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Don’t leave New York’s low-income families out in the cold!

Posted on February 12, 2013 by Arianne Slagle

Baby, it's cold outside!

The Governor’s proposed 2013-2014 Executive Budget aims to get rid of New York’s Family Health Plus (FHP) program by closing off enrollment by the end of this year.  Enrollees who earn below 138% of FPL (about $26,000 per year for a family of three) will get the current Medicaid benefit (with the exception of long-term care).  Parents up to 150% of FPL (about $28,000 for a family of three) will get subsidized coverage on the forthcoming Exchange.

However, eligible folks who aren’t able to enroll by the cutoff date, or whose income shifts into the eligible range after the cutoff date will be out of luck.  These folks will have to look for affordable coverage on the Exchange.

The Exchange will provide premium tax credits to help lower the cost of insurance for most low- and moderate-income folks who purchase coverage on the Exchange.  But, it will still be too expensive for many families.  For example, a family of three earning 150% of FPL will still have to come up woth $1,099 per year on their own for coverage on the Exchange whereas the same family would have gotten free coverage with very low cost-sharing through FHP.

But there is a solution to this affordability problem.

  • First, we ask the State to apply for an 1115 waiver – similar to those being pursued by Massachusetts and Vermont – to provide an affordability wrap for premiums and cost sharing for folks up to 200% of FPL not eligible for Medicaid.  This would help to get out-of-pocket costs on the Exchange down as close as possible to FHP levels. If NY can’t get federal matching funds, the State should earmark a portion of the $2.5 billion in State Medicaid savings under the ACA for this.
  • Next, New York should lay the foundation for a Basic Health Plan (BHP) by authorizing establishment of this program starting in 2015.  The ACA gives states the option of creating a federally-funded BHP to cover adults up to 200% of FPL not eligible for Medicaid.  This program would result in State savings of between $500 million and $1 billion each year.

This is a big opportunity for State lawmakers to ensure affordable coverage is available to the individuals and families who need it most.  And, when federal funds or state savings are factored in, it would require little or no additional cost to the State.

Quite simply, it’s the right thing to do.

 

 

Filed under: ACA, Affordable, Comprehensive Coverage, Governor Cuomo, Insurance Exchange, Insurance reform, New York State Budget, State budget | Tagged: , , , , | Comments Off

The Basic Health Plan sounds like the right choice

Posted on February 1, 2013 by Arianne Slagle

The choice is pretty darn clear

Under the ACA, states are allowed the option of creating a Basic Health Plan (BHP) for low-income adults who earn too much to qualify for Medicaid.  Ordinarily, if these folks don’t have employer-sponsored coverage then come 2014 they will be able to buy insurance through the Exchange with the help of federal tax credits.  But, even with the tax credits this coverage may still be too expensive for them. The BHP then would act as a bridge between the free or low-cost Medicaid coverage and the higher priced options available on the Exchange.

Don’t be fooled by the name though - there is nothing “basic” about it.  According to the ACA, BHP coverage must be as affordable and comprehensive as what these adults would have gotten on the Exchange.  In New York, coverage would likely resemble that of the Family Health Plus program.

New York currently offers public coverage to low-income adults through its Family Health Plus program, the cost of which is split with the federal government.  New York also pays for Medicaid coverage for low-income immigrants without help from the federal government.  Through the BHP program, New York would be able to cover both of these groups and have the federal government pay for it all.  This would save the state between $500 million and $1 billion per year.

Sounds great, right? Problem is, the federal government still hasn’t released guidance on this program, and isn’t planning on doing so anytime soon.  Unfortunately, state policymakers won’t commit to the program until they are sure of all the details.  So, until that happens, it is unlikely that New York will get any of the cost-savings and affordability protections that the BHP has to offer.

HCFANY has created a policy brief on this issue to explain it in detail, urge federal policymakers to release BHP guidance, and provide recommendations to state policymakers. 

Click here to read HCFANY’s policy brief, titled “The Basic Health Program Option in the Affordable Care Act.”

 

Filed under: ACA, Affordable, Comprehensive Coverage, Federal health reform, Immigrants, Insurance Exchange, Insurance reform, Medicaid | Tagged: , | Comments Off

New York Rising

Posted on January 10, 2013 by Arianne Slagle

Its a fine view from up here!

Governor Cuomo gave his annual State of the State address yesterday, and we at HCFANY were generally pleased to see the inclusion of the state’s health benefit Exchange in the Governor’s progressive agenda.

Much of the speech focused on the state’s economic revitalization, and we believe that a consumer-friendly Exchange will do much to further economic growth in New York.  We know that the Exchange will lower health insurance costs significantly for consumers and small businesses, and that’s money in people’s pockets.  The added preventive care benefits provided by the Affordable Care Act will also help to lower health care spending for our state in the long run.

