New York Demographics and the Economy - Term Paper Example

Final State Report for New York under ACA Based on the data and study of the United States Census Bureau, it was found that the population of New York State in 2013 was estimated to be around 19, 570, 261. New York State is considered as the third largest populated state in the US. There has been an increase in the population by 10% from the last census taken in the year 2010. 1 Based on the area and population of the State, the population density of the state is assumed to be around 412 people per square mile and is ranked as the seventh largest population density in the US. Based on the historical data and current trends, it was assumed that by the end of 2020, the total population of the US will reach about 19.67 million. In coming years, the population is set to increase at a rate of 1-1.5% that can be a source of worry for the government. It was further found that 51.5% of the total population of the state are female and the remaining 48.5% are male. 53% of the total population identify themselves as Caucasian, 18% as Hispanic, 8% as Asians, and remaining as native individuals. 1 The health status of New York State operates a state based market place that is known as NY State of Health. It is designed to help and support people to shop and enroll for health insurance coverage along with comparing insurance coverage and costs. The market place also helps people to check their eligibility for healthcare programs such as Medicaid. The market place helps people to know about the financial assistance that plays an important role in availing relevant medical and healthcare services. 2The state seems to be expanding its medical and healthcare coverage for low income adults in order to enhance their wellbeing. _____________________________ 1. Kaiser Family Foundation, New York: Demographics and the Economy. State Health Facts, Accessed March 28, 2014, http://kff.org/state-category/demographics-and-the-economy/?state=ny. 2. New York State Agencies, What is NY State of Health? NY State of Health, Accessed March 28, 2014, http://info.nystateofhealth.ny.gov/what-ny-state-health. Fiscal capacity of a state can be defined as the ability of governmental jurisdiction to transform economic activities within its geographical boundaries into the public spending. The idea is to raise revenue along with keeping a transparent approach in terms of presenting data and information to the public. 3 Thus, the economic capacity of states is based on taking into the account the income produced, income received from the residents, and total property wealth along with relevant expenses on the public needs and demands. Based on the State Heath Facts, it was found that the state fiscal capacity for the year 2013 fell short by $2,000 million and that was around the total shortfall of 3.4%. This was mainly because of the expenses that affected the total earnings and thus the shortfall. 3 It is important to highlight the importance of public sector group in terms of making proper use of the available economic sources. It was found that, in New York, vast numbers of public sector employees are not contracted and the unions representing them have not been successful in improving the wages and benefits especially after the financial crisis of 2008-10. Though, the unionized share of workforce has been relatively high in New York State (23.7%) and can be considered as quite good. In terms of the tax structure, New York State has a three layered tax system that includes income tax, sales tax, and property tax. The state tops the chart in terms of accumulating the highest amount of taxes. Apart from this, there are other taxes in the form of corporate income tax, individual and employment tax, gift tax, and excise tax. 4 ________________________________ 3. Tonya Moreno. New York State Tax Profile, About.com. Accesses, March 28, 2014, http://taxes.about.com/od/statetaxes/a/New-York-State-taxes.htm. 4. Ruth Milkman and Stephanie Luce, A Profile of Organized Labor in New York City, New York State, and the United States. Institute for Workers and Labors Studies, Accessed March 28, 2014, http://sps.cuny.edu/filestore/8/6/3_bc4b97196c5659e/863_916e1989d05f0e6.pdf. This part of the discussion presents an overview of the prior healthcare reform policies. The Federal Health reform uses a systematic approach based on the health insurance places in the different states of the US. The main purpose of the current health care reform system is based on offering access health insurance coverage to a large number of people along with protecting their health rights. States have the option to set their own health insurance reform or policies. In the year 2011, the New York State Legislature passed the bill A8460/S5800 that updated the State’s Public and Health insurance law in line with the federal health care reform. 5 The bill was based on amending the insurance and public law along with implementing the federal’s affordable healthcare reforms and policies. 