The debate over how to provide health insurance to 50 million Americans – nearly 3 million of them New Yorkers – was center stage last week. The US Supreme Court quizzed lawyers supportive of and opposed to the federal health care reform law. In Albany, the debate over Governor Cuomo’s plan to create a health exchange – the entity that would provide health insurance to the states’ uninsured – was a key obstacle to conclusion of the state budget.
At the national level, the Supreme Court debate caught observers by surprise: most had expected that the Court would rule in favor of the law. But the 5 conservative justices’ questions appeared to be sharply critical of the position taken by the Obama Administration. At the end of the week, pundits – who were once overwhelmingly sure that the federal law would be upheld – now hedged their bets.
Of course, the line of questioning is not a sure indicator how the justices will vote, but it wasn’t a good sign.
At the state level, the Senate Republican leadership rejected Governor Cuomo’s plan to create a health exchange. A health exchange is the entity that will negotiate on behalf of the uninsured and small businesses to ensure that plans offered affordable coverage. Establishment of a health exchange is required under federal law. If a state fails to create an exchange, the federal government will set one up itself.
While no one has supported the federal government running New York’s exchange – it is a widely held view that the state would have a better view on how best to offer health coverage – effectively the Senate leadership’s opposition to creation of a New York health exchange would have ensured that the federal government would have to step in. Unless something changed.
And change did happen.
In response to the Senate’s rejection of a state health exchange, the governor instead proposed creating one with his executive powers. Under the state constitution, the governor has extensive powers to unilaterally respond to serious problems facing New York. His powers are not as extensive as those found in the legislative process, but the governor can set up agencies within the executive branch.
The governor has not yet issued his order, so there is nothing to react to. However, creation of an exchange within a state agency – such as the Health Department – allows the governor to dictate the activities of the exchange, if he chose to do so.
The state budget that passed did allow the state to accept money to pay for the exchange and to spend it on the initial activities the exchange will be involved in – for example, offering contracts to set up a website, a telephone center, hire staff, etc. Given the governor’s decision and the ability to receive and spend federal money – the federal government has pledged to pay for the exchange – an exchange should be up and running soon.
And there is no time to waste. In about a year and a half, New Yorkers will begin obtaining health care coverage that will go into effect on January 1, 2014 – the date at which virtually all Americans will be required to obtain health insurance – from their employer, or the state, or purchased on their own. For those who do purchase it on their own, the exchange will be the place that they will go to obtain affordable coverage and government financial assistance if they qualify.
Unless the US Supreme Court strikes down the federal law. We won’t know their decision until late June, but in the meantime the state can obtain federal funds to set up the exchange. If the federal law gets overturned, then New York can follow the lead of the state of Massachusetts. It was Massachusetts, under legislation advanced by then-governor Romney that pioneered the health exchange concept and was the model for the federal law.
Over 98 percent of Massachusetts residents now have insurance, in New York 15 percent are uninsured. Even if the Court strikes down the federal law, New York can use its exchange to get coverage for those who need it most.
Blair Horner is the Vice President for Advocacy for the American Cancer Society, Eastern Division. His commentary does not necessarily reflect the views of the American Cancer Society.
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