Senate unveils health ‘market’

The Daily Mail reported that a bill key to implementing last year’s federal health care overhaul in New York state was introduced this week in the state Senate.

The proposed legislation would establish a health insurance exchange, a marketplace where individuals and small businesses can, come 2014, shop for and compare private insurance plans.

The Senate bill “is a first step in advancing a health insurance exchange that will ensure affordable and accessible coverage that meets the unique insurance needs of all New Yorkers,” said Sen. James Seward, R-Oneonta, who, as chairman of the Senate Insurance Committee, has sponsored the legislation.

Sen. Kemp Hannon, R-Garden City, chairman of the Senate Health Committee, is the bill’s cosponsor.

The bill was drafted following a roundtable discussion in April with health care and insurance experts.

“This legislation sets up the governing structure and basic functions that are required in order for the exchange to begin to function, while providing for a transparent process and careful consideration of policy choices,” Hannon said.

There has yet to be a companion bill introduced in the state Assembly. Seward says talks are ongoing with the Assembly and the governor’s office.

Seward’s bill establishes the exchange as a public authority with an 11-member board of directors. States have the power to choose how the exchanges are governed and whether it will exist as a nonprofit organization, quasi-governmental entity like a public authority or within a state agency.

“We don’t want this to turn into an expensive and beaurcratic program,” Seward said in explaining the decision to create the exchange as a public authority.

The exchange will not receive any state funding, under the bill. Seward said its operation could be kept going by fees paid by participating health care providers and others. It’s unknown at this point how much it will cost to keep the exchange running.

According to Seward, the federal government has given New York $28 million to date to establish the exchange.

Although a public authority operates with more independence than a state agency, questions still exist about whether the exchange will be sufficiently insulated from political influence and special interests within the insurance industry, including who will be charged with choosing the board of directors. “Some of these decisions are yet to be made,” Seward said.

Under the health care law, states must establish the governing structure of the exchanges by the end of this year. By 2013, states must prove to the federal government they are qualified to run the program. Consumers will be able to purchase insurance through the exchanges in 2014.

Members of Congress, too, will be getting their health insurance through exchanges starting in 2014.

The exchanges are a main provision of the health care law. The hope is that by increasing competition among health care plans and providing more choices for individuals and businesses, costs will come down.

“As a result of high costs, the market for individuals in the state has been in sharp decline for years,” said Paul Howard, a senior fellow at the Manhattan Institute for Policy Research, in a recent report. “As recently as 2001, more than 128,000 individuals were enrolled in (health maintenance organizations) in the direct-pay market. By 2010, enrollment had plummeted to just 31,000.” Premiums have roughly tripled during that period, according to Howard.

“In all, about 15 percent (2.6 million) of New York’s residents are uninsured, a group that is largely young (about half are aged 18 to 34), in good health and without dependents,” he added. Under the new federal law, young adults can remain on their parents’ plan until they turn 26. That provision has already taken effect.

To learn more about the law’s many provisions and when they take effect, visit http://www.healthcare.gov/.

“Frankly, I have mixed feelings (about the health care law),” Seward said.

Judges on a federal appeals court panel on Wednesday repeatedly raised questions about President Barack Obama's health care overhaul, expressing unease with the requirement that virtually all Americans carry health insurance or face penalties.

All three judges on the 11th Circuit Court of Appeals panel questioned whether upholding the landmark law could open the door to Congress adopting other sweeping economic mandates. The panel is made up of two Democratic appointees and one Republican appointee.

The Atlanta panel did not immediately rule on the lawsuit brought by 26 states, a coalition of small businesses and private individuals who urged the three to side with a Florida judge who struck down the law. And it's never easy to predict how an appeals panel will decide.

But during almost three hours of oral arguments, the judges asked pointed questions about the so-called individual mandate, which the federal government says is needed to expand coverage to tens of millions of uninsured Americans.

With other challenges to the law before other federal appeals courts, lawyers expect that its fate will ultimately be decided by the U.S. Supreme Court.

Chief Judge Joel Dubina, who was tapped by President George H.W. Bush, struck early by asking the government's attorney “if we uphold the individual mandate in this case, are there any limits on Congressional power?” Circuit Judges Frank Hull and Stanley Marcus, who were both appointed by President Bill Clinton, echoed his concerns later in the hearing.

Acting U.S. Solicitor Neal Katyal sought to ease their concerns by saying the legislative branch can only exercise its powers to regulate commerce if it will have a substantial effect on the economy and solve a national, not local, problem. Health care coverage, he said, is unique because of the billions of dollars shifted in the economy when Americans without coverage seek medical care.

“That's what stops the slippery slope,” he said.

Paul Clement, a former U.S. solicitor representing the states, countered that the federal government should not have the power to compel residents to buy to engage in commercial transactions. “This is the case that crosses the line,” he said.

Hull also seemed skeptical about the government's claim that the mandate was crucial to covering the 50 million or so uninsured Americans. She said the rolls of the uninsured could be pared significantly through other parts of the package, including expanded Medicare discounts for some seniors and a change that makes it easier for those with pre-existing medical conditions to get coverage.

The court, which did not indicate when it would rule, has several options. But Hull and Dubina asked the lawyers on both sides to focus on a particular outcome: What could happen to the overhaul, they asked separately, if the individual mandate were invalidated but the rest of the package were upheld?

Parts of the overall law should still survive, said Katyal, but he warned the judges they’d make a “deep, deep mistake” if the insurance requirement were found to be unconstitutional. He said Congress had the right to regulate what uninsured Americans must buy because they shift $43 billion each year in medical costs to other taxpayers.

Clement, however, argued that the insurance requirement is the “driving force” of the broader package, which he said violates the Constitution's legitimate authority. Without it, he said, the rest of the package should collapse.

“If you take out the hub, the spokes will fall,” Clement said.

Marcus, meanwhile, said the case struck him as an argument over individual liberties, but questioned whether the judicial branch should “stop at the water’s edge” or intervene.

The 11th Circuit is not the first appeals court to hear arguments about the constitutionality of the federal health care overhaul, as panels in Cincinnati and Richmond have both heard similar legal challenges to the law within the last month. But legal observers say the Atlanta panel’s decision could be the most pivotal because the ruling by U.S. District Judge Roger Vinson of Florida is considered the broadest assault yet on the law.

While a Republican-appointed federal judge in Virginia struck down the requirement that nearly all Americans carry health insurance, Vinson invalidated the entire law, from the Medicare expansion to a change that allows adult children up to age 26 to remain on their parents’ insurance. Three federal judges, all Democratic appointees, have upheld the law.