The administration of Governor Andrew Cuomo on Tuesday launched New York State of Health, a marketplace where the uninsured will be able to buy coverage from private insurance companies. Consumers can shop online, through phone operators or with live people who will be fanning out to various gathering spots around the state.
The new insurance coverage will kick in on January 1, 2014, but enrollment will start in October.
New York has about 2.7 million uninsured residents. State officials estimate 1.1 million of them will get insurance through the new marketplace. Hundreds of thousands of additional uninsured people are expected to enroll in the newly expanded Medicaid system.
Under Obamacare, states can either create their own exchanges or let the federal government do so for them. New Jersey Governor Chris Christie opted for the latter. Officials in the U.S. Department of Health and Human Services have said these "federally facilitated" exchanges will meet the October 1 deadline.
WNYC has been following the evolution of these exchanges and has answers to common questions about how development is proceeding and what the finished product will look like.
1. Last week, Oregon announced its website will not be ready for the October 1 deadline, and other states also have reduced the scope of what they will be able to offer in these online marketplaces. Will New York’s and New Jersey's exchanges be ready in six weeks – fully ready, with nothing scaled back or postponed?
Donna Frescatore, executive director of New York State of Health, offered an unequivocal "Yes"—and, jokingly, declined to add “knock wood.”
“Our customer service center will answer general questions, starting in mid-September,” she said. “People will be able to apply online on October 1.”
Even sooner, she said, the website will have a calculator that will allow people to plug in their income and get an estimate of the tax credit they will receive, if they’re eligible, and at the same time look at the different plans and rates. But that will be only a prolog to the fully interactive website.
Regarding New Jersey, the federal government has also said everything will be ready for October 1. A report by the federal Government Accountability Office in June found the federally run exchanges were running behind, but the U.S. Department of Health and Human Services says it has largely caught up.
2. What will these “marketplaces” actually look like?
Whether run by the federal government or individual states, the exchanges are supposed to be one-stop shopping for all uninsured American citizens. You’ll plug in your income, and first it will tell you whether you qualify for Medicaid—which is for very poor people—or for private insurance on the exchange. If you make too much for Medicaid, the website will tell you whether or not you qualify for a federal subsidy. To get that, you have to make less than about $46,000 or $94,000 for a family of four. The less income you have, the more generous the subsidy. The website will also help you compare Platinum, Gold, Silver and Bronze plans offered by different insurance companies. The less you pay in premiums, the more you will pay in out-of-pocket expenses on deductibles, medications and more.
3. And in addition to the website, there will be specially trained people to assist consumers?
The state and federal government know this system will be daunting, so they’re spending millions of dollars to hire and train special “navigators,” to hold people’s hands and help them figure it all out. As WNYC has reported, New York is receiving about $27 million to pay for navigators, while New Jersey, because it handed over the reins to the federal government for its marketplace, is only getting about $2 million.
4. Why have other states had delays? What are the technical challenges?
Exchanges have been compared with websites such as Travelocity or eHealthInsurance, a longstanding site where people can already shop for private health insurance, long before Obamacare. But this new system is much more complicated, because it has to communicate between various agencies in the state and federal government, and it has to be very secure. Among other things, it has to take personal income information, and see what kind of federal subsidies people qualify for—something that’s crucial to making to making insurance premiums affordable. The system was supposed to be able to verify whether people have been offered affordable health insurance through their employer, but it’s currently doubtful that many—or any—of the exchanges will be able to do this, initially.
5. What’s currently happening in Albany with the marketplace – lots of system testing?
Frescatore says all the different connections are being tested: from the exchange to the private insurance carriers, the I.R.S. and other agencies. Software engineers are trying to swamp the system with a lot of applications all at once to see if it crashes, and they’re probing for security weaknesses to see if personal data can be hacked and stolen. Asked what kind of scores the computer system is receiving on these tests, Frescatore replied, “If I were to grade it, I would say it’s probably in the B range. There certainly are some things we’ve learned through the testing process that we need to go back and correct or fix, but it really demonstrates the value of the very rigorous testing that’s going on right now.” Lauren Summers, who is consulting with several states on health exchanges for Leavitt Partners, doesn’t have specific knowledge of the New York system, but she said there is widespread concern that states aren’t pushing their software through the paces forcefully enough. “If they’re not running the stress tests as they need to, when they start putting real people in, is the security going to be there as needed?” Summer said. Frescatore, however, said the stress test treadmill is going fast, and New York’s online marketplace is being challenged.
6. What if states are ready on October 1, but the federal government is not?
In some ways, this matters more for New Jersey, which is largely at the mercy of the federal government—though New York and the other states with their own exchanges still must interact extensively with federal databases, too. Many people are skeptical, including Robert Laszewski, a Washington, D.C., -based consultant whose blog is followed closely by healthcare observers. “[HHS] isn’t even testing some of the key systems for security and privacy until as little as a few days before October 1,” Laszewski told WNYC. “How are they going to fix it, if something’s wrong?” Frescatore said New York has contingency plans if various federal data pipelines are not working—but problems in Washington could definitely slow down the ability of people in New York to enroll.