The Governor also said he wanted to restore New York to its “rightful place as the progressive capital of the nation” and that the forthcoming health benefit Exchange will help make our state’s health care system the “finest in the nation.”  We know that the Exchange will help more than one million uninsured New Yorkers afford health insurance coverage.  HCFANY will be working hard this year to make sure that implementation of the Exchange is as consumer-friendly as possible so that it may indeed be the finest in the nation!

HCFANY issued a short statement on the Governor’s State of the State address, which you can read by clicking here.

You can also read the Governor’s full State of the State book, which includes his prepared remarks as well as background information.

 

Filed under: Affordable, Governor Cuomo, Insurance Exchange, Insurance reform, New York Health Benefit Exchange, New York State Politics, Public Health, Women | Tagged: , , , , , | Comments Off

Prior approval law saves New Yorkers $500 million

Posted on January 7, 2013 by Arianne Slagle

Yes folks, it's the Hoover Dam!

A press release issued by Governor Cuomo’s office yesterday announced that New Yorkers will save over $500 million on health insurance premiums this year thanks to the Department of Financial Services’ (DFS) utilization of the State’s prior approval law.  As you may remember, New York’s 2010 prior approval law allows DFS officials to review insurance rate increases before they go into effect and scale them back if they are too high.

Health insurers had requested overall increases averaging around 12.4%, which were then cut down to an average of 7.5% by DFS.  Rate increases for small group plans will increase an average of 9.5%, down from the average 15.7% increase requested by the insurance plans.  Prior to passage of the prior approval law, annual premium rate increases averaged 14%. 

These modest increases stand out at a time when many states are experiencing double-digit increases in premiums.  For example, an article in Saturday’s New York Times notes that states like Florida and Ohio have seen rates rise by as much as 20%, with similar rate increases proposed in California.

The Affordable Care Act requires states to review any proposed rate increases above 10%, however New York is one of 37 states which allows state officials to deny excessive rate increases (an issue that is explored further in the Times article). 

So, thanks again to our Senate Democrats who really championed this issue back in 2010 and made savings like this possible today.  We appreciate the work you do!!!

 See below for a breakdown of the average requested rate increase and what the DFS ended up actually approving.  For the full list of increases by insurance plans, see the Governor’s press release.

 

Health Insurance Market Segment
Total Number
of Members Affected
Requested Annual Rate Increase (Weighted Average)
Approved Annual Rate Increase (Weighted Average)
Reduction by DFS
Individual, direct-pay
52,383
+9.54%
+4.48%
-5.06%
Small Group
1,280,649
+15.77%
+9.59%
-6.18%
Large Group
611,780
+7.84%
+5.20%
-2.64%
HealthyNY
117,859
+24.84%
+11.81%
-13.03%
Medicare Supplement
319,722
+3.27%
+2.59%
-0.68%
Overall
2,382,393
+12.37%
+7.52%
-4.85%

Click here to read the Governor’s press release.

Click here to read the NYTimes article, titled “Health Insurers Raise Some Rates by Double Digits.”

 

 

Filed under: ACA, Accountability, Affordable, Employer Sponsored Health Insurance, Federal health reform, Governor Cuomo, Governor Paterson, HealthyNY, New York Health Reform, Premiums, Small Business | Tagged: , , , , , | Comments Off

Blindsided by Bills

Posted on November 20, 2012 by Arianne Slagle

Connor is a 68-year-old Westchester resident with heart problems, insured in a preferred provider organization (PPO). He had a stent put in last year, and when he was experiencing extreme shortness of breath he rushed to his local in-network hospital. The heart problem was too severe to be treated there, so he was transferred to a major academic medical center nearby, also in-network. After observation and testing, his treatment team decided that he needed emergency open heart surgery to implant a special pump. Though he was at an in-network hospital, neither the surgeon nor his assistant was in-network. The surgeon billed $71,000, out of which Connor’s insurer’s out-of-network benefit paid $29,000. The assistant billed $35,000, out of which Connor’s insurer paid $6,737. In total, Connor was left owing more than $70,000 for his surgery, even though he had “good insurance” and went to in-network facilities for his emergency treatment.

Connor is one of many New Yorkers who have been blindsided by balance billing, when patients are charged the difference of what an insurer agrees to pay a provider.

The problem of “surprise” out-of network medical billing has recently gained attention in the press, including an article in today’s New York Times. Earlier this year, the New York State Department of Financial Services released a report, An Unwelcome Surprise: How New Yorkers Are Getting Stuck with Unexpected Medical Bills from Out-of-Network Providers. 

