222 Bloomingdale Road, Suite 400, White Plains, NY 10605

JDM’s headquarters is nestled in downtown White Plains on Bloomingdale Road, right in the heart of Westchester.

But some of the most important work we do on behalf of our clients takes place beyond the county’s borders, some 150 miles north in the state capitol.

At home in Westchester, we work side-by-side with our clients to provide personalized insurance and benefits services. In order to do that — to stay abreast of the latest regulatory developments, and advocate for our clients’ interests — we need a foothold in Albany.

Recently, the JDM team spent time in the New York State Capitol on behalf of the New York State Association of Healthcare Underwriters, a trade group that examines the interplay of health insurance policy, the state’s economic landscape, and consumers.

In short: Our two days up north were spent researching, advocating for, and taking a critical look at various components of New York State’s current healthcare ecosystem. These are complicated times: With the repeal of the individual mandate, the “small group” definition change, talk of a single-payer system, and reference-based pricing breaking into the Northeast, it’s more important than ever for JDM to listen and be heard in Albany. Our clients expect and depend on it.

Below, you’ll find an overview of the topics we covered, and the impact they may have on you and your business.

Addressing the ‘small group’ definition change

New York is an outlier — and not in a good way.

When it comes to the realm of health insurance and businesses, New York is just one of four states that defines “small group” as fewer than 101 employees. Up until 2016, New York defined “small group” as one to 50 employees.

Due to this change, businesses in New York with between 51 and 100 employees have seen major increases in premiums over the past two years. Further, affected employers now also see fewer carrier and network options, and fewer plan design options to choose from.

As a result of this, medium-sized companies across the state have been struggling spectacularly. There’s nothing “small” about this change — it hits pocketbooks hard and can have ripple effects across the state.

During our time in Albany, we met with leadership at the Department of Financial Services and discussed reverting back to the pre-2016 definition. JDM didn’t stop there: We also spent time with members and leadership from the state senate and assembly to discuss the very same issue.

Employers, take note: A bill to revert to the old definition recently passed the New York State Senate unanimously, and for the third-consecutive year. So what’s next? The bill is awaiting release by the Assembly Insurance Committee.

(For those who don’t mind getting in the weeds: You can learn more about this legislation on the New York State Senate website.)

 Addressing the rising cost of healthcare

The “small group” debate is a major part of the benefits and policy landscape right now, but it’s hardly the only issue.

During our time in Albany, JDM also heightened awareness about the rising health insurance costs that all New York State employers face, regardless of size. Just one example:  Employers are required to cover a number of state mandates. Each of these mandates comes with a price tag — which, in turn, drives up rates. Several years back, Albany planned to launch a Mandate Review Commission to provide in-depth evaluation of each mandate. The Commission would examine the costs and impacts, creating a more balanced insurance ecosystem.

But the Commission never launched. And each year, more and more mandates are passed without proper review, and continue to burden employers and increase rates. In Albany, we reiterated this issue to lawmakers.

Lending guidance where we can

At JDM, we spend each and every day navigating the insurance and benefits landscape for our roster of clients. As a result, we’re constantly expanding our knowledge of what works, what doesn’t, and how the system can be improved.

In Albany, we regularly offer our expertise to legislators to assist with constituent issues. One senator noted that residents in her district will sometimes be denied coverage by an insurance company due to an expensive condition. Another senator noted that many voters will call her office and criticize insurance companies for mandating the use of a specific drug brand for their condition. In cases like these, we aim to provide policymakers with the best input we can. And although every issue requires a custom solution, we’ve found that one particular tactic is always a good starting point: Getting all the stakeholders — doctors, hospitals, employers, brokers, pharmaceutical companies and insurance carriers — in a room together for a constructive conversation.

Our two days in Albany were productive. With each trip to the capitol, we’re able to further advocate for and support our clients, so they can focus on what matters most: running their core business.

James D. Schutzer

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