Implementing Federal Health Care Reform: A Roadmap for New York State

Authors: Patricia Boozang | Melinda J. Dutton | Alice J. Lam

Landmark federal health reform legislation, the Affordable Care Act (ACA), enacted earlier this year has the potential to bring about near universal coverage and transform how health care is provided and paid for throughout the United States. However, it has become increasingly clear that its ultimate success will largely depend on state-level implementation efforts to extend coverage, improve access, and reform the delivery system.

The New York State Health Foundation (NYSHealth) – in a recent report authored by the Manatt Health Solutions’ team of Patricia Boozang, Melinda Dutton and Alice Lam and NYSHealth Visiting Fellow Deborah Bachrach – provides a health care reform implementation roadmap for New York, a state with a highly evolved regulatory infrastructure that has been a leader in health care coverage access and consumer protections but now faces a daunting fiscal crisis. “Implementing Federal Health Care Reform: A Roadmap for New York State” summarizes the major provisions of the ACA, analyzes their implications unique to the State, and outlines the key implementation tasks and issues that New York will confront as it begins ACA implementation. The ACA provisions are organized into three areas: Coverage, Access for the Insured and Uninsured, and Payment and Delivery System Reform.

Coverage expansions, reforms, and mandates serve as cornerstones to reform, dramatically reducing the number of the uninsured, spreading the risk and costs of insurance across a greater and healthier pool of New Yorkers, and ensuring that health care providers have a reliable reimbursement mechanism to pay for their services. Access provisions, aimed at expanding the health care workforce and health care infrastructure, seek to ensure that health care providers are equipped to meet the rising demand for health services that is expected to accompany expanded coverage. Finally, reform of the State’s delivery system is necessary to improve the quality and efficiency of health care delivery to ensure that coverage is affordable and sustainable for employers, consumers, and State and Federal governments alike.

The report concludes that health care reform will require an overhaul of the State’s existing regulatory and delivery infrastructure. Some of New York’s existing regulations will have to be repealed; new health and insurance guidelines will have to be drawn up and issued; and significant new infrastructure and administrative systems will have to be created. Some of the specific tasks identified in the report that the State government and other stakeholders must undertake include:

Bolstering Public Coverage: Medicaid and the Children’s Health Insurance Program (CHIP) serve as a foundation for enhancing health insurance coverage under Federal health reform. New York must reconcile the state’s existing public insurance system with new mandates and options for coverage of vulnerable individuals. Thoughtful analysis and preparation also will be crucial for the State to effectuate the new eligibility and enrollment procedures and supporting infrastructure that will make it easier for eligible New Yorkers to get and keep their coverage.

Creating the Exchange(s): Federal reform calls for the creation of state-based insurance exchanges, and many questions must be addressed before New York can successfully implement an exchange, including whether to create one exchange or multiple exchanges; what entity or entities will run the exchange(s); and which insurers will be allowed to participate.

Expanding Access to Care: New York State must increase primary care capacity to prepare for an influx of newly-insured people who will seek care. It will be equally important to preserve a strong safety net for those New Yorkers who remain uninsured.

Reforming the Payment and Delivery System: Federal reform enables New York to pursue lower costs and better outcomes through new care and payment models. Careful planning and execution will be needed to synch these models with care providers across the State.

New York’s path to ACA implementation will be unique. Success will depend on the ability of State government leaders and their partners in the private sector to marshal the substantive expertise, political will, and human and financial resources necessary to capitalize on the opportunities presented by Federal reform to achieve transformative change. This report provides a starting point for that collaboration.

The full report is available on the New York State Health Foundation website.

This report is part of Manatt Health Solutions' growing body of work on federal health reform, which also includes an analysis of the impact of reform on the State of California published by the California Healthcare Foundation

For additional information on this issue, contact:

Patricia Boozang is a health care policy consultant, with particular interest and expertise in improving insurance coverage and health care access for low-income children and families. Ms. Boozang provides government relations, policy and regulatory advice to a wide range of non-profit healthcare and social services organizations. 

Melinda Dutton serves as a Partner within the healthcare division of Manatt, Phelps & Phillips, LLP, and also plays a leadership role within Manatt Health Solutions (MHS), an interdisciplinary policy and business advisory practice within the firm.  Ms. Dutton’s practice concentrates on advising clients in the healthcare industry with respect to regulatory, public policy and business matters.

Alice Lam provides policy analysis, project implementation support, and strategic and regulatory advice to healthcare, human services, and advocacy organizations.