photo_mvullo-1261374Confirmation hearings for Maria Vullo, Governor Cuomo’s nominee for superintendent of the Department of Financial Services, hit a sour note on Thursday when the questioning turned to last year’s collapse of Health Republic Insurance.

Although the fiasco unfolded before Vullo’s time at the department, her comments gave a misleading account of events and downplayed DFS’s own responsibility for what went wrong—raising doubt as to whether she has learned from her predecessors’ mistakes.

Health Republic was a non-profit “co-op” (consumer-operated and oriented plan) founded under the Affordable Care Act in 2013. By offering top-drawer benefits at rock-bottom prices, the company both attracted customers and ran up deficits from the beginning. DFS not only failed to stop Health Republic’s money-losing practices, but denied its full rate-hike requests in 2014 and 2015.

The company then learned that some $200 million in federal subsidies it had been banking on would not materialize, leaving it effectively insolvent. DFS shut the plan down in November 2015, disrupting coverage for 215,000 customers and sticking medical providers with hundreds of millions in unpaid bills.

Asked by senators how she would have handled things differently, Vullo asserted that the department was misled about Health Republic’s deficits.

“What I can tell you is that the company had provided financial statements to DFS of solvency, a very high level of solvency, throughout the time period,” she said. “And it was only until June 2015, when an outside auditor provided an audited financial statement that caused a deep-down review, where we saw that the estimates of liabilities were higher than perhaps they should have been.”

In fact, the department had plenty of earlier warnings about trouble at Health Republic—from the company’s filings, from its competitors, and even from the company’s top executive.

According to a revealing post mortem by Crain’s New York Business, newly appointed CEO Debra Friedman concluded in the summer of 2013—before Health Republic had sold a single policy—that its premiums were too low to be sustainable.

By August, one month into her new job and two months before New Yorkers could begin enrolling in Obamacare plans, Friedman realized the insurer had set itself up for disaster, former staffers said. She asked DFS to let Health Republic refile its rates. The regulator refused. Troy Oechsner, the agency’s deputy superintendent for health, said changing approved rates would be akin to having a closed bid and then letting one bidder change its offer after all the bids were made public.

As for why the company looked solvent on paper, this was because it expected tens of millions of dollars in “risk corridor” subsidies from Washington, and plainly reported that mushrooming amount on its balance sheet as an asset receivable. That was a questionable practice to say the least, since the subsidy was meant to partially compensate insurers for excessive operating losses in the early years of the ACA—meaning the more money Health Republic lost, the bigger this “asset” grew. Plus, in December 2014, a newly passed law barred the Obama administration from using tax dollars to make up a shortfall in the risk corridor program, putting both Health Republic and DFS on notice that the company was unlikely to collect its full amount. In the end, insurers owned money from risk corridors received only 12.6 cents on the dollar.

As Senate Health Chairman Kemp Hannon said to Vullo: “It became pretty obvious in retrospect—and hindsight always gives you great wisdom … that there were warning signs all along the way, that we should have known, we could have known. It wasn’t just the June or July outside auditor.”

Also discouraging, if unsurprising, was Vullo’s expression of support for New York’s “prior approval” law, which empowers DFS to directly regulate health insurance premiums. The industry charges that the department, under political pressure to keep prices low for consumers, tends to cut too deep—a complaint bolstered by the department’s decision to lower some of Health Republic’s rates a few weeks before declaring it insolvent. Also, there’s no evidence, in New York’s competitive insurance industry, that regulation works better than competition to keep premiums in line.

Yet Vullo’s comment on prior approval was: “From the regulator’s perspective, I think that serves New Yorkers well.”

She also resisted the idea, as suggested by Insurance Committee members, that the department should present actuarial evidence to back up its rate decisions.

To her credit, Vullo emphasized that she considers assuring the financial health of insurers—which was the original purpose of insurance regulation—to be her top priority.

“My main goal is the fiscal soundness of the institutions,” she said. “That is the primary part of my job, and I take that incredibly seriously.”

Prior approval, she said, means “balancing the financial solvency issues, which is my primary concern, and the tremendous cash burden on people, on your constituents, in terms of health insurance rates. And that’s not an easy task.”

It’s a balancing act she should not have to perform.

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

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

State Offers Taxpayer-Funded Health Coverage to Unionized Home Care Workers

In a new subsidy for the health-care union 1199 SEIU, the Hochul administration is allowing the union's benefit fund for home care aides to shift some members into taxpayer-funded health coverage through the Essential Plan. Read More

A Closer Look at $4 Billion in State Capital Grants to Health Providers

[Editor's note: This post was corrected after it came to light that records supplied by the Health Department gave wrong addresses for 44 grant recipients. The statistics and tables below were updated on July 18.] Read More

Lawmakers Seek To Revive a $10 Fee for Prescriptions That Was Dropped by DFS

A plan to require a $10.18 "dispensing fee" for filling drug prescriptions is back on the table in Albany – this time in the form of legislation rather than regulation. The Read More

How a Medicaid ‘Cut’ Could Lead to More Unionization of Home Care Aides

A money-saving maneuver in the newly enacted Medicaid budget could end up increasing costs in the long term – by paving the way for more unionization of the state's burgeoning home health workforce. Read More

Budget Deal Slows Medicaid Growth But Plants Seeds for Future Spending

The growth of New York's Medicaid spending is projected to slow but not stop as Governor Hochul and the Legislature effectively split their differences over health care in the newly enacted state budget. Read More

Albany’s New Health Insurance Tax Comes with Few Limits

The newly enacted state budget imposes a multibillion-dollar tax on health insurance without specifying who must pay how much – leaving those basic details to be decided later by the health commissioner in negotiation wit Read More