New York Assembly Bill A04498

New York 2025-2026 Regular Session

• Introduced: 2/4/25
• Refer: 2/4/25
• Refer: 1/7/26

Caption

Provides that the New York state health care quality and cost containment commission shall: evaluate each mandated benefit; investigate current practices of health plans with regard to the mandated benefit; investigate the potential premium impact of repealing and/or modifying the mandated benefits on all segments of the insurance market; hold at least two public hearings; submit a report to the legislature; makes related provisions.

Summary

This bill expands the duties of the New York State Health Care Quality and Cost Containment Commission, a body within the Department of Insurance that reviews health insurance mandated benefits. It keeps the commission’s existing role in evaluating proposed mandated benefits, but makes that review mandatory rather than discretionary when requested by the governor or the chairs of the Assembly and Senate insurance committees. The bill also requires the commission to use evidence-based medical literature, examine premium impacts, consider state costs in light of the Affordable Care Act, and gather information from public hearings and diverse stakeholders. The bill goes further by requiring the commission to conduct a recurring review of all existing state laws that mandate health benefits, beginning within nine months after the commission is seated and repeating at least every three years. After that review, the commission must issue recommendations for repealing or modifying mandated benefits and submit implementing legislation by February 1, 2026. The bill also sets a fast-track legislative process for that implementing bill: it must be introduced without amendment, voted on within a specified window, and, if approved, sent to the governor.

Impact

If enacted, the bill would amend Insurance Law section 213 to broaden the commission’s authority from reviewing proposed mandated benefits to systematically reviewing existing mandated-benefit laws. It would affect health insurers, health plans, self-funded plans to the extent they can be evaluated, health care providers, consumers, and employers by creating a formal process to assess whether mandated benefits should be repealed or modified based on cost, quality, and evidence-based effectiveness. It also imposes procedural requirements on the legislature by directing introduction and expedited consideration of implementing legislation.

Sentiment

The available context suggests the bill is framed as a cost-containment and evidence-based review measure, with an emphasis on premium impact, quality, and independent analysis. Because there are no recorded votes or committee transcripts provided, there is no direct record of support or opposition in the supplied materials. The bill’s structure indicates a policy preference for scrutinizing health insurance mandates and potentially reducing or modifying them if they are not cost-effective or evidence-supported.

Contention

The main points of contention are likely to be whether the commission should be required to review and potentially recommend repeal or modification of existing mandated benefits, and whether that process could lead to reduced coverage for consumers. Health insurers and cost-containment advocates would likely support the bill’s focus on premiums and evidence-based review, while consumer advocates, providers, and groups benefiting from mandated coverage may object to the possibility of weakening benefit mandates. The requirement that implementing legislation be introduced and voted on without amendment may also be controversial because it limits legislative flexibility.