August 15, 2025 • 14 mins
Aug. 15, 2025- State lawmakers approved a handful of new health insurance mandates this year, including bills dealing with inhalers and speech therapy, but insurers say these well-intentioned efforts won't result in lower costs. New York Health Plan Association President & CEO Eric Linzer explains how insurers determine what they cover and argues that policymakers should focus on the underlying cost of treatments.
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:04):
While death and taxes are two things you can always
count on, followers of the state legislature and Albany can
also reliably bet on bills requiring health insurers to cover
more services and treatments. And while this type of well
meaning legislation is intended to make healthcare more affordable, the
reality of our medical system in America is that there's
no such thing as a free lunch or maybe an inhaler.
(00:24):
To discuss some of these mandates approved by state lawmakers
this year, we're joined on the Capitol of Pressium by
Eric Lindser, head of the New York Health Plant Association,
which represents insurers covering more than eight million New Yorkers.
Welcome back to the show. Eric, Thanks for having me Dave,
so we can get into some of the different mandates
proposed this year's by state lawmakers, like no costs inhalers
and coverage for speech therapy for stuttering but for starters,
(00:48):
can you explain how insurers determine what they're going to
provide coverage for and what that process looks like and
maybe how fluid it might be.
Speaker 2 (00:58):
Yeah, health plans will use it. Pharmacy and therapeutic committees
to develop guidelines based on nationally recognized clinical evidence. Now,
those committees are typically comprised of folks with clinical knowledge,
both you know that may work with the plantball also
outside experts, including individual providers in the local region. So
what they'll do is they'll look at the latest clinical literature,
(01:21):
standards of practice, consultations with outside experts, outcome data, and
then make determinations as to the types of services that
they're that they're covering. Additionally, you know, oftentimes plans will
look to see what Medicare is also covering. So it's
a variety of different inputs that are coming, but it's
all based on looking at the national recognized clinical guidelines
(01:45):
to ensure that what they're providing for and what the
coverage represents is in the best interest of the patient.
Speaker 1 (01:51):
And when you say the best interest, is it just
about the health outcomes or is there a cost benefit
analysis that you do as well, Because you know, while
individuals might say I'm going to spend all the money
in the world to get myself healthy, you're in a
different business than that. You obviously look at the situation
more holistically. Well.
Speaker 2 (02:12):
Two important points Dave. First, national studies have shown that
about fifteen to thirty percent of care is care that's
not really in the best interest to the patient either
it's you know, excessive or unnecessary care, So that adds
to cost. But typically the pharmacy and therapeutic committees first
we'll look at quality clinical the clinical evidence. Cost becomes
(02:35):
a secondary factor if there are competing or comparable services therapies, drugs,
et cetera. So cost is an element of it, but
it all starts with first looking at the clinical evidence
to determine if it's sound medical practice that has solid
outcomes behind it.
Speaker 1 (02:53):
So let's talk about an example that is tangible and
of something that lawmakers weighed in this year nearly unanimously,
and that's dealing with insurance coverage for inhalers at no costs.
And it's a little more specific than that because it's
certain types of inhalers. So can you talk about this
(03:13):
final version that lawmaker has approved and is now awaiting
the governor signature and what your concerns might be.
Speaker 2 (03:19):
Sure, while the bill is certainly well intentioned, it does
a couple of things. First and foremost, it limits cost
sharing or prohibits cost sharing for at least one rescue
inhaler and one controller inhaler. Now plans already provide coverage
for asthma medications, but limiting or prohibiting cost sharing doesn't
(03:40):
get at the underlying issue, which is the rising cost
of prescription drugs. In this instance, the original bill.
Speaker 3 (03:47):
Was much broader.
Speaker 2 (03:48):
Both houses recognized the concerns that our industry and the
employer community had raised about the potential cost implications of
prohibiting any cost sharing, and limited the bill to acquiring
plans to offer coverage for one form of a controller
therapy and one form of a rescue in hailer at
(04:08):
no cost. So the challenge with this is anytime you
start cap or prohibit cost sharing, it doesn't really get
at the factors that are driving the affordability challenge, which
is the high price of, among other things, the high
price of prescription drugs.
