Financial Health report for NY under ACA - Example

Financial Health report for NY under ACA Financial Health report for NY under ACA College New York State spent $17,918 million dollars on health care expenses during the year 2013 out of its budgeted receipts of $14,770 million, which is about 12% of the total receipts. Further, its health care spending stood at the fourth rank as compared to other expenditures like state operations, local assistances, and school aid. New York state government has committed to introduce the Affordable Care Act (ACA) from 2010 onwards and is now offering four schemes under the above act and but , still continuing its Medicaid programmes. Under ACA, a New Yorker is now able to choose a health insurance plan as per his taste. NY State sponsored Medicaid is also offering insurance coverage for downtrodden New Yorkers. This research essay will analyze the financial implication for New York State under the Affordable Care Act and will discuss its merits and demerits, past health insurance schemes and also make recommendation how to overcome these difficulties through an exhaustive analysis of the subject. I -Introduction / Background on State a. “Population size and Health Status” As per the United States Census Bureau, in 2013, the population in New York was projected to be 19,570,261 and the New York State was being the third largest populated state in U.S.A. Based upon the area of the state, New York’s population density is estimated at 412 people per square mile. About 16% or 2.7 million New Yorkers under the age of sixty-five has not subscribed to any health insurance scheme as of date. The Majority of the uninsured population belongs to working community and those who are not eligible to medical programs like Medicaid. About 1 million New Yorkers are receiving health coverage in the market place. From 1st October 2013, New Yorkers are having the facility to compare and purchase health their insurance coverage through the market place. $368 million has been earmarked to develop the market place by the US Federal Government. New Yorkers who are not eligible for Medicare insurance coverage will have to use the marketplace for their health care insurance needs. Poverty As per New York State Community Action Association (NYSCAA) (2013), about 2,845,024 or 15.1% of individuals live in poverty, about 902,006 or 21.2% of Children under the age of 18 live in poverty, about 1,542,776 or 12% of adults who are in the age of 25+ live in poverty and 266,268 or 11.3% of senior citizens who are in the age of 65+ live in poverty. Out of employed people in the NY state, about 14.5% and about 30.9% unemployed people in the NY state have no health insurance policy or coverage. (Ams.nyscommunityaction.org 2013) As of 2009, the Medicare spending in NY State was estimated at $11,604. Between 2000 and 2012, the Medicaid enrolment in NY State witnessed a sharp increase by more than 80%, which covered more than 5 million New Yorkers. Annual cost per enrolee of Medicaid program declined sharply by more than 32% from $13,100 to $ 8,900 between 2000 and 2012 after adjusting inflation. b. “Fiscal Capacity of the state “ New York State Budget for the year 2014-15 In $ millions 2013-14 2014-15 Total Receipts 140.770 141,901 Total Disbursements 140,865 142,141 Source: http://www.osc.state.ny.us/reports/budget/2014/executivebudget2014.pdf “Spending on Health Care” Details of Health Care Expenses $ in millions 2013-14 DOH Medicaid 15,878 Other Health Care Programs 2,040 Total Healthcare Spending 17,918 Source: “osc.stat.ny.us” In the financial year 2007-08, New York State (herein after will be referred as NYS) had a budget of $25.2 million for the HFNY program (Healthy Families New York Home Visiting Programmes). In 2008-09, there was a reduction of 8% for HFNY program fund, which stood at $23.3 mn. Up to 2014, the same $23.3 mn was spent on HFNY. As per survey by Prevent Child Abuse New York, prolonged flat funding has resulted in a lower level of services. In the year 2012-13, an additional $2 mn funding was provided for Nurse-Family Partnership home visiting program. NYS allocated $5 mn as Medicaid funds for voluntary foster care agencies in 2013-14 and additional funding has been proposed for the year 2015-16. (SCCA 2014). “Source: osc.stat.ny.us” Total Medicaid Disbursements - Estimates Source: osc.stat.ny.us From the above table, we can understand that NYS spent$ 55,607 on Medicaid during 2013-14, which includes NYS share of 38%, U.S.As Federal government share was 46% and 16% was met by local governments in NYS. Further, NYC is expected to spend about 20% on Medicaid disbursements during 2017-18 as compared to 2013-14 figures. II. Prior Health Care Reform Policy or Policies Through the Health-Care Reforms Act 2000, the Healthy NY program was introduced to offer more affordable health insurance to the New Yorkers who are in need of it. The program is overseen by the New York State Department of Financial services, which are governed by New York state regulations and law. Small