New York Codes, Rules and Regulations › Title 9 - EXECUTIVE DEPARTMENT › Subtitle A - Governor's Office › Chapter I - Executive Orders › Part 8 - Executive Orders (Andrew M. Cuomo) › Section 8.42 - Executive Order No. 42: Establishing the New York Health Benefit Exchange

Current through Register Vol. 46, No. 28, July 10, 2024
WHEREAS, the implementation of a Health Benefit Exchange
					 and other reforms in New York will:
(1) result in lower premiums for individuals
				  and small businesses;
(2) allow
				  individuals and small businesses purchasing coverage through such Exchange to
				  receive $2.6 billion in federal tax credits and cost sharing subsidies; and
(3) provide one million additional
				  New Yorkers access to affordable, comprehensive health insurance, reducing the
				  percentage of New Yorkers who are without health insurance;
WHEREAS, a state that chooses to operate its own Exchange
					 must demonstrate to the federal government, by January 1, 2013, that its
					 Exchange will be able to begin accepting applications by October 1, 2013, and
					 will be operational by January 1, 2014, and if the state does not demonstrate
					 operational readiness of its own Exchange, its residents will be required to
					 participate in a federal Exchange;
WHEREAS, the State of New York is best positioned to:
(1) understand the ramifications of
				  operating an Exchange within New York's commercial insurance market;
(2) consider the unique regional and economic
				  needs of the State's individual and small business health insurance markets;
(3) account for the diversity of
				  its population, with its ethnic, cultural and language differences; and
(4) decide what benefits will be
				  provided to enrollees in the Exchange, which health plans can participate in
				  the Exchange, what rules should apply to the marketing of products by health
				  plans, and how to operate the Small Business Health Option Program ("SHOP") for
				  small businesses;
WHEREAS, the Affordable Care Act requires an Exchange to
					 evaluate the eligibility of individuals for Medicaid and other public health
					 coverage and enroll them if eligible, meaning that it will be essential to
					 coordinate the operations of the Exchange with the State's administration of
					 these programs;
WHEREAS, the taxpayers of this State subsidize the costs
					 associated with care for the 2.7 million New Yorkers without health insurance,
					 who frequently forego preventive care and other needed treatment, putting them
					 at risk of being sicker throughout their lives and dying sooner than those who
					 have health insurance, which diverts funds from other public uses and costs
					 state and county taxpayers more than $600 million annually just to pay for a
					 portion of the services rendered by hospitals to people without
					 insurance;
WHEREAS, New York's uninsured working families often earn
					 too much to qualify for public health insurance, but not enough to purchase
					 coverage that costs, on average, over $1,200 per month for an individual and
					 $3,450 per month for a family of four;
WHEREAS, small businesses, without assistance, cannot
					 afford to purchase health insurance coverage for their workers, nearly 800,000
					 of whom have lost employer-sponsored coverage over the last decade, and thus
					 face a major competitive disadvantage that inhibits their ability to grow,
					 create jobs and otherwise support the State's economic development;
WHEREAS, the costs associated with care for the uninsured
					 are shifted through increased premiums to those individuals and groups that
					 purchase health insurance coverage, causing working families with health
					 insurance to pay $800 more in premiums on average each year;
WHEREAS, the development and operation of an Exchange in
					 New York will impose no cost on the State, but will be funded entirely with
					 federal funds until January 1, 2015, at which time the Exchange will be wholly
					 self-funded, meaning that no State or county taxpayer dollars will be used for
					 such purposes; and
WHEREAS, it is therefore critical that the State of New
					 York establish and operate its own Exchange, and that it do so
					 expeditiously;
NOW, THEREFORE, I, Andrew M. Cuomo, Governor of the State
					 of New York, by virtue of the authority vested in me by the Constitution and
					 the Laws of the State of New York, do hereby order as follows:
1. There is hereby established within the
				  Department of Health, in conformity with the Affordable Care Act, the New York
				  Health Benefit Exchange (the "Exchange"). The Department of Health, in
				  conjunction with the Department of Financial Services and other state agencies,
				  shall take all necessary steps to effectuate the Exchange, and expedite its
				  ability to perform those functions necessary to carry out the requirements and
				  serve the goals of the Affordable Care Act.
2. The Exchange shall, among other things,
				  facilitate enrollment in health coverage and the purchase and sale of qualified
				  health plans in the individual market in this state, and enroll individuals in
				  health coverage for which they are eligible in accordance with federal
				  law.
3. The Exchange shall, among
				  other things, take such actions necessary to enable eligible individuals to
				  receive premium tax credits and cost-sharing reductions and to enable eligible
				  small businesses to receive tax credits, in compliance with all applicable
				  federal and state laws and regulations.
4. The Exchange shall, among other things,
				  enter into agreements with appropriate entities, including but not limited to
				  federal, state and local agencies, to the extent necessary to carry out its
				  duties and responsibilities, provided that such agreements incorporate adequate
				  protections with respect to the confidentiality of any information to be
				  shared.
5. The Exchange shall,
				  among other things, convene regional advisory committees, consisting of
				  consumer advocates, small business consumer representatives, health care
				  providers, agents, brokers, insurers, labor organizations, and any other
				  appropriate stakeholders, to provide advice and make recommendations on the
				  establishment and operation of the Exchange, including recommendations about
				  relevant regional factors, and shall provide opportunities for public input on
				  such matters.
6. The Exchange
				  shall, among other things, become financially self-sustaining by January 1,
				  2015, as required by the Affordable Care Act.
7. Nothing in this Order shall be construed
				  to duplicate, preempt, supersede, limit or otherwise restrict the statutory
				  authority, duties and functions of the Department of Health, the Department of
				  Financial Services or any other agency of this State.
Signed: Andrew M. Cuomo
Dated: April 12, 2012