5 With the introduction of this amendment, there have been benefits for the early retirees, small business tax credit, consumer protection in terms of keeping the past healthcare programs, benefits to children till the age of 26 years to stay on their parents’ insurance, and no discrimination against children and women. This amendment changes the overall healthcare reform and policies to an extent by adding value to it in terms of offering unified and equal medical and healthcare rights to individuals. Furthermore, it helped in protecting the women and children rights that further strengthened the healthcare system. There is no doubt that amendments were made to enhance the healthcare structure and framework. Furthermore, the introduction of New York State Health Care Reform Act based on the financing law helped in funding the proposed healthcare initiatives and reforms to a positive extent. 6 ____________________________ 5. Federal Healthcare Reform, Federal Healthcare Reform in New York State, New York State, Accessed March, 28, 2014, http://www.healthcarereform.ny.gov/. 6. Department of Health, New York State Health Care Reform Act (HCRA), New York State, Accessed March, 28, 2014, http://www.health.ny.gov/regulations/hcra/. The major goals of these reforms revolve around offering a systematic and transparent healthcare overview to people in terms of enhancing their health through effective healthcare reforms and policies. The benefits for early retirees are seen in the form of offsetting the cost of claims along with offering them the feel of being secured. On the other hand, discrimination against children and women is also considered to be the most concerning issue and through the implementation of the amendment, this brings more equality and uniformity that add value to the health framework. Furthermore, the participation of the third party payers and provider of healthcare services and facilities in financing the healthcare initiative has added a great deal of value in restructuring the healthcare framework. 7 The efficiency level of the proposed amendments can only be known once the benefits are ascertained and underpinned at the macro level. As the amendments in the past healthcare reforms are based at the macro level including children, adults, and old people; it becomes important and significant to analyze the success and acceptance rate of these reforms. In terms of the equality, it can be believed that the amendments are purely based on the equality and mitigation of discrimination. The concept of equality in the healthcare industry is based on wide arrays of factors like demographic, social, personal, and psychological and thus, analysis of all these factors along with political influence and policies decide the concept of equality. Considering the scope of the highlighted reforms, it can be believed that equality has been introduced but evidences and data needs to be generated. 7 _______________________________ 7. Sheldon Silver, A8460/S5800 Amendments, New York State Assembly, Accessed March, 28, 2014, http://assembly.state.ny.us/leg/?default_fld=&bn=S05800&term=2011&Summary=Y&Actions=Y&Memo=Y&Text=Y. This part of the discussion presents an analysis of the outcomes of the past reform in a critical manner. Medicare and Medicaid programs were created in the year 1965 with a focus on allowing access to medical care and facilities through insurance reforms. These healthcare reforms were of great help in terms of offering healthcare benefits to people with little or no income requiring healthcare treatments. The Medicare Savings Program 2013 is administered by the local departments of social services in New York State. The first program is full Medicaid for dual eligibles that is for Medicaid and Medicare. This program pays for the medical care of beneficiaries whose income is below $800 for singles and $1175 for couples. Second program is Qualified Medicare Beneficiary Program that pays premium for singles whose income is below $978 and for couples whose income is below $1313. Another program is for Specified Low Income people followed by Qualified Individual and Qualified Disabled and Working individual with different criteria and benefits. 8 In the last few years, it was found that, 1 million (16%) of adult individuals in New York did not have insurance. 27% of the young Hispanics were not insured till 2010. Self employed or unemployed people were more in numbers in terms of lacking healthcare insurance. Furthermore, people living in households with below the poverty level mentioned by the Federal were ten times more uninsured. The benefits of Medicare and Medicaid were not largely shared by the entire population of the New York State mainly because of the uninsured individuals who were not a part of the Medicaid and Medicare initiatives. Though, results have been achieved in terms of offering medical assistance to large numbers of individuals but numbers are not huge.8 _____________________________ 8. EPI Research Report, Health Care Reform in New York City — Access to Primary Care before Reform, New York City Department of Health, Accessed March, 28, 2014,http://www.nyc.gov/html/doh/downloads/pdf/epi/epiresearch-healthcare-access.pdf/. It was further found that out of the insured individuals, 60% of them had primary