The accumulated surplus of the state-run Essential Plan had ballooned to $9.9 billion by the end of December, putting it on track to break $10 billion before the close of the fiscal year on March 31, according to newly released records from the comptroller’s office.

The plan, which provides free health coverage to 1.1 million low-income New Yorkers, was established in 2015 through an optional provision of the Affordable Care Act.

Due to a quirk in its funding formula, the program generates far more federal funding than it needs to pay expenses – resulting in an operating surplus that has grown to almost $3 billion per year.

Federal law bars the state from diverting the money for any other purpose, causing a $9.9 billion cash balance to build up in the program’s trust fund.

 

Despite this snafu, the Hochul administration is seeking even more federal aid to finance an expansion of the program, which would lift the income eligibility threshold from 200 percent to 250 percent of the poverty level.

If the proposal is approved, the state projects that the program's annual surplus would get half a billion smaller – but the cash balance would continue to mount.

The plan was established under an optional provision of the ACA that allows states to establish a "basic health program" similar to Medicaid for people with incomes up to 200 percent of the federal poverty level, or $29,160 for an individual. New York and Minnesota are the only states to exercise the option so far.

The programs are entitled to 95 percent of the amount that the federal government otherwise would have spent on premium tax credits and other subsidies if enrollees had purchased silver-level insurance through an ACA exchange.

Unexpectedly, the money generated by this formula has far exceeded the actual cost of coverage – likely because the Essential Plan pays lower fees to doctors, hospitals and other medical providers than the typical commercial plan.

The plan provides comprehensive medical, dental and drug coverage with no monthly premium and minimal cost-sharing.

Its enrollees include several hundred thousand legally present immigrants who are ineligible for federal funding in Medicaid. Before 2015, the state had been paying the full cost of this group's Medicaid coverage, as required by a court ruling. Switching them into the Essential Plan has saved the state hundreds of millions per year.

The state's only expense for the program has been administrative costs, which have amounted to about $75 million or 2 percent of the overall budget.

About the Author

Bill Hammond

As the Empire Center’s senior fellow for health policy, Bill Hammond tracks fast-moving developments in New York’s massive health care industry, with a focus on how decisions made in Albany and Washington affect the well-being of patients, providers, taxpayers and the state’s economy.

Read more by Bill Hammond

You may also like

Hochul Hides the Specifics of a Looming Tax on Health Insurance

The Hochul administration has requested federal approval for a multibillion-dollar "MCO tax" on health plans without announcing the move or providing details to the public. As by l Read More

Hochul’s CDPAP Overhaul Hands a Costly Win to 1199

Governor Hochul's overhaul of the Consumer Directed Personal Assistance Program reached a milestone Monday when she named a Georgia-based company as the winning bidder to be the program's statewide "fiscal intermediary" – Read More

New Yorkers’ Health Costs Spiral as Officials Take Credit for ‘Savings’

The latest round of health insurance premium hikes announced by New York regulators adds to evidence that state policies are drowning consumers instead of helping them. Late last mo Read More

What Paul Francis Got Wrong About the Empire Center’s Nursing Home Research

In February 2021, the Empire Center published the first independent analysis of the Cuomo's administration much-debated directive ordering Covid-positive patients into nursing homes. The report found that the directive was associated with a statistically significant increase in resident deaths in the homes that admitted the  infected patients. Read More

Internal Cuomo Administration Documents Showed Evidence of Harm from Nursing Home Order

State Health Department documents from June 2020, newly unearthed by congressional investigators, appear to show harmful effects from a controversial order requiring nursing homes to admit Covid-positive patients. Read More

How 1199 Earns its Reputation as Albany’s No. 1 Labor Power Broker

For the fourth time in six years, the president of New York's largest health-care union, George Gresham of 1199SEIU, has won the top spot on the "Labor Power 100" list from City &am Read More

New York Runs Away from the Pack on Medicaid Spending

New York's per capita Medicaid spending jumped 14 percent in 2023, moving it further ahead of the rest of the country, recently released nationwide data show. In the federal fiscal year that ended last September, New York spent $95.6 billion on Medicai Read More

Hochul’s Pandemic Review Contract Included a Gag Clause, Records Confirm

The authors of a report on New York's pandemic response are barred from discussing their findings with media under a provision of their contract with Governor Hochul's office, records obtained by the Empire Center confirm. Read More