By Joseph Spector, Gannett Albany
There are 1.2 million New Yorkers aged 25 to 44 without health insurance, mainly people who are single and earn less than $45,960 a year.
As the state aggressively seeks to enroll 1 million uninsured over the next three years, they are looking to grow the insured ranks through young, single people and older workers who either work part-time or have been laid off.
Many of them - if they earn less than $45,960 a year as an individual or $94,200 as a family of four - would also be eligible for tax credits if they enroll. That's the 400 percent threshold over the poverty line.
The new health exchange opened for registration on Oct. 1. The state Health Department said Wednesday that 174,000 New Yorkers have applied for health insurance through the exchange program, and 37,030 have fully enrolled. But two-thirds of those were determined to be eligible for taxpayer-funded Medicaid, not a private insurer.
State officials said they expect most enrollees will be eligible for some tax breaks, even if they make too much to qualify for Medicaid.
"Nevertheless, there's certainly some people over 400 percent of the federal poverty level who can purchase through marketplace and will see rates that are 53 percent less on average than today's individual direct pay market," said Donna Frescatore, the executive director of the New York Health Benefit Exchange.
After a rocky start, Frescatore said the state is pleased with the response to the national program. New York had more than 30 million visits to its website in the first week - which appears to be largely due to a computer glitch that limited access to potential enrollees.
But many questions remain for consumers and for small businesses that could use the exchanges.
If a company has fewer than 50 workers, it won't have to offer health insurance, but can do so through the exchanges. For larger employers, they could face fines if they don't offer the insurance by 2015.
Some businesses, like the Rochester-based Wegmans food chain, said it would cut benefits for some part-time workers, encouraging them to enroll in the exchanges.
Businesses "are skeptical of it at best," said Brian Sampson, executive director of Unshackle Upstate, a Rochester-based business group.
"From a financial standpoint, they have to look at what they are paying for the cost of insurance for their employees now compared to the cost of a fine as to whether they offer health insurance," he said.
Even before the exchange, the number of uninsured in New York dropped nearly 5 percent between 2011 and 2012, U.S. census data analyzed by Gannett's Albany Bureau found.
The percentage of uninsured in Monroe County dropped from 7.8 percent in 2011 to 6.7 percent last year, according to the data. That's one of the lowest percentages in the state.
A report for the state Health Department in May by the Urban Institute showed that New York had 2.7 million uninsured New Yorkers.
Nearly half were aged 25 to 44, and half made less than 400 percent of the federal poverty rate, the report found.
Thirty-eight percent were white and 33 percent were Hispanic, with 17 percent who were black. Forty-six percent were single, and 57 percent were male. A majority had only a high school education.
The majority of people who will benefit from the exchanges are young people who aren't offered health insurance through their employer or older people who work several jobs without insurance, said Elisabeth Benjamin, who heads health policy for Community Health Advocates, a statewide group based in Manhattan.
Benjamin is one of the state's hundreds of "navigators" who are trained to help people enroll in the exchanges. She said she signed up a home-care worker in her 30s from the Bronx who earned 174 percent above the poverty limit. The woman is paying $72 a month for a health-insurance plan after tax subsidies.
"That's what it's all about: to really protect working-class people, who don't have a lot of disposable income, to give them really good protection from financial ruin," Benjamin said.
Queens, the Bronx and Brooklyn led the state in the percentage of uninsured New Yorkers, census data showed. In Queens, 17 percent were uninsured in 2012. The data only includes counties with populations above 60,000.
But it's not just a big-city issue. Cattaraugus County in western New York ranked fourth statewide in number of uninsured residents, nearly 11 percent of its population.
Poor individuals and families in need of health care isn't just an inner-city issue, said Nikisha Johnson, president of Mercy Community Services in Rochester. She said the community organization has increasingly seen clients who live in the suburbs.
"Most of the people that we see are people that they're COBRA benefits are expiring," Johnson said. "They are piecing together two or three jobs."
The challenges are formidable to get New Yorkers enrolled in the controversial program.
Young and healthy people may balk at paying a few hundred dollars a month for health insurance. If an uninsured person doesn't get health insurance, they would likely be fined as a tax penalty on their 2015 income taxes. It's about a $95-per-adult penalty for the first year, or 1 percent of annual income. And it increases over time, to as much as $695 a year.
Frescatore said health insurance makes sense over the long term.
"For the security and the peace of mind in the event that something unexpected occurs, and to be able to access preventative services, many of which doesn't have any out-of-pocket costs, the decision to be insured is really right for them," she said.