Experts feel a change can be expected next year when the premiums come down by half, under The Affordable Care Law, due to increased competition on the state exchange and when healthy young people buy insurance.
"It's not an exact science. You have to make assumptions, and that's what we did. But they're informed assumptions, based on our experience in the market," said Don Ingalls, HealthNow New York's vice president for state and federal relations.
Offering subsidies and less expensive options will give access to millions of uninsured.
"The early signs from New York are very promising," said Heather Howard, program director for the State Health Reform Assistance Network, which is funded by the Robert Wood Johnson Foundation.
When healthy uninsured people sign up for coverage it balances the costs for the ill. When people don't sign up, they are required to pay penalties. They should be able to afford the coverage and also be able to navigate the enrollment system on the insurance exchange.
"This is a brand new environment for everyone - the state, insurers and consumers. The exchanges are very much a work in progress," said Peter Kates, a Univera Healthcare spokesman.
Today, while millions of New Yorkers receive coverage through an employer, and many receive health insurance through the federal Medicaid and Medicare programs, just 17,000 people in the state pay for insurance coverage directly.
"For an individual looking for insurance, it is virtually impossible to find affordable coverage, or to access it," said Larry Zielinski, a former president of Buffalo General Medical Center who teaches at the University at Buffalo School of Management.
"I will say it is very difficult to make comparisons between the rates for coverage being paid today and the rates for coverage beginning in 2014. That's because the coverage will be so different," said Jennifer Tolbert, director of state health reform for the Kaiser Family Foundation.
Representatives from the three largest area insurers are confident in their projected plan rates. When people buy insurance today is when they have no other option and need health care. On the exchange a larger spectrum of consumers can be targeted and may find it to their advantage to sign up when the cost is reasonable.
Nine companies are approved to sell insurance in the region through the state exchange, including HealthNow New York, the parent of BlueCross BlueShield of Western New York.
The exchange plans will attract people who are eligible for a subsidy or who are in bad health, said Greg Pasieka, HealthNow New York's director of health care reform.
"We do not expect all of the uninsured to enroll in a policy with us," Pasieka said, adding, "We're trying to forecast what consumers will do."
Many people in good health may opt to pay the penalty, said Brian M. Murphy, a partner with Lawley Benefits Group.
"That's why the insurance carriers are really nervous," Murphy said, because to make it work financially, "you need the good and the bad."
Hannah Punitha (IRDA Licence Number: 2710062)
Stephen T Watson, August 2013