healthcare coverage through their employers and only on third through the government’s Medicare and Medicaid. This shows that the healthcare reform facilities offered by the state government were not robust enough to cater to the needs of the entire state. In the year 2010, 18% of the population of the New York State did not have a regular healthcare provider and uninsured individuals were around 51% in terms of not having a healthcare provider. This shows that the concept of equality was not uniform and thus posing danger for the healthcare reforms and policies. There were not many evidences on last checkup of insured and uninsured people but it was assumed that one out of ten individuals did not avail medical and healthcare checkups in last 2 years. This again highlights the loopholes in the past healthcare reforms especially in the Medicare and Medicaid. 9 Equity in insurance and access to healthcare needs was considered as the biggest concern for the past healthcare reforms. This was mainly because large numbers of people were not insured and thus were not been able to pay premium for the healthcare services. This made them suffer for their healthcare needs and compelled them to seek professional healthcare services personally by paying on their own. This again put financial pressure on them along with restricting the government to create an equity framework for all the individuals residing in the New York state. 9Efficiency in the healthcare reforms cannot be blamed much considering the fact that efficiency was related to the demographic and social factor that posed great dissimilarities and thus little efficiency and effectiveness. ____________________________ 9. EPI Research Report, Health Care Reform in New York City — Access to Primary Care before Reform, New York City Department of Health, Accessed March, 28, 2014,http://www.nyc.gov/html/doh/downloads/pdf/epi/epiresearch-healthcare-access.pdf/. This part of the discussion presents an analysis and investigation of current steps under Affordable Care Act (ACA). In October 2012, New York State submitted its application to HHS for state based health benefit exchange. NYS also selected the State’s largest small group initiative known as Oxford EPO as the benchmark plan. It was further declared that New York State will be establishing the state based health benefit exchange in line with the ACA. The move was based on introducing the open market place for Medicare and Medicaid services. The insurance exchange program is based on the establishment of a structured market place for the sale and purchase of insurance pertaining to healthcare. The insurance companies can sell their services but have to comply with customer rights along with offering insurance to quality applicants. The major purpose of this market place is based on bringing together the buyers and sellers of insurance with the aim and objective of increasing insurance coverage. 10 It was further found that, in order to attract large numbers of people under the ACA, the government asked all the people to register before 31st March and people failing to register themselves before the stated date will have to suffer tax penalty. Out of the enrolled individuals, it was found that 70% were not insured and thus stating the present healthcare framework of the State that can be considered as quite worrisome. It was also estimated that out of the enrolled individuals, around 50% signed up for private insurance while the remaining were qualified for Medicaid. 11This shows that the initiative taken by the government pertaining to insurance exchange seems to be quite beneficial especially for poor people. 10. Glenin Blain, New York Obamacare Exchange Enrolls 717,207 People With A Week To Go Before Deadline, Daily Politics, Accessed March, 28, 2014, http://www.nydailynews.com/blogs/dailypolitics/new-york-obamacare-exchange-enrolls-717-207-people-week-deadline-blog-entry-1.1733255. 11. Jacobs, Lawrence R.; Theda Skocpol, Health Care Reform and American Politics. (Oxford University Press, 2010), 102. Since the basic purpose of Medicaid is to cover those who have no income or are poor; expansion is based on offering healthcare facilities to poor and their families. The budget office of the New York State stated that 300,000 additional people in the state will be on Medicaid roll in the year 2014. Furthermore, the Medicaid roll will expand from 5.3 million to 5.6 million by the end of 2014 and can be considered as quite good. 12 It needs to be mentioned that around one million uninsured people in the New York State will receive free healthcare and thus will be able to lead a healthy life. Since the roll out of the Medicaid program, half of the people who signed for the insurance on the state run exchange qualified for the Medicaid. This shows that the expansion rate has been positive and commendable. It was also found that 50% of the people registered for Medicaid showing the acceptance for the program. 