This year, Health Care For All New York made a statement on out-of network billing, including recommendations: New York should protect insured consumers from “Surprise” out-of-network billing, require all insurers to have adequate networks and offer a reasonable mechanism to go out-of-network when medically appropriate, and ensure transparency about billing from health providers and plans.

Visit Community Health Advocates  for the Out-of-Network DIY Appeals Packet if you think your plan is not reimbursing you enough for out-of-network care.

Filed under: Affordable, Balance billing, Employer Sponsored Health Insurance, Insurance reform | Comments Off

New York’s Uninsured Children Don’t Have to Wait Until 2014

Posted on October 23, 2012 by Arianne Slagle

Nationally, the number of uninsured children decreased to 5.5 million in 2011 from 6.4 million in 2009, according to a new report by the Georgetown University’s Center for Children and Families. New York has contributed to that success by extending coverage to more children through Medicaid and Child Health Plus. The state has successfully reduced the number of uninsured children from about 205,000 in 2009 to about 181,000 in 2011.

“Children need health care coverage to grow and thrive so this is good news for New York and the nation,” said Joan Alker, Co-Executive Director of the Georgetown University research center.

New York has made progress but still ranks 6th in terms of states with the highest number of uninsured children in the nation. Half of all uninsured children live in Texas, California, Florida, Georgia, Arizona and New York.

“While the uninsured rate for New York children is heading in the right direction, we can do more toto ensure that every child has the coverage they need and deserve,” according to Kate Breslin, Executive Director of the Schuyler Center for Analysis and Advocacy.

About 96 percent of New York children have health care coverage while the success of Medicaid’s companion program, Medicare, has brought the insured rate for seniors up to about 99 percent.

In New York, school-age children are more likely to be uninsured than those age 6 and under.

“Most of New York’s uninsured children are already eligible for coverage through Medicaid or Child Health Plus but haven’t enrolled because they don’t realize they qualify or have been unable to overcome bureaucratic barriers to enrollment,” Lorraine Gonzalez, Director of Health Policy at the Children’s Defense Fund – New York.

New York is now working on making the enrollment process easier by removing unnecessary paperwork requirements and setting up an online application. Those improvements are expected to be completed by 2014 as part of the Affordable Care Act implementation.

“There’s been a lot of talk about all the help uninsured people can expect in 2014 but New York’s uninsured kids don’t have to wait that long,” said Kate Breslin. “They are very likely to be eligible for affordable coverage right now.”

To apply for public health insurance in New York, click here to find a Facilitated Enroller near you.

The Georgetown University Center for Children and Families (CCF) is an independent, nonpartisan policy and research center. Click here for the full report.

Filed under: ACA, Affordable, Children, Medicaid, Uninsured | Comments Off

Another ACA victory: The PoopStrong Effect

Posted on August 6, 2012 by Arianne Slagle

Click here for more info!It has not ceased to amaze me just how many stories of people who have been helped by the ACA continue to come out of the woodwork.

The most recent one to hit the media’s attention is that of 31 year-old Arijit Gurha, a graduate student at the University of Arizona who was recently diagnosed with stage 4 colon cancer.

Unfortunately for him, his Aetna student health plan had a $300,000 lifetime benefit limit.  Needless to say, the plan offered little protection to him once his cancer was discovered.

Arijit’s story has a happy ending, thanks to three very different aspects of the ACA: (1) a new provision that says that student health plans can no longer have lifetime benefit limits or unreasonable annual limits, (2) the new pre-existing condition insurance plan, and (3) the new scrutiny that the ACA has brought onto both health insurer profits and spending through the new MLR rules, and on consumer protections.

See, Arijit was eventually given the option of securing coverage through a newly renegotiated student health plan or the PCIP.  However, his six months spent undergoing lifesaving cancer treatments with no health insurance benefits left him with over $100,000 of debt.

His fundraising blog, aptly titled poopstrong.org, helped him raise some money, but it wasn’t enough.  So, Arijit decided to put Aenta’s feet to the fire by utilizing his Twitter account.  The New York Times’ Well Blog has a great account of the conversation that ensued, which you can read here.  But the amazing thing is that IT WORKED.  Yes, that’s right, in the end, Aetna agreed to pay the over $100,000 debt he had accrued since hitting his lifetime max.

How was this possible, you ask? Well basically, it had to do with what I’d like to refer to as the PoopStrong Effect.  Basically, because of the new consumer protections written into the ACA, health insurance profits and spending have begun receiving a whole lot of attention from the mainstream media.  Pair this with a young person with an incredibly compelling story and the power of the internet behind him, and a forthcoming law that will change the rules in his favor, and you’ve got yourself the perfect conditions to bring forth some serious health plan PR damage control. 

