July 16, 2025
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7/16 – State of Politics article re: need for special session of NYS legislature ——————– Please find the Public Notice below which appeared in today’s State Register for the Targeted Inflationary Increase (we used to refer to this increase as a COLA) provided in the final budget effective on and after April 1, 2025. PUBLIC NOTICE Pursuant to 42 CFR Section 447.205, the Department of Health The Department of Health proposes to amend the Title XIX All Services The following is a clarification to the March 26, 2025, noticed pro- With clarification, this increase will now be 2.6 percent (2.6%) and The estimated net aggregate increase in gross Medicaid expendi- Non-Institutional Services The following is a clarification to the March 26, 2025, noticed pro- With clarification, the estimated net aggregate increase in gross Institutional Services With clarification, such DSH transactions will continue April 1, Long Term Care Services With clarification, the estimated net aggregate increase in gross The public is invited to review and comment on this proposed State For the New York City district, copies will be available at the following places: New York County Queens County, Queens Center Kings County, Fulton Center Bronx County, Tremont Center Richmond County, Richmond Center For further information and to review and comment, please contact: Please let us know if you have any questions. Thank you.
—————————— ADVOCACY: Thinking About Advocacy and Organizing Given Recent Enactment of Federal Budget Reconciliation Law Here are some slides created for a recent Webinar hosted by Health Care for All America regarding its post-enactment organizing and advocacy plans. In addition, here are some really good talking points focused on Medicaid, Medicare and other insurances: Talking Points: The Ugly Truth About the GOP’s Big Beautiful Bill Act —————————– Small businesses flee state-regulated insurance market as premiums soar |
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| The trend spells trouble for business owners whose employees aren’t young and healthy, according to a new analysis by the Fiscal Policy Institute. | |||||||||||||||||||||
| By Maya Kaufman | 07/16/2025 05:00 AM EDT, Politico | |||||||||||||||||||||
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NEW YORK — The state’s small group health insurance market is in “serious trouble,” according to a new analysis by the Fiscal Policy Institute. The think tank’s analysis, which was shared exclusively with POLITICO, found policymakers have done little to address an exodus of participants from the highly regulated insurance market for small businesses across the state. Premiums in the small group market have soared, incentivizing business owners with younger and healthier workers to look elsewhere for affordable coverage, according to the analysis. That causes rates to rise even higher, prompting more small businesses to exit the market. The self-reinforcing cycle has accelerated in recent years, meaning some small businesses could soon find themselves without any affordable health insurance options, experts with the Fiscal Policy Institute warned. “One of the unsung but really significant achievements of the ACA was to create a stable, reliable group market, and we see here that is potentially going away,” Michael Kinnucan, the Fiscal Policy Institute’s director of health policy, told POLITICO. Background: New York’s small group market offers coverage to businesses with up to 100 employees under a provision of the Affordable Care Act. Those plans are community-rated, meaning insurers have to charge the same premium to all small businesses in a given region instead of setting each business’ rate based on the demographics and health status of their workforce. Additionally, insurers’ annual rate increases are subject to approval by the state Department of Financial Services. More than 700,000 New Yorkers are enrolled in small group plans, according to state data. The findings: Participation in the small group market plummeted 24 percent between 2020 and 2024, representing 227,000 fewer individuals covered, according to the Fiscal Policy Institute’s analysis of the most recent available state data. The decline was especially steep in New York City and on Long Island, which have higher premiums than other areas of the state, the think tank found. The average monthly base premium for gold tier plans — the most common type in the small group market, designed to cover roughly 80 percent of medical costs — was $1,274 per enrollee in New York City last year and $1,257 on Long Island. In the Buffalo area, in comparison, it was $647. Why it matters: The high premiums straining the small group market are closely connected to rising health care prices, according to the Fiscal Policy Institute’s analysis. A Department of Financial Services spokesperson cited the cost of inpatient hospital stays and rapid increases in drug prices as key drivers. Another contributing factor is a loophole that allows small businesses to purchase health insurance policies through professional employer organizations. The organizations take advantage of state labor law’s definition of “employer” to bundle businesses together and purchase large group insurance on their behalf. Data on professional employer organizations is limited, but an industry publication cited in the Fiscal Policy Institute’s analysis found New York has the third-highest penetration of any state. Bailey Hu, a health policy analyst for the Fiscal Policy Institute and the report’s lead author, said the findings should prompt policymakers to tighten oversight of professional employer organizations and pursue measures to control health care prices. Asked for comment, the Department of Financial Services did not address the role of professional employer organizations or the think tank’s policy recommendations. The department also did not say what officials are doing to strengthen the small group market. What’s next: Insurers requested an average rate increase of 24 percent for small group plans next year. Those requests are pending approval by the Department of Financial Services. A department spokesperson said they closely scrutinize rate requests to ensure they are not excessive, inadequate or unfairly discriminatory. |