All 5 boroughs will implement NYC Care by 2020, with the Bronx at the front of the line. What might this mean for health insurance?

The average cost for healthcare in America is among the highest in the world. Recent years saw it averaging around $11,000 per person annually which is expected to reach $17,000 by 2027. Family healthcare coverage through an employer has already risen to $20,000. Hikes in pricing and an increase in the aging population mean more people require care but are less likely to be able to afford it.

It seems like the perfect climate for New York City Mayor Bill de Blasio to have made his progressive healthcare announcement back in May. The NYC Care Program launched as planned on August 1 in the Bronx, designed to provide NYC citizens with a new health coverage option.

How the NYC Care Program works

The program estimated that around 600,000 New Yorkers are currently without health insurance due to financial constraints or immigration status. The latter group constitutes roughly half of that number. Now, undocumented immigrants will be able to receive primary healthcare at any of the city’s Health + Hospitals facilities by applying for an NYC Care membership and card.

A 6-month residency in the city is required before being eligible for the service. Every cardholder receives guaranteed access to their own physician, free care or affordable co-pays, and round-the-clock appointment booking and pharmacy services. While only the Bronx benefits from the NYC Care Program, for now, it’s planned to be implemented in Brooklyn and Staten Island in January 2020 and citywide by the end of next year.

Those New Yorkers who aren’t in the immigrant group will be also be cared for through an expansion of the city’s public hospital’s health insurance program, MetroPlus, which is already used by over 500,000 New Yorkers and offers several plans for its members.

How the program compares to having health insurance

NYC Care isn’t health insurance—rather, the city is paying for direct care. It’s better viewed as a routine preventative health measure rather than the buffer which traditional insurance provides against illness or accidents.

The service is indeed free for some recipients, and for others, it’s a low-cost option with almost 3,000 prescriptions having already been filled. The program states that all members have received access to a primary care provider within two weeks of needing one—a respectable figure when it can take Americans an average of 24 days to see a doctor.

However, there are certain services NYC care doesn’t cover, namely:

Dental services—available to NYC Care members and other uninsured patients through NYC H+H Options (a free or discount payment plan to make health care services affordable)

Skilled nursing or long-term acute care

Emergency care and hospital stays—Emergency Medicaid may cover these services

The lack of skilled nursing on the plan immediately highlights a big gap between the provisions of the program and the wide array of healthcare services available with traditional insurance. And it’s important to note that this could make a huge difference to an ill or injured person.

A reading of the program’s services page sees a repetition of the word “routine” applied to care. Routine care is, of course, essential, but the program’s inability to handle long-term and emergency situations makes it far less effective than having a health insurance policy.

How these programs might affect health insurance

The primary potential effect here is boosting public awareness of healthy options combined with significant care to back it up. The smarter people are about proactively managing their health, the better decisions they’re likely to make in looking after themselves. The program certainly increases public awareness of the healthcare options available, as over 5,000 Bronx residents have already enrolled.

It’s possible that, over time, this focus on preventative care could reduce health insurance premiums in NYC much like a big drop in auto accidents would for vehicle coverage. Mayor de Blasio stated that NYC will save money through the program because it will reduce costly emergency room visits and hospital stays.

These two outcomes cost more than doctor’s visits for both the patient and the hospital which, if all goes to plan, will lead to big savings for the city … which may also have a positive ripple effect on insurance premiums.

The program is not without its critics, as John Bacon of USA Today reported—so, it remains to be seen if NYC Care will have a positive impact or even endure. If it lasts, it wouldn’t be without precedent to see a nationwide knock-on effect. Whenever a large metropolitan area or highly populous state implements a significant policy change, it tends to slowly catch on across the country until it becomes a more accepted practice.

We’ll see whether programs like NYC Care will lead to a healthier America and eventually, lower health insurance premiums for everyone. You can review the program’s 36-page handbook for the complete picture and get in touch with us to discuss your insurance needs.

NICRIS Insurance focuses on providing clients with the appropriate suite of products to protect them, their interests, and their loved ones. If you need some insurance advice or would like a free, personalized insurance review, just drop us a line.