Speaker 1 (04:21):
What about this idea that the initial upfront cost is
a deterrent for some people and as a result an inhaler,
the person then has to go to an emergency room
and maybe they care that they're going to receive there
is demonstrably more than what the health insurer might have
(04:42):
had to pay if they were going to ensure that
inhalers were available at no cost. Is that something that
insurers have to sort of game out when thinking about, say,
why they might be opposed to something like this.
Speaker 2 (04:54):
It's important to remember that plans have robust programs for
the treatment of asthma, want individuals who may you may
have asthma taking the necessary steps, including first and foremost,
you using a controller and hailer so that they don't
end up in the emergency room. That said, there are
other approaches that plans may take. In some instances, plans
(05:16):
have eliminated cost sharing for certain asthma medications, but at
the same time, having a blanket prohibition for all sends
the message to prescription drug manufacturers that they don't have
to do anything to control the underlying costs. So the bill,
by limiting the prohibition around cost sharing to just one controller,
one rescue and hailer, I think recognizes those concerns. At
(05:39):
the same time, it sets a challenging precedent that anytime
you start to limit prohibit cost sharing, those costs then
flow back in the form of higher premiums.
Speaker 1 (05:50):
Well, yeah, I want to talk about why there might
be some interested stakeholders that aren't patients when it comes
to these types of mandates. But first let me reintroduce
you for listeners joining us. This is the Capital press
Room and we're speaking with Eric Lindzer, the President and
CEO of the New York Health Plan Association, which represents
insurers in New York. So something like the inhalers we've
(06:12):
been discussing, or legislation dealing with coverage of backup cochlear
implant devices. I have to imagine that the people who
are making those devices have a vested interest in basically
making them more widely available if someone is paying for them.
(06:33):
That from their perspective, let's get these into the hands
of more people. And as long as someone's paying for it,
we don't really care who right, right.
Speaker 2 (06:41):
And I mean that's certainly a challenge when we think
about affordability. Premiums reflect the underlying cost of care. So
as prices go up, that means premiums are going to
become more expensive. So if you've got a mandate or
a provision that prohibits any kind of cost sharing, there's
no incentive on the part of the manufacture, whether it's
a pharmaceutical company or a device manufacturer, to think about
(07:03):
how to compete on price. Instead, they look at it
and may say, well, essentially, the potential for an unlimited
benefit here, there's no incentive for them then to contain
their costs if the member doesn't have to have any.
Speaker 3 (07:17):
Kind of out of pocket costs.
Speaker 2 (07:19):
Ultimately, those out of pocket costs that the members not
paying end up in the form of premiums. It's something
that folks may not necessarily connect, but it is a
factor in rising health insurance premiums.
Speaker 1 (07:31):
So you made the point that some of these coverage
mandates are too broad, and you are supportive of them
becoming more tailored and more narrow, even though not necessarily
happy with the final versions. What about that same critique
of the health insurance that their approach to some of
these issues is too broad and not with enough nuance.
(07:53):
And is there an argument to be made that maybe
you'd accept that if insurers took a more nuanced approach
to how they were going to cover something like speech
therapy or the access to inhalers, that then maybe we
wouldn't need legislative responses like that. Is there room for
improvement there?
Speaker 2 (08:13):
Well, I think you have to look at the different
ways that insurers have to justify their cost, their procedures,
the services that they cover first and foremost, we have
a very rigorous process with the Department of Financial Services
in reviewing the health plan rates. Second, when it comes
to coverage determinations, there is the opportunity for both internal
(08:37):
appeals and external grievances that if an individual feels like
they're not getting the services that they need or deserve,
that there's a way to escalate that process. Plants have
to provide that information in every determination that they make.
And then finally, for a lot of these decisions, there's
an extensive amount of reporting that gets submitted to the state.
