What The Affordable Care Act Means For New Yorkers

In 2009, nearly 14 percent of New Yorkers reported they were unable to see a doctor when needed because of cost. The Common Wealth Fund reports that between 2003 and 2009, the cost of health insurance policies for families in New York increased 46 percent; the cost of policies for individuals rose 43 percent over the same period.

Who are the uninsured in New York?

Of the New Yorkers with health insurance, 48 percent have coverage through an employer. The public programs Medicaid and Medicare insure 34 percent of residents, and four percent of New Yorkers purchase individual private policies. In the state, eight percent of children ages 18 and younger lack health insurance. The rate of uninsured among those ages 19-64 is 18 percent. [1]

The rate of uninsured increases substantially, to 31 percent, for adults with household incomes less than 139 percent of the Federal Poverty Level. Disparities in uninsured rates exist among ethnicities and races, with 23 percent of New York’s Hispanic population lacking health insurance. Black New Yorkers are uninsured at a rate of 19 percent, and the uninsured rate among Whites is 11 percent. [2]

How does the Affordable Care Act affect New Yorkers?

The Affordable Care Act (ACA) requires states provide access to an online marketplace where individuals and small businesses may compare, select and purchase private health insurance policies that offer a minimum level of coverage. States have the option of establishing their own exchange, operating an exchange in cooperation with the federal government, or turning all administration of the health care marketplace over to the federal government. New York State, along with 16 other states and the District of Columbia, is providing its citizens access to a health care exchange with its own state-run health care marketplace.

New York’s application to establish its own health care exchange, which followed Governor Andrew Cuomo’s executive order establishing a statewide health exchange, was conditionally approved by the U.S. Department of Health and Human Services in December 2012. All health plans offered in the health care exchanges must meet federal quality standards, but states do have discretion in how their exchanges are organized. New York’s exchange will be state-operated as part of the existing New York State Department of Health.

Small Business Health Options Program (SHOP)

Under the ACA, small business employers with fewer than 50 full-time workers, or full-time equivalent workers, will not be required to offer health insurance to their employees. (Check here for a definition and calculator to determine who qualifies as a full-time worker.) However, the ACA encourages many small business employers to provide health insurance by offering small business health care tax credits.

Many small businesses were already offering health insurance packages to their employees before the ACA was passed and signed into law. These plans are accepted, or grandfathered in, under the ACA.

For small business owners who wish to change their coverage plans, or for those who did not offer health insurance before the new law, the ACA establishes the Small Business Health Options Program or SHOP. SHOP allows employers to compare and shop for quality insurance plans side by side for their employees. New York small business owners may access SHOP through New York’s health insurance exchange.

New York’s health insurance exchange

New York’s health insurance exchange, officially named the New York Health Benefit Exchange, will contract with private health insurance providers as an Active Purchaser. With this model, the state will select plans and negotiate premium prices. An alternative to this model is the Open Marketplace Clearinghouse model, which allows all insurers with qualified plans to compete in the state exchange. New York State is also soliciting bids from insurers for stand-alone dental policies to be included in the exchange offerings.

Uninsured New Yorkers who are U.S. citizens or lawfully present immigrants are eligible to participate in the exchange. Enrollment begins October 1, 2013 for coverage that begins on January 1, 2014.  New Yorkers who are insured through an employer, but contribute more than 9.5 percent of their total household income to their premiums, may also shop for insurance in the state exchange. Individuals with annual incomes less than $45,960, and families of four with annual incomes less than $94,200, may be eligible for financial assistance to offset the premium costs.

Individuals and small businesses may enroll online at the New York Health Benefit Exchange. Information at the website will initially be provided in English and Spanish, with other languages to follow. Those who have questions or require enrollment assistance may contact one of the following centers:


For updates and additions to the list of enrollment support sites, visit the New York Health Benefit Exchange.

External resources for New York residents

See the full list of external resources from CBS New York.


[1] http://kff.org/state-category/health-coverage-uninsured/?state=ny
[2] http://kff.org/uninsured/state-indicator/rate-by-raceethnicity/?state=ny

Gillian Burdett is a freelance writer covering all things home and living. Her work can be found on Examiner.com.


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