The health of 8 million children

girls_doctor_officeThe Alliance for Health Reform and Kaiser Family Foundation held a briefing on Monday about the Children’s Health Insurance Program (CHIP). CHIP provides quality health coverage for over 8 million kids – including nearly 500,000 in New York under Child Health Plus.

The Program was extended in the ACA through 2019, but unfortunately funding for the program expires next September without congressional action. This would be bad news for kids - many could lose coverage (some due to the “family glitch“) or pay more for comprehensive coverage. Not to mention it would cut short a program that has been enormously successful in reducing the child uninsurance rate, which fell by half since the program began in 1997.

A summary of the briefing and all materials are available on the Alliance for Health Reform website, including background materials, videos, and speaker presentations. Speakers included Joan Alker, executive director at Center for Children and Families at Georgetown University, Robin Rudowitz, associate director for Kaiser Commission on Medicaid and the Uninsured, Robert Stewart, analyst at the Congressional Budget Office, and Cathy Caldwell, director of the Bureau of Children’s Health Insurance in the Alabama Department of Public Health.

Check it out!

 

 

kid examining monkey This week, National Academy for State Health Policy and Georgetown University’s Center for Children & Families released a joint report analyzing Children’s Health Insurance Program (CHIP) coverage in 42 separate programs in 38 states. For the past 17 years, CHIP has given states federal funds to operate public health insurance programs designed for children. New York’s own version of the program, Child Health Plus, has been running even longer - 2014 marks it’s 24th year!

Why the focus on CHIP coverage now? The ACA extends CHIP funding through 2015, but after that point the future is somewhat uncertain. By April 15, 2015, the Secretary of HHS will have to determine if coverage offered under the new Qualified Health Plans is “at least comparable” to the benefits and cost-sharing in CHIP. States will soon after have the option to cover children through comparable QHPs. It’s important that advocates and consumers alike know and voice the benefits of CHIP, which has been responsible for millions of children gaining coverage since it’s inception. More children are gaining coverage through the program all the time – recent enrollment numbers show over 80,000 children enrolled in New York’s Child Health Plus program between October 1 and April 15, nearly 70,000 of whom are newly uninsured.

There are federal rules for certain aspects of CHIP coverage and costs – for example, the cost paid by families can’t be more than 5% of their income. Within these requirements States still have a fair amount of flexibility to choose benefits and cost-sharing for enrollees. The report finds that CHIP programs generally offer comprehensive coverage with low cost-sharing. About 1/3 of the programs provide benefits very like the Medicaid packages in their state, which are known for being very comprehensive. Plans generally cover basic physical, hospital, and laboratory services without limitations; all plans cover dental, vision, and hearing services, though with varying limitations. Most programs charge some sort of premium, but about 1/3 of the programs have no cost-sharing.

New York’s Child Health Plus, is one of the most generous in the country, offering subsidized coverage for any child up to 19 from families up to 400% of the Federal Poverty Level. Premiums range from $9 per child for those just above the Medicaid level, to $180 for those at the 400% of FPL who live in high cost regions of the state. New York is also one of the states with no cost-sharing beyond premiums, making Child Health Plus a particularly affordable option. And, coverage is open to any child, regardless of immigration status. Children in families with incomes above 400% FPL can still buy into the program at full price.

Child Health Plus covers most services without limitations, including physician, hospital, and lab services, prescription drugs, pre-natal care vision and dental services. Uncovered services include nursing care, case management, and care coordination, as well as non-Emergency Transport. And, a few services, like orthodontics and outpatient mental health services, are covered with limitations.

For more on coverage and costs, including a handy table for Child Health Plus on page 91, visit the full report.

Want to learn more about children’s health coverage in New York? Join HCFANY for our Children, Youth and Families Task Force Meeting on May 28 in Albany. More details here.

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Photo: Advocates and consumers at HCFANY’s press conference about how the Governor’s budget would make coverage more affordable, stop surprise bills, and support consumer assistance programs. From left: Gladys Puglla, consumer; Mark Scherzer, New Yorkers for Accessible Health Coverage; Elisabeth Benjamin, Community Service Society; Lara Kassel, Medicaid Matters New York; Bob Cohen, Citizen Action of New York; Oswil Liz, consumer; Kate Breslin, Schuyler Center for Analysis and Advocacy (podium)

It’s budget season, and our advocacy efforts are in full swing. Yesterday, HCFANY members and supporters gathered in Albany from across the state – some trekking 5 hours to get there – to advocate for our key budget priorities:

  • Create a Basic Health Program
  • Protect consumers from surprise medical bills
  • Support consumer assistance programs

We were not alone – the halls and elevators were full of other advocates who came to the capitol to make their case to the legislature. More importantly, we are not alone in our continued efforts to advocate for quality, affordable health care!