businesses, individuals and sole proprietors are the real beneficiaries under Healthy NY program, which offered comprehensive health insurance to them since 2001. However, starting 2014, Healthy NY will be available as a small employer program only. From the year 2014, Healthy NY will include more wide-ranging coverage for important health benefits, which include outpatient and inpatient hospital services, maternity care, physician services, diagnostic services, preventive health services, chiropractic care, prescription drugs, mental health care, and emergency and ambulance services. “Types of Tax Structure” Source: “osc.stat.ny.us” a. Name/ dates – waivers or others key reforms Until 1986, NY had in force a State Health Plan (SHP) which provided primary care, inpatient acute and long-run care, mental health services, disease prevention and health promotion, and the prevention and treatment of substance and alcohol abuse. In 1978, the Federal government requirements for health planning activities and agencies were repealed. Federal planning funds were stopped in 1986. Till 1995, NYS prolonged to support both regional and state healthcare planning activities. Due to the stoppage of funding, six Health System Agencies were closed. With annulment of the National Health Planning and Resources Development Act of 1974 (NHPRDA) and stopping of funding to HAS gradually resulted in phasing out of SHA. (Health.ny.gov 2012). Since at the start of 1990s, County Health Departments established periodic (once in 4 years) Community Health Assessments (CHAs). Further, from 1990 onwards, hospitals have been mandated to establish (every three years) a Community Service Plan (CSP) enumerating health care and health needs of the community and how the hospital is catering those requirements. From 2008, hospitals in NY have been assigned responsibility for developing their CSPs in cooperation with the county health departments to spread about health care facilities with local health departments. Rural Health Networks (RHNs) is currently funding about 35 Rural Health Networks. The Emergency Medical Services (EMS) community has a wide system of regional cooperation and clinical council coordination with state-level service and clinical policy councils. Under Heal 9, the Department of Health discharged funds under the Health Care Efficiency and Affordability Law for New Yorkers (HEAL NY) Phase 9 titled “Local Health Initiatives Grant Program” mainly to rekindle the health care and local health planning. As the HSAs have been stopped functioning and the desertion of the State Health Plan process, NYS wide health planning has been intermittent and issue-specific. Berger Commission was established under the title “Commission on Health Care Facilities in the 21st Century “mainly to reform the emergency, acute, inpatient and residential health care facilities in NYS. b. Explain some details –waivers or other key reforms The cost of insurance is made easy for many New York Citizens as per the NY Health care reform and for instance, in 2014; financial help is made possible to NY citizens who earn up to $45,960 and families of four which earns up to $84,200. This is made possible for extending tax credits to help with monthly premiums and through the offer of subsidies to assist to pay out-of-pocket expenses while availing medical treatment. Further, a NY citizen is eligible for Medicaid, even if he was not eligible before and this is mainly due to income level of the individual and still he can avail higher Medicaid. All health plans that are made available to NY citizens will offer coverage for ten qualities, necessary health benefit types, which includes services like reimbursement of hospital stay expenses, routine doctor visits, and medical prescriptions. The scheme will cover preventive –health care services also. The following are the ten benefits that can be availed under NY all health plans; Paediatric services which include vision care Laboratory tests Never-ending-disease supervision and health-care and preventative services “Rehabilitative and habilitative services “ “Substance –abuse and mental disorder treatment” Prescription drugs “New-born and maternity care “ Enjoying emergency- room services Hospital care “Routine doctor check-ups.” c. State Goals of Reform / Expected Effects Regarding Under Affordable Care Act (ACA), any NY citizen under the age 65 can avail the medical insurance and those in the age of 65 and above, they will be covered under Medicare. However, undocumented immigrants are not eligible to avail health care benefits under ACA. Under earlier scheme, a New Yorker has long been able to buy individual insurance in spite of health or age status, but majorities of the health insurance plans are expensive. However, under ACA, the NY citizens can find more affordable health care insurance available in the marketplace. Under ACA, the following four medical insurance policies are available namely; Platinum – Under this policy, about 90% of all medical expenses incurred will be reimbursed