12 The Medicaid program’s managed care service delivery structure has also changed in the sense that the commissioner’s authority to mandate new populations has been increased, new programs for dual eligibles and disabled people have been included, along with the inclusion of behavioural health services. At the same time premium assistance is available on top of the federal tax credit which means that enrollees are not supposed to pay cost related to the premium. Enrollees in the silver plan can avail this service but this premium assistance program is only an interim measure. Overall, it can be said that the Medicaid’s program has been of great support especially for the poor in terms of transforming their health and well being. 13 _______________________________ 12. Carl Campanile, ObamaCare to put 300,000 NYers on Medicaid, New York Post, Accessed March, 28, 2014, http://nypost.com/2013/11/29/obamacare-to-put-300000-nyers-on-medicaid/. 13. Trilby De Jung, New York Medicaid Expansion under the ACA and other 2013 budget changes, New York Health Access, Accessed March, 28, 2014,http://www.wnylc.com/health/entry/186/. This part of the discussion deals with the anticipated effects of reforms under ACA in an illustrative and critical manner. As the most favorable impact of the ACA, more than 32 million individuals will no longer be uninsured. This means that most of these individuals will be having a minimum level of health insurance that is defined as coverage via government sponsored insurance plan, employer sponsored insurance (ESI), and insurance purchased from the insurance market. The main idea of this reform is to offer insurance to majority of the people in the State along with making healthcare accessible and easy in the long run. ESI is considered as the most common form of insurance coverage in the US with more than 59% of individuals covered by their employers in the year 2009. The numbers of ESI has decreased a bit in last few years with an increase in individual insurance coverage. ACA also introduced premiums and penalties in order to maintain the required level of healthcare insurance coverage. 14 Incentives include premium subsidies to ensure higher degree of affordability and enhanced access to Medicaid through the eligibility expansion program. At the same time, penalties are exposed on individuals failing to maintain the required degree of healthcare insurance coverage. The Medicaid coverage is a state based insurance program and its benefits can only be availed by individuals who are insured and come under the eligibility factors stated by the State. It can be said that the current ACA initiatives will put pressure on the insurance coverage participants and Medicaid administrators in delivering the healthcare measures and solutions in a systematic and well planned manner especially when there will be an increase in the number of insured individuals in the State. 14 _____________________________ 14. Chaikind Henry., Peterson Charles, “Summary of Potential Employer Penalties Under the Patient Protection and Affordable Care Act (PPACA), Congressional Research Service (CRS), Accessed March 30, 2014. http://www.ncsl.org/documents/health/EmployerPenalties.pdf. This part of the discussion presents an understanding over the facilitators and barriers to reform under ACA. The facilitators and barriers have been identified in the form categories in the form of the market place, highlighting the quality of the market, state governmental in terms of keeping an eye on healthcare facilities, organisational in terms of their participation and efforts in enhancing the value of healthcare reforms, and design of the payment system in terms of its simplicity, complexity, and potential impact. 15There is no doubt that the insurance companies, organisations offering insurance to their employees, and state government employees carrying the insurance process are the key participants in the ACA reform. They are responsible for carrying out the goals and objectives of the reform along with making it a success in the long run through joint efforts and initiatives. The role of these facilitators becomes all the more important and significant in terms of maintaining the transparency and simplicity in the system for a long period of time. 15 The first barrier can be in the form of expecting providers to be accountable for the cost that they cannot control in terms of the healthcare expense. The second barrier can be in the form of analysing the compensation of physicians and doctors based on volume and not value. The third barrier can be maintaining the highest quality of healthcare along with offering healthcare solutions in minimum of time. The fourth barrier can be in the form of lack of neutral bodies that can assess the benefits and loopholes of the proposed and active reforms. In order to control these reforms, it is important to integrate the reform framework by ascertaining the loopholes and problem areas in the very beginning and finding adequate solutions. 16 ________________________________ 15. Feldman, Arthur M, Understanding Health Care Reform: Bridging the Gap between Myth and Reality. (CRC Press. 2011), 103 16. Barr, Donald A, Introduction to U.S. Health Policy: The Organization, Financing, and Delivery of Health Care in America. (JHU Press. 