Company Overview Of Health Republic Insurance Of New York

The American healthcare industry is a complex system of players, with insurers, providers, and consumers all vying for their interests. In this ecosystem, Health Republic Insurance of New York, a non-profit health insurance company, emerged in 2013 as a darling of the Affordable Care Act (ACA). Health Republic Insurance of New York was one of the 23 co-op plans created to provide affordable healthcare coverage to individuals and small businesses. It started operations in 2014 and became the largest co-op insurer in New York, with over 200,000 members (Waldholz, 2016). However, in late 2015, Health Republic Insurance of New York announced that it would not participate in the 2016 enrollment period and would eventually shut down due to financial

In other words, those who need healthcare the most are more likely to enroll in health insurance plans, leaving the insurer with a disproportionate number of high-risk members. Health Republic Insurance of New York was one of the few co-ops offering low-cost plans with broad provider networks, attracting many high-risk enrollees. According to the Centers for Medicare and Medicaid Services (CMS), Health Republic Insurance of New York had the highest-risk enrollee population of all co-ops nationwide, with a risk score of 1.92 in 2014 (Wyman, 2016). This high-risk population led to higher-than-expected healthcare costs, which strained the insurer's financial

Firstly, Health Republic Insurance of New York could have adjusted its premium rates to reflect the high-risk nature of its enrollee population. The insurer had many sick and elderly members who required costly medical treatments. By raising premiums to reflect the risk of insuring this population more accurately, the insurer could have generated additional revenue to offset its medical claims expenses. Moreover, the insurer could have limited the number of providers in its network, which would have reduced the cost of medical treatments. By limiting its network, Health Republic Insurance of New York could have negotiated lower prices with providers and passed those savings on to its