(08:57):
But by and large, what we're seeing, whether it's around
claim denials or external appeals, is that the plans generally
do a very good job in making those determinations, and
it's very small percentage of denials that are actually taking place.
Speaker 1 (09:13):
So I don't know if you watch South Park, but
there is an excellent episode about Eric Cartman trying to
appeal a decision by his health insurance company, and it
speaks to kind of the byzantine process that some people experience.
Speaker 3 (09:29):
And do you.
Speaker 1 (09:31):
Feel like there's any room for improvement in that area,
because I think a lot of listeners probably have had
or know someone who's tried to get coverage for something
that maybe they thought they were tode and maybe even
at the end they got it, it wasn't necessarily the
easiest process, and.
Speaker 2 (09:47):
We're certainly open to having conversations about ways to improve
the process. But also remember, anytime a plan makes a determination,
particularly if they deny a particular service, plans have to
include information to the member and provider about how to
appeal those decisions. So the information is there, there's a
(10:07):
there's a state external appeals process, so there's a number
of different ways that individuals have to be able to
appeal uh, you know, or dispute dispute a health planned decision.
But you know, then again we're certainly willing to engage
in that conversation. I think part of the challenge here
is also that other aspects of the healthcare system, drug manufacturers, hospitals,
(10:30):
providers should be subject to similar rigorous standards that the
health plans are.
Speaker 1 (10:36):
So where do things stand now with the mandates that
are under consideration for the governor, whether it is inhalers,
UH screenings for lung cancer, speech therapy for stuttering, the
cochlear implants or creative art therapy. Uh, they haven't been
delivered to the governor as far as I'm aware, So
they haven't. You know, the clock's not starting on those yet.
(10:58):
But what sort of conversation are that are going on
right now? And what is the argument you make to
the governor on why she should veto these or maybe
make Chapter amendments.
Speaker 2 (11:09):
You're certainly right, they haven't been sent up, Dave. I
think it's important to recognize that first, state law already
mandates coverage of about forty seven specific services, treatments, supplies,
and practitioners. So there's an extensive number of mandates that
New York has on the books. When we've talked with legislators, staff,
and the administration, our argument is that at a time
(11:31):
when affordability is the focal point, particularly in healthcare, adding
new costs, whether it's mandated benefits or requiring coverage of
specific services, these are going to ultimately lead to higher
premiums for employers and consumers. But the other challenge here, Dave,
is that while folks think about these mandated benefits as
being applicable to everybody, mandated benefits only apply to a
(11:54):
very small number of individuals in New York. It's largely
worn by the vigils and small businesses because large companies
typically will self ensure, and in New York about fifty
five percent of individuals are covered by a self insured policy.
So as the state passes more and more mandated benefits, employers,
(12:15):
particularly small and mid size companies, are the ones that
bear these costs because they don't have the same type
of flexibility that large companies have.
Speaker 1 (12:24):
Well, before I let you go, we're coming up on
about two years since the Governor announced her New York
State Commission on the Future of Healthcare, and we still
haven't heard word one from them. Have you heard anything
from them? Have they reached out to you and wething
going on?
Speaker 3 (12:37):
We haven't heard much.
Speaker 2 (12:38):
I know there was that TU article maybe about a
month month or two ago. We're certainly very interested in
understanding what some of the recommendations are going to be.
You know, at a time when affordability is a challenge.
You know, there's a lot obviously a lot of conversation
this time of year around the premium rates, which the
Department of Financial Services will you know, eventually announce the
(13:00):
approved rates, but there really needs to be a lot
more focus on the underlying costs hospital prices, prescription drug prices,
and the other piece, Dave. As far as mandated benefits,
there really should be a process similar to what's in
place in thirty other states that the state looks at
what the cost of these mandated benefits are going to
be to understand what their implications are going to be
(13:22):
for the individuals that purchase insurance, particularly individuals and small businesses.
Speaker 1 (13:27):
Well, we've been speaking with Eric Lindser. He is the
head of the New York State Health Plan Association. Eric,
thanks so much for making the time. Really appreciate it.