2011), 110 ACA has been the prime force and reform in facilitating and strengthening the healthcare framework of the US. A number of states have been benefitted by this reform and New York is no more an exception. Based on the discussion, it was found that, the reform is ideally suited for low income people who are not insured. Furthermore, this allows them to avail healthcare benefits and facilities based on their income and productivity. 17 The government has offered a number of options under employer sponsored insurance and open market insurance through the introduction of Medicare and Medicaid. 18It was also found that in order to add value to the proposed framework, it is important to mitigate the impact of discussed barriers and integrate the power of facilitators to seek greater degree of value and benefits. 19This will help in achieving the proposed value and benefits of the reform in a systematic and well planned manner. 20 ________________________________ 17. John E. McDonough, Inside National Health Reform, (University of California Press. 2011), 103 18. Obama Care Facts, ObamaCare Medicaid Expansion, Obama Care Facts, Accessed March 30, 2014, http://obamacarefacts.com/obamacares-medicaid-expansion.php. 19. Employer Health Benefits, 2010 Summary of Findings, Kaiser Family Foundation and Health Research and Educational Trust, 2010, Accessed March, 30, 2014, http://ehbs.kff.org/pdf/2010/8086.pdf. 20. Jessica Zigmond, Reform Update: ACA's effect to decrease labor supply was expected, experts say, Modern Healthcare, Accessed March, 30, 2014, http://www.modernhealthcare.com/article/20140205/NEWS/302059974. Bibliography Arthur, Feldman M. Understanding Health Care Reform: Bridging the Gap between Myth and Reality. CRC Press, 2011. Blain, Glenin. New York ObamaCare Exchange Enrolls 717,207 People With A Week To Go Before Deadline. Daily Politics. Accessed March, 28, 2014, http://www.nydailynews.com/blogs/dailypolitics/new-york-obamacare-exchange-enrolls-717-207-people-week-deadline-blog-entry-1.1733255. Campanile, Carl. ObamaCare to put 300,000 NYers on Medicaid. New York Post. Accessed March, 28, 2014, http://nypost.com/2013/11/29/obamacare-to-put-300000-nyers-on-medicaid/. Department of Health. New York State Health Care Reform Act (HCRA). New York State. Accessed March, 28, 2014, http://www.health.ny.gov/regulations/hcra/. Donald, Barr. Introduction to U.S. Health Policy: The Organization, Financing, and Delivery of Health Care in America. JHU Press, 2011. EPI Research Report. Health Care Reform in New York City — Access to Primary Care Before Reform. New York City Department of Health Accessed March, 28, 2014,http://www.nyc.gov/html/doh/downloads/pdf/epi/epiresearch-healthcare-access.pdf/. EPI Research Report. Health Care Reform in New York City — Access to Primary Care Before Reform. New York City Department of Health Accessed March, 28, 2014,http://www.nyc.gov/html/doh/downloads/pdf/epi/epiresearch-healthcare-access.pdf/. Employer Health Benefits, 2010 Summary of Findings, Kaiser Family Foundation and Health Research and Educational Trust, 2010, Accessed March, 30, 2014, http://ehbs.kff.org/pdf/2010/8086.pdf. Federal Healthcare Reform. Federal Healthcare Reform in New York State. New York State. Accessed March, 28, 2014, http://www.healthcarereform.ny.gov/. Henry, Chaikind and Charles, Peterson. “Summary of Potential Employer Penalties under the Patient Protection and Affordable Care Act (PPACA)” Congressional Research Service (CRS), Accessed March 30, 2014 http://www.ncsl.org/documents/health/EmployerPenalties.pdf. Kaiser Family Foundation. New York: Demographics and the Economy. State Health Facts. Accessed March 28, 2014, http://kff.org/state-category/demographics-and-the-economy/?state=ny. Lawrence, Jacob and Skocpol, Theda. Health Care Reform and American Politics. Oxford, 2010 Moreno, Tonya. New York State Tax Profile. About.com. Accesses, March 28, 2014, http://taxes.about.com/od/statetaxes/a/New-York-State-taxes.htm McDonough, John. Inside National Health Reform. University of California Press. 2011. Milkman, Ruth and Luce, Stephanie. A Profile of Organized Labor in New York City, New York State, and the United States. Institute for Workers and Labors Studies. Accessed March 28, 2014, http://sps.cuny.edu/filestore/8/6/3_bc4b97196c5659e/863_916e1989d05f0e6.pdf. New York State Agencies. What is NY State of Health? NY State of Health. Accessed March 28, 2014, http://info.nystateofhealth.ny.gov/what-ny-state-health. Obama Care Facts. ObamaCare Medicaid Expansion. Obama Care Facts, Accessed March 30, 2014, http://obamacarefacts.com/obamacares-medicaid-expansion.php. Silver, Sheldon. A8460/S5800 Amendments. New York State Assembly. Accessed March, 28, 2014, http://assembly.state.ny.us/leg/?default_fld=&bn=S05800&term=2011&Summary=Y&Actions=Y&Memo=Y&Text=Y. Trilby De Jung. New York Medicaid Expansion under the ACA and other 2013 budget changes. New York Health Access. Accessed March, 28, 2014,http://www.wnylc.com/health/entry/186/. Zigmond, Jessica. Reform Update: ACA's effect to decrease labor supply was expected, experts say. Modern Healthcare, Accessed March, 30, 2014, http://www.modernhealthcare.com/article/20140205/NEWS/302059974. Read More