The Obama administration has delayed until mid-December the deadline for states to decide whether to establish health insurance exchanges as required under the national Affordable Care Act.
The exchanges are an online marketplace where private insurers can offer state-approved plans so businesses and individuals shopping for insurance can compare benefits and prices and determine what tax credits they might be eligible for to reduce their monthly premiums. States have to decide now by Dec. 14 whether to operate their own or to opt for a federally-run exchange.
Nationally, about 30 million Americans, who will be required by law to have insurance, are expected to get coverage through the exchanges. They are supposed to be operational Jan. 1, 2014, but hesitant states question the costs and how much control they will have over the mandated exchanges especially since the Obama administration has yet to issue final regulations. However, Gov. Andrew M. Cuomo has signed an executive order establishing an exchange meant to expand coverage and reduce costs to businesses and individuals.
A state exchange offers an opportunity to tailor programs to state needs rather than be forced to accept a one-size-fits-all approach imposed from Washington. A benchmark plan that other insurers must meet has already been chosen, but the premiums and deductibles have yet to be established.
Competition should reduce premiums while insurers will benefit from the nearly 1 million New Yorkers expected to enroll in the plans. The state-run plan offers federal subsidies to cover co-payments and other out-of-pocket expenses. Those subsidies might not be available through federally operated exchanges.
The exchange will help those who do not have coverage through their employer but do not qualify for Medicaid and cannot afford private insurance. The newly insured will have access to basic medical care when they need it with reduced costs to taxpayers who subsidize health care through government plans.
New York has already received $88 million in federal aid to set up the exchange and will be eligible for billions of dollars in additional financing. New tax credits will reduce premiums to no more than 4 percent of income for individuals earning up to 149 percent of the poverty level. Families up to 400 percent of the poverty level, or up to $92,200 for a family of four, will pay no more than 9.5 percent for premiums.
The potential benefits to New Yorkers, insurers and businesses make it worthwhile to move ahead with the state-run health exchange.