New York state is taking steps to ensure that health insurers maintain coverage for certain benefits currently provided under federal law and continue participating in the health insurance exchanges.

This occurs as the Trump administration and the GOP-led Congress continue efforts to repeal and replace the Affordable Care Act.

"For the public health and general welfare, the department is promulgating this rule on an emergency basis in the event that Congress repeals the ACA," the Department of Financial Services wrote in the rule, posted to the State Register last week and subject to a 45-day public comment period.

The trade group representing health plans in the state, however, is questioning the legality of the directive to require insurers to stay in the exchanges as a condition of participating in Medicaid.

Democratic Gov. Andrew Cuomo announced emergency regulations earlier this month requiring any private insurance company doing business on the state's health insurance marketplace to guarantee 10 "essential health benefits," as required by former President Barack Obama's signature 2010 health law.

Mirroring the ACA's essential health benefits, the emergency regulations issued through the state Department of Financial Services would require insurers to cover maternity and newborn care as well as abortion, pediatric services, mental health and substance use disorder services and emergency care, among other services.

The regulations also prohibit against discrimination in the issuance or rating of health insurance due to race, color, national origin, sex and disability.

Cuomo also ordered the state's Department of Health to bar any company that withdraws from the exchange from participating in Medicaid, the health insurance program for low-income individuals, or its Children's Health Insurance Program (Child Health Plus) and Essential Plan, in an effort to thwart insurers from leaving the state's health insurance market, which has achieved relative success while other states' health exchanges have struggled.

Some hospital and physician groups including the Greater New York Hospital Association applauded the directives.

Insurers, however, say most of the requirements are already covered under state law.

"We believe most—if not all—these coverage requirements exist in current law or regulation, so we do not understand the 'emergency' here" said Paul Macielak, the president and CEO of the New York Health Plan Association, a trade group that represents 29 managed care health plans across the state, providing health care to more than 7 million New Yorkers.

Macielak also questioned the "legality and timing" of Cuomo's directive to ban plans that don't participate in the health exchange from Medicaid and Child Health Plus. "In many ways, the governor's press release has the potential to create more uncertainty for plans than the uncertainty of the proposals being discussed in Washington," he added.

Macielak served as counsel to the Majority Leader of the New York state Senate from 1989 to 1992 and chief counsel to the Assembly Minority Leader from 1983 to 1988, according to Bloomberg LP.

Meanwhile, as the U.S. Senate abruptly postponed a vote on the health care bill to repeal and replace the Affordable Care Act on Wednesday due to increasing opposition from members of the Republican Party, the state's Department of Financial Services is reviewing applications from insurers requesting insurance rate increases.

Trying to navigate an uncertain landscape, the DFS has asked insurers to provide estimates of how the possible repeal and replace of the ACA would affect their rates. Health insurance companies in New York are asking for an average 16.6 percent rate increase on the individual market, lower than last year's request of 19.3 percent.

On average, insurers that provided an estimate, said that a full repeal of the individual mandate would increase insurance rates by an additional 32.6 percent, the DFS said.

Instant Insights /

NY issues emergency rules for health insurers pending possible ACA repeal

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