The state’s success was no accident. It began with a receptive customer base and the benefit of experience, since New York already had some of the country’s most generous insurance coverage for the poor and sick. Resistance to the health exchange among Republicans in the state may, oddly enough, have helped make it more successful. […]That Republican opposition meant that the team Cuomo put in charge by executive order to create the exchange was experienced and could craft an exchange that meant tight regulations for consumers and insurers alike, resulting in a successful—though not entirely popular—program. They decided to require all insurers to offer the same type of coverage in the plans they sold off the exchange as those they sold on it. The end result is that none of the state's insurers offered out-of-network coverage for individuals, an effort to keep their costs down. The downside for consumers there is that they're restricted to providers. The upside for consumers is that this means their premiums are greatly reduced: "Individual premiums for Manhattan residents, for instance, dropped from $1,534 for a standard health maintenance organization, or H.M.O., in 2013 to $621 for a comparable exchange plan now."
[T]he exchange had a rough start. Republicans in the State Senate tried to block it by refusing to support the creation of an independent authority to run it. New York could have followed 36 other states in simply joining the exchange set up by the federal government, whose numerous problems were not yet evident. Instead Gov. Andrew M. Cuomo established the state’s exchange by executive order, deeding it to “seasoned stagehands,” as Mr. Newell put it, in the Health Department.
Benjamin Lawsky, the state’s financial services superintendent, says that after the first year or two of operations, they'll revisit the issue of whether or not to require that insurers also allow out-of-network coverage. But, for now, they've hit on a pretty successful formula.