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date: 10 April 2021

Abstract and Keywords

This article covers the provision of public and private health insurance. Health care has major implications for the state budget and the state economy. It describes New York's policies that regulate private health insurance and shape its Medicaid program. It then describes efforts to reform Medicaid through “executive federalism.” New York offers two major cautions for health reformers who support major federal initiatives to constrain the growth in health care costs. Health care is a key driver of state and local government costs. The dominance of Medicaid in New York's health insurance market, who it covers, and its sheer size in the state budget have tended to overshadow the private health insurance market. The tools of executive federalism represent potential mechanisms for shifting control of the Medicaid program to the executive branch. New York provides a cautionary note for health and long-term care reform at the national level.

Keywords: health insurance, health care, state budget, state economy, Medicaid, New York, executive federalism

Michael K. Gusmano

Michael K. Gusmano is Associate Professor of health policy and management at New York Medical College and a Research Scholar at the Hastings Center.

Courtney Burke

Courtney Burke is the Commissioner of the New York State Office for People With Developmental Disabilities. At the time of chapter writing she was the Director, NYS Health Policy Research Center at The Nelson A. Rockefeller Institute of Government.

Frank J. Thompson

Frank J. Thompson is Professor at the School of Public Affairs and Administration at Rutgers-Newark and at the Rutgers Center for State Health Policy in New Brunswick.

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