Guest post by Claudia Calhoon, MPH, Director of Health Policy at the New York Immigration Coalition.
On Wednesday, December 13, the Assembly Committee on Health, the Assembly Puerto Rican/Hispanic Taskforce, and the Assembly Taskforce on New Americans convened a public hearing on Immigrant access to healthcare. Coverage 4 All, a campaign of Health Care For All New York led by the New York Immigration Coalition and Make the Road New York was instrumental in advocating for the hearing. The campaign’s goal is to expand insurance eligibility to all New Yorkers to reduce disparities in coverage. Barriers to coverage are just one of the many current threats to immigrant health access and quality.
Agencies that provided testimony included the New York State Department of Health, the New York City Mayor’s Office for Immigrants Affairs, New York City Department of Health and Mental Hygiene, and New York City Health + Hospitals. In addition, fifteen individuals from a range of social service, advocacy, health care, and community settings spoke about the impact of the federal administration on immigrant mobility, health utilization, coverage eligibility, and enforcement of language access regulation. Amid a federal landscape hostile to immigrants, New York State programs and protections are increasingly important.
Critical areas of particular attention included making sure that new mothers know they can safely continue to enroll in Medicaid and get prenatal care regardless of their immigration status, and continue to use the Women’s Infants, and Children (WIC) Food and Nutrition services. Another area of common interest among advocates was the opportunity that the state has to expand the Child Health Plus insurance program to cover young adults up to age 29 at a cost of $81 million. Dr. Alan Shapiro, co-founder of Terra Firma, which works with unaccompanied minors, noted that health needs don’t end when young people turn 19. These individuals “still have comprehensive primary care needs. They need access to immunizations, urgent care, sexual and reproductive health services.” The Child Health Plus Expansion is part of Health Care for All New York’s policy agenda, and the key priority of the Coverage 4 All campaign.
Hearing testimony from multiple stakeholders also highlighted the critical nature of improving enforcement of language access regulations, addressing mental health needs of immigrant communities subject to heightened stress under enhanced federal immigration enforcement, and ensuring that safety net hospitals have the revenue they need to care for all New York State residents.
Guest post by Ann Danforth, Progressive States Advocacy and Policy Manager at Raising Women’s Voices-NY.
In their latest attack on women’s health, the Trump Administration released two new rules that weaken the Affordable Care Act (ACA)’s birth control benefit. The interim final rules (see here and here), which went into effect immediately, allow employers to deny their employees birth control coverage because of an employer’s moral objection to birth control. In addition, the rules expand the scope of employers who can cite religious objections for denying their employees birth control coverage. Luckily, here in New York, many (but not all) women will be protected by new state regulations that require insurers to cover birth control with no cost sharing.
The ACA guarantees coverage for a set of women’s preventive health care services, which through federal regulations issued by the Obama administration, include birth control. As a result, employers are required to cover all methods of FDA-approved birth control for employees with no cost sharing. Under the Obama administration, houses of worship were exempt from the requirement to cover birth control for their employees. An accommodation ensured that women who work for a narrowly-defined group of employers that object to providing coverage on religious grounds still had access to seamless birth control coverage.
The Trump Administration’s recent actions expand the exemption to include all employers, universities, and insurance companies, and make the accommodation optional. Now, instead of an accommodation that protects employers’ religious views and women’s access to vital health care, these new rules simply allow almost any employer to refuse to provide birth control coverage to their employees for either moral or religious objections to contraception.
While not all employers will choose to deny contraceptive coverage to their employees, these rules create sweeping new exemptions that put women’s coverage at risk, and roll back important gains in women’s health. Thanks to the ACA, 62.4 million women have insurance coverage for their birth control with no out-of-pocket costs. The percentage of women with employer sponsored insurance who were paying out-of-pocket expenses for birth control pills fell from 1 out of every 4 women before passage of the ACA to just 1 out of every 28 women in 2014. And in 2013 alone, women saved $1.4 billion in co-pays and deductibles on birth control pills.
Here in New York, an estimated 3,855,517 women between the ages of 18 and 64 have preventive services coverage, including birth control, with zero cost sharing thanks to the ACA. Fortunately, many New York women will still have guaranteed access to contraception with no cost sharing because of recently finalized New York State regulations. These regulations require coverage without co-pays for one type of contraception in each of the 18 FDA-approved categories (the federal ACA standard), and allow for the dispensing of 12 months of contraception after an initial three-month allotment (June 28, 2017 Register: Page 13, Notice of Adoption). Unfortunately, however, our state requirements do not reach “self-funded” insurance plans, which are regulated by the federal government, and not subject to the New York regulations. Because as many as 40 percent of New Yorkers have these self-funded plans, there are a number of New York women who will not be protected. The Trump Administration’s new rules have put us in a place where a woman’s zip code, employer, or income determine her ability to access the contraception she needs.