Over the past few weeks, HCFANY and allied groups and coalitions have joined forces to make sure that the three proposals above (all in Governor Cuomo’s executive budget) remain in the budget as the process moves forward. We’ve submitted memos of support and organizational sign-on letters on surprise bills and our three budget priorities, and gathered in Albany for advocacy days. We’ve also held two press conferences featuring the real stories of New Yorkers who would be helped by the Governor’s budget proposals. This collaboration helps to amplify our voices in Albany.

Key Budget Priorities Press Conference

We kicked off yesterday’s HCFANY advocacy day with a press conference featuring both advocates and consumers. Members of the HCFANY steering committee – Mark Scherzer of New Yorkers for Accessible Health Coverage, Elisabeth Benjamin from the Community Service Society of New York, and Kate Breslin of Schuyler Center for Analysis and Advocacy – joined Medicaid Matters New York Coalition Coordinator Lara Kassel to outline the benefits of the Basic Health Program, out-of-network protections, and consumer assistance programs. And, we heard from New Yorkers who have been directly affected by these issues:

Oswil Liz, 24, spoke about the challenge of affording health insurance, even with the subsidies available on the Marketplace. Thanks to the ACA, Oswil now has insurance, but with student loans and his wages working as a manager at McDonald’s, the premiums are still difficult for him to afford. A Basic Health Program would benefit Oswil and others in his situation.

Gladys Puglla, a single mother with three children told the stunning story of her experience with surprise medical bills. When Gladys had a stroke in 2012, she received services at two hospitals. Gladys has insurance, but she was unconscious when admitted to both hospitals and so couldn’t give her insurance information. After her treatment, she was hit with $138,000 in surprise medical bills for out-of-network services. Gladys makes $37,000 a year. Thankfully, Gladys was able to seek help from Make the Road New York, part of the Community Health Advocates statewide network of consumer assistance services. With their help, Gladys was able to reduce her bill and received a grant from the New York Times Neediest Cases fund to pay the difference. Many consumers do not have these resources, which is why HCFANY is working to stop surprise bills and support consumer assistance programs like those that helped Gladys.

Surprise Bills Press Conference

Late last week, Bill Ferris of AARP, Blair Horner of New York Public Interest Research Group (NYPIRG), and Chuck Bell of Consumers Union joined HCFANY members Heidi Siegfried of New Yorkers for Accessible Health Coverage, Mike Burgess of the American Cancer Society Cancer Action Network, and Gene Veigl and Aaron Ward of the MS Society at another press conference calling on the Legislature to pass the Governor’s legislation specifically to protect consumers from surprise medical bills.

Claudia Knafo, a concert pianist who received a surprise medical bill seeking $101,000 for neck surgery, for which her health plan offered to pay only $3,500, told her compelling story.  You can see coverage by the local nbc affiliate here.

Learn more about our budget priorities:

Basic Health Program: take a look at our policy brief and read the Community Service Society 2012 report

Stop Surprise Bills: Read our policy brief and visit our new take action: stop surprise bills page and Consumer Union’s new website: stopsurprisemedicalbills.org.

Consumer Assistance: Read our policy brief and visit communityhealthadvocates.org

Hooray!

New Yorkers have a LOT to smile about this morning! The proposed health insurance rates for the New York Health Benefit Exchange have been released and show that prices on the individual market will soon be dropping by a whopping 50%.

This means that New Yorkers who currently buy coverage on their own, costing more than $1,000 per month in most cases, will be able to save thousands on health insurance next year without having to compromise on quality.

Health Care For All New York (HCFANY) had the pleasure of reviewing the proposed rates for the non-Exchange plans, which were released last month, and found the average Silver-level plan to be about $500 per month.  These same plans sold on the Exchange will be even more affordable for New Yorkers who qualify for premium tax credits to further lower costs.  You can read HCFANY’s comments on the proposed non-Exchange plans by clicking here.

The premium rates for all health insurance plans in New York can be found on the Department of Financial Services website.  As with the annual rate review process, everyone is encouraged to look over the proposed rates and supporting documentation and submit comments online.  You can find the proposed rates by clicking here.

The New York Times has produced stellar coverage of this phenomenon in an article out today, “Health Plan Cost for New Yorkers Set to Fall 50%.”  They have also posted a great document that shows all of the proposed rates for Exchange plans.  You can find that document by clicking here.