or met. The premium for platinum coverage will be around $450 to $913 per month. Under the Gold, about 80% of the health costs will be either met or reimbursed where the premium costs will between $395 and $750 per month. Under silver plan, about 70% health expenses will be met where the premium will be in the range of $360 and $635 per month. Under Bronze scheme, about 60% medical expenses will be met and $ 3000 allowed as a deductible and premium for this policy and premium will be $308 per month. Under catastrophic policy, a NY citizen under the age of 30 can pay just $183 to cover the medical expenses. If a citizen’s earning is $15000, he will be eligible for Medicaid, and up to $46,000, one can be eligible for subsidies. Under ACA, any insurance plan will have the cover either for the physical health bills or mental health bills. (Nymag.com 2013). Subsidy is the major advantage of ACA where the marketplace will evaluate a citizen’s eligibility footed upon income, where you reside, the immigration status, etc. A beneficiary can claim the subsidy every month off his premium or avail it by way of a single cheque at tax time. C. State Goals of Reform / Anticipated Impacts a) Efficiency : Expansion of Insurance Coverage: Under the past health-care reforms , about 2.2 million New Yorkers were uninsured and there is an urgent need to expand insurane coverage, mainly through efficient implementation of health-care reforms. Once ACA is introduced in NYS ,about 1.2 million will be expected to be covered .(NYShealthfoundation.org 2013). b) Decreased Costs and Aanalouges Care In the year 2008 , about $ 126 million was spent on health care in NY State and about $47 million went to Medicare alone, which is the highest Medicaid spending by a state in USA.Further , NYS had a budget deficit of $ 2 billion and when ACA is implemented in NYS , it is probable to add extra cost to the State. Hence , success of New York State’s past health care reform was banked upon cost reduction strategies and improving the standard of New Yorkers’ health care .(Knickman 2009). III Current Steps under ACA a. Insurance exchange From October 1 2010 onwards, health insurance exchange has been established across USA, which has brought radical transformation to how a citizen can purchase an individual health insurance plan through an exchange where he can compare and contrast and buy health insurance plans. Each and every state in USA has the choice to manage its own healthcare insurance exchange, work in tandem with the federal government to manage the exchange, or it can use the federal exchange for its health care plans. An insurance exchange can extend a toll free hotline where a customer can ask question and get assistance, an exchange can set up a navigator program so as to assist consumers to comprehend and ensure whether the health care plans offered to adhere with the regulatory needs and norms. An exchange may offer an online calculator to consumers who can evaluate their costs where the calculator will take into account subsidies or tax credits, which are available to the consumer. (“Zamosky, 2013, p.67”). b. Medicaid expansion One another way to escape from the provisions of ACA for a New Yorker is to obtain coverage under Medicaid. If an individual has the eligibility for the enrolment of in NY’s Medicaid program, he need not sign up for another medical insurance program. Though the Affordable Care Act (ACA) has enlarged the Medicaid eligibility to cover more individuals who cannot afford to avail health insurance schemes as the U.S. Supreme court was of the opinion that it is upto an individual state to elect whether or not to expand Medicaid facilities. On the footing upon the U.S Supreme court verdict, New York State has decided to enlarge its Medicaid program. Thus , a resident of New York State can join the Medicaid programme if his earning is up to 138% of the Federal poverty level and in 2014, the Federal poverty level is determined as $16,100 for an individual or $32,900 for four members of a family.(Thomas & Hall ,2014,p.17). VI. Anticipated Effects of Reform under ACA Under the ACA , it is estimated that more than one million NY residents who were earlier uncovered from insurance will be receiving health insurance coverage, mainly due to market place reforms , and with help of federal subsidies and due to Medicaid eligibility. Elements like more wide-ranging advantages, higher enrolment and cost-sharing restrictions will definitely impact the health care costs in many ways. The gravest effects will be witnessed in the individual health insurance market as the 75% of NY residents enjoying the medical coverage either through the government or through their employers and hence, only very negligible quantum NY State population will buy their insurance, mainly through the NY health benefits exchange. Under ACA , many preventive services are provided free of cost like well-women and well-baby check-ups , screenings for cancers , blood pressure and obesity , screening for childhood immunisations , but the costs of the above will be included in the cost of individual’s health insurance premium(Nyhpa.org 2014). a. Insurance Coverage As per New York State of Health (NYSOH), as of 7th April 2014, about 1,264,859 New Yorkers have filed the health insurance applications and since the introduction of Marketplace on October 1, 2013, about 908,572 workers were registered for coverage. It is to be noted that more than seventy percent of those who have registered were not covered with any insurance policy at the juncture of their application. Further, NY state government has set a target of 1.1 million individuals for applying for healthcare policy in the market place by the close of 2016. (Mystateofhealth 2014). V. Conclusions As per New York State of Health (NYSOH), as of 7th April 2014, about 1,264,859 New Yorkers have filed the health insurance applications and since the introduction of Marketplace on October 1, 2013, about 908,572 workers were registered for coverage. It is to be noted that more than seventy percent of those who have registered were not covered with any insurance policy at the juncture of their application. Under the ACA , it is estimated that more than one million NY residents who were earlier uncovered from insurance will be receiving health insurance coverage, mainly due to market place reforms .Subsidy is the major advantage of ACA where the marketplace will evaluate a citizen’s eligibility footed upon income, where you reside, the immigration status, etc. A resident of New York State can join the Medicaid programme if his earning is up to 138% of the Federal poverty level and in 2014, the Federal poverty level is determined as $16,100 for an individual or $32,900 for four members of a family. Elements like more wide-ranging advantages, higher enrolment and cost-sharing restrictions will definitely impact the health care costs in many ways. The gravest effects will be witnessed in the individual health insurance market as the 75% of NY residents enjoying the medical coverage either through the government or through their employers and hence, only very negligible quantum NY State population will buy their insurance mainly through the NY health benefits exchange. Under ACA , many preventive services are provided free of cost like well-women and well-baby check-ups , screenings for cancers , blood pressure and obesity , screening for childhood immunisations , but the costs of the above will be included in the cost of individual’s health insurance premium. V. “Recommendations for changes to reform in NYS Healthcare Insurance Coverage Prevention and population health care provisions will offer multiple chances to New York State to enhance the public health system and to enhance its assimilation with the medical care system under the Affordable Care Act. (ACA). Further, NYS will have innumerable chances to integrate population health care preferences within the provisions of ACA. Thus, NY government can achieve a new vision for health that minimizes the incidence of diseases, removes health care inequalities and enhances the New Yorkers’ health by functioning closely in partnership with families, communalities, and individuals to recognize health requirements and to support both the individual and collective action to put an end to illness, to safeguard and promote health care needs, and to accomplish greater individual and community well-being. References Ams.nyscommunityaction.org (2013) .The Full Poverty Report. Retrieved April 11, 2014, http://ams.nyscommunityaction.org/Resources/Documents/News/NYSCAAs_2013_Poverty_Report.pdf > Mystateofhealth (2014). More than 908,000 New Yorkers Enrolled on NY State of Health. Retrieved April 11, 2014, < http://www.healthbenefitexchange.ny.gov/news/press-release-more-908000-new-yorkers-enrolled-ny-state-health> Nyhpa.org. (2014).6-Ways ACA –The New York Health Plan Association. Retrieved April 11, 2014, from Thomas, K. C., & Hall, J. P. (2014). The Medicaid Medically Improved Group: Losing Disability Status and Growing Earnings. Medicare & Medicaid Research Review, 4(1). Zamosky, L. (2013). Healthcare, Insurance and You. New York: Apress NYShealthfoundation.org. (2013). Expanding Healthcare Coverage . Retrieved May 5, 2014,< http://nyshealthfoundation.org/priority-areas/expanding-health-care-coverage> Knickman , J R. (2009). Containing Costs Key to Health Reform Success. Retrieved May 5, 2014,< http://nyshealthfoundation.org/news-events/james-knickman/containing-costs-key-to-health-reform-success> Health.ny.gov. (2012, May 14). Healthcare Planning in NY State. Retrieved April 11, 2014, http://www.health.ny.gov/facilities/public_health_and_health_planning_council/meetings/2012-03-21/docs/health_planning_in_nys Nymag.com. (2013, January 10). A New Yorker’s Guide to Signing up for Obama care. Retrieved April 11, 2014, < http://nymag.com/daily/intelligencer/2013/09/new-york-guide-to-signing-up-for-obamacare.html> Dfs.ny.gov. (2013). Healthy NY. Retrieved April 11, 2014, http://www.dfs.ny.gov/healthyny/hny_about.htm Read More