Two years ago, before the ACA became law, the PoopStrong Effect would have never been possible.  Remember the 2007 Michael Moore film “Sicko”? A great conversation starter, but it didn’t do much to help the folks profiled in the film who had suffered from insurance industry abuses.  Yet today, a young guy with cancer and a twitter account is able to move a mountain.

The landscape has certainly changed, hasn’t it? And for that, we can thank the ACA.

 

Filed under: ACA, Accountability, Affordable, Children, Comprehensive Coverage, Federal health reform, Insurance reform, Medical debt, Uninsured, young adult | Tagged: , , , , , , | Comments Off

Tele-Town Hall on Women’s Preventive Health TOMORROW!

Posted on July 31, 2012 by Arianne Slagle

For many women, the fight for insurance coverage of women’s preventive health services has been a very long one. 

But, thanks to the Affordable Care Act (ACA), women will no longer need to worry about getting much of the preventive health care they need because of the costs associated.  

A new provision in the ACA is scheduled to go into effect starting tomorrow, August 1st, which requires all new health plans will have to cover the following services without co-pays or deductibles:

  • Well-woman visits
  • Gestational diabetes screening
  • HPV DNA testing
  • STI counseling, and HIV screening and counseling
  • Contraception and contraceptive counseling
  • Breastfeeding support, supplies, and counseling
  • Domestic violence screening

To kick off the event tomorrow, Senator Mark Begich (D-AK), Chairman of the Senate Democratic Steering and Outreach Committee, Senator Patty Murray (D-WA), Senator Barbara Mikulski (D-MD) and other Democratic Senators will be hosting a Tele-Town Hall on the new free preventive services for women under the ACA. 

The call will be held tommorrow, Wednesday, August 1, 2012 at 3:00 p.m. ET. 

For dial-in information, please RSVP to: https://democrats.senate.gov/steering/tele-town-hall-on-free-preventive-services-for-women/

 **Please note that this call is not for press purposes**

 

 

Filed under: ACA, Affordable, Federal health reform, Insurance reform, Underinsured, Women, young adult | Tagged: , , , , | Comments Off

Women, we can (and will) do better.

Posted on July 16, 2012 by Arianne Slagle

A new Commonwealth Fund report released last Friday shows that American women are more likely to go without needed health care because of cost and have a harder time paying for medical bills than women in 10 other countries with unversal health care systems in place.

These countries included Germany, the United Kingdom, France, Canada, Sweden, Norway, Switzerland, the Netherlands, New Zealand, and Australia.

A total of 43% of women surveyed in the U.S. reported that they had gone without needed care or had not filled a prescription due to cost in the past year.  Only 7% of women in the U.K. reported having the same problem.  

The report also showed that the number of unininsured and underinsured women in the U.S. is climbing.  18.7 million women were uninsured in the U.S. in 2010, up from 12.8 million in 2000.  In 2010, 16.7 million women were underinsured, up from 10.3 million in 2003.

However, times they are a changing!  Thanks to the Affordable Care Act (ACA), the U.S. may soon catch up to other industrialized nations when it comes to women’s health. The health reform law will dramatically lower women’s exposure to high health care costs and remove a number of barriers to  health care. And, while a lot of the major insurance expansions won’t start until 2014, a lot of the early reforms are already helping women access affordable care.

The report estimates that, once fully implemented, the ACA will provide near-universal health insurance coverage for women. Only 8% of women are estimated to remain uninsured, compared with the 20% who lack health insurance today. 

Click here to read the full Commonwealth Fund report, titled “Realizing Health Reform’s Potential: Oceans Apart: The Higher Health Costs of Women in the U.S. Compared to Other Nations, and How Reform Is Helping.”

 

 

Filed under: ACA, Affordable, Comprehensive Coverage, Federal health reform, Insurance reform, Medical debt, Underinsured, Uninsured, Women, young adult | Tagged: , , , | Comments Off

The road to financial freedom just got a little smoother

Posted on July 6, 2012 by Arianne Slagle

Keeping in line with our “independence” theme this week, Forbes.com posted a great article on how the recent decision by the Supreme Court to uphold the Affordable Care Act (ACA) is improving many folk’s financial ability to retire.

And just how is it doing that, you ask?  Well, there’s a number of ways.  Basically, all of these things that the ACA is doing for folks - discounts for folks with Medicare who hit the donut hole, the pre-existing condition insurance plan (called the NY Bridge plan), tax-credits, etc - amounts to more money in your pockets.  More money in your pockets means more money that you can put towards other things – like retirement.

It’s pretty interesting stuff! You can check out the full article by clicking here.  

 

Filed under: ACA, Affordable, Federal health reform | Tagged: , , , , , | Comments Off

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