Speaker 3 (13:35):
Thanks for having me back, and for more
Speaker 1 (13:53):
Capital Pressroom content, visit Capitol Pressroom dot org or wherever
you download your favorite podcasts.
While death and taxes are two things you can always
count on, followers of the state legislature and Albany can
also reliably bet on bills requiring health insurers to cover
more services and treatments. And while this type of well
meaning legislation is intended to make healthcare more affordable, the
reality of our medical system in America is that there's
no such thing as a free lunch or maybe an inhaler.
(00:24):
To discuss some of these mandates approved by state lawmakers
this year, we're joined on the Capitol of Pressium by
Eric Lindser, head of the New York Health Plant Association,
which represents insurers covering more than eight million New Yorkers.
Welcome back to the show. Eric, Thanks for having me Dave,
so we can get into some of the different mandates
proposed this year's by state lawmakers, like no costs inhalers
and coverage for speech therapy for stuttering but for starters,
(00:48):
can you explain how insurers determine what they're going to
provide coverage for and what that process looks like and
maybe how fluid it might be.
Speaker 2 (00:58):
Yeah, health plans will use it. Pharmacy and therapeutic committees
to develop guidelines based on nationally recognized clinical evidence. Now,
those committees are typically comprised of folks with clinical knowledge,
both you know that may work with the plantball also
outside experts, including individual providers in the local region. So
what they'll do is they'll look at the latest clinical literature,
(01:21):
standards of practice, consultations with outside experts, outcome data, and
then make determinations as to the types of services that
they're that they're covering. Additionally, you know, oftentimes plans will
look to see what Medicare is also covering. So it's
a variety of different inputs that are coming, but it's
all based on looking at the national recognized clinical guidelines
(01:45):
to ensure that what they're providing for and what the
coverage represents is in the best interest of the patient.
Speaker 1 (01:51):
And when you say the best interest, is it just
about the health outcomes or is there a cost benefit
analysis that you do as well, Because you know, while
individuals might say I'm going to spend all the money
in the world to get myself healthy, you're in a
different business than that. You obviously look at the situation
more holistically. Well.
Speaker 2 (02:12):
Two important points Dave. First, national studies have shown that
about fifteen to thirty percent of care is care that's
not really in the best interest to the patient either
it's you know, excessive or unnecessary care, So that adds
to cost. But typically the pharmacy and therapeutic committees first
we'll look at quality clinical the clinical evidence. Cost becomes
(02:35):
a secondary factor if there are competing or comparable services therapies, drugs,
et cetera. So cost is an element of it, but
it all starts with first looking at the clinical evidence
to determine if it's sound medical practice that has solid
outcomes behind it.
Speaker 1 (02:53):
So let's talk about an example that is tangible and
of something that lawmakers weighed in this year nearly unanimously,
and that's dealing with insurance coverage for inhalers at no costs.
And it's a little more specific than that because it's
certain types of inhalers. So can you talk about this
(03:13):
final version that lawmaker has approved and is now awaiting
the governor signature and what your concerns might be.
Speaker 2 (03:19):
Sure, while the bill is certainly well intentioned, it does
a couple of things. First and foremost, it limits cost
sharing or prohibits cost sharing for at least one rescue
inhaler and one controller inhaler. Now plans already provide coverage
for asthma medications, but limiting or prohibiting cost sharing doesn't
(03:40):
get at the underlying issue, which is the rising cost
of prescription drugs. In this instance, the original bill.
Speaker 3 (03:47):
Was much broader.
Speaker 2 (03:48):
Both houses recognized the concerns that our industry and the
employer community had raised about the potential cost implications of
prohibiting any cost sharing, and limited the bill to acquiring
plans to offer coverage for one form of a controller
therapy and one form of a rescue in hailer at
(04:08):
no cost. So the challenge with this is anytime you
start cap or prohibit cost sharing, it doesn't really get
at the factors that are driving the affordability challenge, which
is the high price of, among other things, the high
price of prescription drugs.
