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A Blueprint for Universal Health Insurance Coverage in New York



Executive Summary


This report presents the Blueprint for Coverage in New York, a project undertaken by the United Hospital Fund and The Commonwealth Fund to explore options for achieving universal health insurance coverage in New York. We developed approaches that would address the specific characteristics of New York's 2.8 million uninsured and establish a more secure foundation of coverage for all New Yorkers. We explored a combination of voluntary public program reforms, premium subsidies to make coverage more affordable, a new group insurance purchasing mechanism, and employer and individual mandates to reach these goals. While these changes could be made individually, when implemented together they would achieve universal coverage and improve coverage options for the insured to provide a more stable health insurance system for all New Yorkers. We present the estimated costs and coverage impacts of these expansion scenarios as prepared by The Lewin Group using its Health Benefits Simulation Model.


Our approach is designed to be implemented as a series of "building blocks" with which reforms would first be made to public programs, to increase participation rates and make affordable coverage available to a greater share of low- and moderate-income persons. Specifically, we would simplify public program rules to enroll those who are currently eligible but uninsured, expand Family Health Plus (FHP) eligibility for childless adults, and allow low-to-moderate-income New Yorkers to "buy in" to FHP with income-related premium assistance. With the introduction of the buy-in, New York would implement a new statewide purchasing mechanism—an "Insurance Exchange"—that would provide individuals with a choice of additional coverage options at group rates. These changes would lay the foundation for other reforms.

The following public policy changes were modeled:

Public Programs. Simplification and expansion of existing public programs with three components:

  • Simplification of public program rules to ease enrollment and renewal in order to increase participation rates among eligible but uninsured persons;
  • Expansion of Family Health Plus eligibility for childless adults to 150 percent of the federal poverty level (FPL);
  • Subsidized buy-in to FHP so that affordable coverage is available to more moderate-income New Yorkers (up to 300 percent FPL);


Insurance Exchange. Implementation of a new purchasing entity for individual purchase of coverage at pooled group rates;

Employer Requirements. Two variations of assessments on employers with 10 or more employees that do not offer health insurance:

  • A modest employer assessment of $400 per worker per year;
  • An employer "pay-or-play" assessment of 8 percent of payroll or a credit toward this assessment for coverage offered (on average, the assessment would be $3,200 per worker);


Individual Mandate. A requirement that all residents purchase health insurance coverage, with income-related premium assistance.


Publication Details



D. Holahan, E. Hubert, C. Schoen, A Blueprint for Universal Health Insurance Coverage in New York, The United Hospital Fund and The Commonwealth Fund, December 2006