Democratic votes and instead let the deal die.
Now the leadership has argued against their own agreement and have, at least so far, refused to consider the exchange. They do not offer alternatives, thus guaranteeing the uninsured must continue to gamble that they won’t get real sick anytime soon.
Unfortunately, too many of the uninsured lose that gamble. About 10 percent of all cancer patients, for example, lack health insurance when they are told that they have cancer. For those people, the cost of medical care is far too high. As a result, they may face more debilitating treatments and their prognoses may be catastrophic. No one should have to choose between paying the medical bill or paying their housing and food bills.
So why would the Senate leadership refuse to help these people? There are two major complaints.
The biggest complaint – “It costs too much.” According to a letter released by Senate Majority Leader Skelos, “Federal health reforms could cost NY taxpayers more than $65 billion for the Medicaid portion alone!” That cost estimate is based on wildly exaggerated estimates.
Here is the background for that claim: The estimate comes from a report by the conservative think tank the Cato Institute. Cato’s estimate of $65 billion over 10 years presumes that there is no new federal aid to cover these new enrollees in the state’s Medicaid program.
But there will be. Under the federal law, New York will qualify for additional federal reimbursements because it has already offered coverage to those eligible for public coverage.
The Cato report also averages out the “cost per enrollee” based on current spending and assumes that that cost will be the same for all new Medicaid enrollees. However, studies show that those who are eligible but unenrolled in Medicaid tend to be healthier and, once covered, generate lower costs than those who have been covered previously.
In addition, Senator Skelos wrote, “Another complication to establishing a health exchange is a pending lawsuit before the United States Supreme Court challenging the constitutionality of the federal health care reform mandates.”
The Supreme Court is considering arguments challenging primarily the individual mandate, not the creation of a health exchange. To date, a majority of the appellate court decisions have ruled in favor of the Affordable Care Act and the individual mandate requirement. But even in the unlikely case that the Supreme Court rules against the mandate, it does not negate the creation of the exchanges and the federal subsidies that are provided to Americans who qualify.
For those hundreds of thousands, or even a million, of New Yorkers who will get health insurance, the arguments are irrelevant. They need coverage, not rhetoric. Action to create a health exchange is the first step of many that must be accomplished soon if the state can be ready to begin enrolling the uninsured and offer low-cost insurance for small businesses.
Hopefully that logic will prevail. If so, the governor and the legislature can begin to deal with the real problem afflicting too many New Yorkers – it’s too expensive to get sick.
Blair Horner is the Vice President for Advocacy for the American Cancer Society, Eastern Division. His commentary does not necessarily reflect the views of the American Cancer Society.
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