Speaker 1 (04:21):
What about this idea that the initial upfront cost is
a deterrent for some people and as a result an inhaler,
the person then has to go to an emergency room
and maybe they care that they're going to receive there
is demonstrably more than what the health insurer might have
(04:42):
had to pay if they were going to ensure that
inhalers were available at no cost. Is that something that
insurers have to sort of game out when thinking about, say,
why they might be opposed to something like this.
Speaker 2 (04:54):
It's important to remember that plans have robust programs for
the treatment of asthma, want individuals who may you may
have asthma taking the necessary steps, including first and foremost,
you using a controller and hailer so that they don't
end up in the emergency room. That said, there are
other approaches that plans may take. In some instances, plans
(05:16):
have eliminated cost sharing for certain asthma medications, but at
the same time, having a blanket prohibition for all sends
the message to prescription drug manufacturers that they don't have
to do anything to control the underlying costs. So the bill,
by limiting the prohibition around cost sharing to just one controller,
one rescue and hailer, I think recognizes those concerns. At
(05:39):
the same time, it sets a challenging precedent that anytime
you start to limit prohibit cost sharing, those costs then
flow back in the form of higher premiums.
Speaker 1 (05:50):
Well, yeah, I want to talk about why there might
be some interested stakeholders that aren't patients when it comes
to these types of mandates. But first let me reintroduce
you for listeners joining us. This is the Capital press
Room and we're speaking with Eric Lindzer, the President and
CEO of the New York Health Plan Association, which represents
insurers in New York. So something like the inhalers we've
(06:12):
been discussing, or legislation dealing with coverage of backup cochlear
implant devices. I have to imagine that the people who
are making those devices have a vested interest in basically
making them more widely available if someone is paying for them.
(06:33):
That from their perspective, let's get these into the hands
of more people. And as long as someone's paying for it,
we don't really care who right, right.
Speaker 2 (06:41):
And I mean that's certainly a challenge when we think
about affordability. Premiums reflect the underlying cost of care. So
as prices go up, that means premiums are going to
become more expensive. So if you've got a mandate or
a provision that prohibits any kind of cost sharing, there's
no incentive on the part of the manufacture, whether it's
a pharmaceutical company or a device manufacturer, to think about
(07:03):
how to compete on price. Instead, they look at it
and may say, well, essentially, the potential for an unlimited
benefit here, there's no incentive for them then to contain
their costs if the member doesn't have to have any.
Speaker 3 (07:17):
Kind of out of pocket costs.
Speaker 2 (07:19):
Ultimately, those out of pocket costs that the members not
paying end up in the form of premiums. It's something
that folks may not necessarily connect, but it is a
factor in rising health insurance premiums.
Speaker 1 (07:31):
So you made the point that some of these coverage
mandates are too broad, and you are supportive of them
becoming more tailored and more narrow, even though not necessarily
happy with the final versions. What about that same critique
of the health insurance that their approach to some of
these issues is too broad and not with enough nuance.
(07:53):
And is there an argument to be made that maybe
you'd accept that if insurers took a more nuanced approach
to how they were going to cover something like speech
therapy or the access to inhalers, that then maybe we
wouldn't need legislative responses like that. Is there room for
improvement there?
Speaker 2 (08:13):
Well, I think you have to look at the different
ways that insurers have to justify their cost, their procedures,
the services that they cover first and foremost, we have
a very rigorous process with the Department of Financial Services
in reviewing the health plan rates. Second, when it comes
to coverage determinations, there is the opportunity for both internal
(08:37):
appeals and external grievances that if an individual feels like
they're not getting the services that they need or deserve,
that there's a way to escalate that process. Plants have
to provide that information in every determination that they make.
And then finally, for a lot of these decisions, there's
an extensive amount of reporting that gets submitted to the state.
(08:57):
But by and large, what we're seeing, whether it's around
claim denials or external appeals, is that the plans generally
do a very good job in making those determinations, and
it's very small percentage of denials that are actually taking place.
Speaker 1 (09:13):
So I don't know if you watch South Park, but
there is an excellent episode about Eric Cartman trying to
appeal a decision by his health insurance company, and it
speaks to kind of the byzantine process that some people experience.
Speaker 3 (09:29):
And do you.
Speaker 1 (09:31):
Feel like there's any room for improvement in that area,
because I think a lot of listeners probably have had
or know someone who's tried to get coverage for something
that maybe they thought they were tode and maybe even
at the end they got it, it wasn't necessarily the
easiest process, and.
Speaker 2 (09:47):
We're certainly open to having conversations about ways to improve
the process. But also remember, anytime a plan makes a determination,
particularly if they deny a particular service, plans have to
include information to the member and provider about how to
appeal those decisions. So the information is there, there's a
(10:07):
there's a state external appeals process, so there's a number
of different ways that individuals have to be able to
appeal uh, you know, or dispute dispute a health planned decision.
But you know, then again we're certainly willing to engage
in that conversation. I think part of the challenge here
is also that other aspects of the healthcare system, drug manufacturers, hospitals,
(10:30):
providers should be subject to similar rigorous standards that the
health plans are.
Speaker 1 (10:36):
So where do things stand now with the mandates that
are under consideration for the governor, whether it is inhalers,
UH screenings for lung cancer, speech therapy for stuttering, the
cochlear implants or creative art therapy. Uh, they haven't been
delivered to the governor as far as I'm aware, So
they haven't. You know, the clock's not starting on those yet.
(10:58):
But what sort of conversation are that are going on
right now? And what is the argument you make to
the governor on why she should veto these or maybe
make Chapter amendments.
Speaker 2 (11:09):
You're certainly right, they haven't been sent up, Dave. I
think it's important to recognize that first, state law already
mandates coverage of about forty seven specific services, treatments, supplies,
and practitioners. So there's an extensive number of mandates that
New York has on the books. When we've talked with legislators, staff,
and the administration, our argument is that at a time
(11:31):
when affordability is the focal point, particularly in healthcare, adding
new costs, whether it's mandated benefits or requiring coverage of
specific services, these are going to ultimately lead to higher
premiums for employers and consumers. But the other challenge here, Dave,
is that while folks think about these mandated benefits as
being applicable to everybody, mandated benefits only apply to a
(11:54):
very small number of individuals in New York. It's largely
worn by the vigils and small businesses because large companies
typically will self ensure, and in New York about fifty
five percent of individuals are covered by a self insured policy.
So as the state passes more and more mandated benefits, employers,
(12:15):
particularly small and mid size companies, are the ones that
bear these costs because they don't have the same type
of flexibility that large companies have.
Speaker 1 (12:24):
Well, before I let you go, we're coming up on
about two years since the Governor announced her New York
State Commission on the Future of Healthcare, and we still
haven't heard word one from them. Have you heard anything
from them? Have they reached out to you and wething
going on?
Speaker 3 (12:37):
We haven't heard much.
Speaker 2 (12:38):
I know there was that TU article maybe about a
month month or two ago. We're certainly very interested in
understanding what some of the recommendations are going to be.
You know, at a time when affordability is a challenge.
You know, there's a lot obviously a lot of conversation
this time of year around the premium rates, which the
Department of Financial Services will you know, eventually announce the
(13:00):
approved rates, but there really needs to be a lot
more focus on the underlying costs hospital prices, prescription drug prices,
and the other piece, Dave. As far as mandated benefits,
there really should be a process similar to what's in
place in thirty other states that the state looks at
what the cost of these mandated benefits are going to
be to understand what their implications are going to be
(13:22):
for the individuals that purchase insurance, particularly individuals and small businesses.
Speaker 1 (13:27):
Well, we've been speaking with Eric Lindser. He is the
head of the New York State Health Plan Association. Eric,
thanks so much for making the time. Really appreciate it.
Speaker 3 (13:35):
Thanks for having me back, and for more
Speaker 1 (13:53):
Capital Pressroom content, visit Capitol Pressroom dot org or wherever
you download your favorite podcasts.
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