While our colleagues at the ACLU and the Center for Reproductive Rights have already filed lawsuits challenging the new rules, we must call on employers to stand up for their employees and publicly declare they will continue to provide contraceptive coverage. In addition, all of us who are employees can demand that our employers affirm they will continue providing contraceptive coverage. We will also continue to support legislation here in New York – the proposed Comprehensive Contraception Coverage Act – that would place even stronger contraceptive coverage requirements into state law.
Although it has no immediate effect, the executive order the President signed yesterday morning instructs several federal agencies to consider proposals that could destabilize the individual insurance markets established under the Affordable Care Act (ACA).
The executive order instructs relevant agencies to propose regulations that would:
- Expand the use of association health plans, which allow small businesses to group together to purchase health insurance;
- Allow more people to enroll in short-term limited duration insurance, which are exempt from ACA consumer protections, for longer periods of time; and
- Allow the sale of health insurance across state lines.
The expansion of association and short-term limited duration health plans would both create loopholes for younger, healthier consumers to purchase one of these plans instead of plans offered through the Marketplace. If younger, healthier people leave the Marketplace, premiums will rise for consumers that remain and may become unaffordable.
Selling insurance across state lines presents a different problem, especially for states like New York. New York has worked really hard to pass insurance regulations that protect consumers. Insurance sales across state lines would essentially allow insurance companies to choose their regulators, which would make insurance less available and less accountable to the needs of New Yorkers and consumers across the country.
If federal agencies do propose these rules as the President instructs, there will be an official notice of proposed rulemaking and at least a 30-day comment period before any new regulation would go into effect. It is therefore unlikely that any changes will take place before 2018.
This does not affect the upcoming open enrollment period, which will begin on November 1. If you or someone you know needs help enrolling in health insurance, please call (888) 614.5400 for in-person assistance in your area. Don’t forget, consumers enrolling in Medicaid, the Essential Plan, and Child Health Plus can enroll year-round.
You can check out additional resources on the executive order here.
Guest post by Max Hadler, Senior Health Policy Manager at the New York Immigration Coalition. On Tuesday, September 5, the Trump administration announced that it was terminating the Deferred Action for Childhood Arrivals (DACA) program in six months. The announcement sets in motion a process to further disrupt the lives of 800,000 individuals who President Trump has been threatening since he launched his campaign in 2015. Created by an executive order signed by President Barack Obama in 2012, DACA provides two-year work authorizations and deferral of deportation to DREAMers – people who came to the U.S. before the age of 16, have resided in the country continuously since 2007, do not have a criminal record, and have either graduated from high school, are currently enrolled in an educational program, or have served in the U.S. military.
The cruelty and inhumanity of Trump’s DACA decision have serious health implications. Most acutely, the stress and anxiety caused by the uncertainty around DACA have created an immediate need for mental health services for recipients and their families. The rescission undermines the powerful emotional healing effect DACA has had on U.S. citizen children with DACAmented mothers, an impact recently highlighted in this Science article.
At a time when DACA recipients most need access to comprehensive health coverage, the termination of the program profoundly threatens their eligibility for any coverage at all. As a result of the work authorizations granted by their DACA status, many of the 42,000 DACAmented New Yorkers are covered by employer-sponsored insurance. Once their work authorizations expire, these individuals will lose access to both their jobs and their health insurance.
The impending end of DACA is particularly important in New York. Our state considers DACA recipients to be “permanently residing under color of law,” or PRUCOL, and thus eligible for state-funded Medicaid. As a result, between 5,000 and 10,000 DACAmented New Yorkers have Medicaid coverage. Many advocates believe there is a legal argument that DACA recipients should still be considered PRUCOL after they lose DACA status, but it remains unclear if the State agrees.
Even without a specific legal underpinning, the state can and should continue to cover this population. The Department of Health seemed to acknowledge this by releasing a statement on Tuesday that read in part, “New York State believes it has a legal and moral obligation to exhaust every available avenue to protect immigrants and their families by providing comprehensive access to health care, regardless of circumstance.”
The Coverage 4 All campaign has proposed a number of solutions for New York State. To start, New York can ensure the continued coverage of DACA recipients through state-financed Medicaid. There are also existing policy proposals that would protect a broader range of young adult immigrants, including those who lose their employer-sponsored insurance. Assembly Bill 8054 would expand the Child Health Plus program to age 29, extending New York’s universal children’s coverage program to young adults currently excluded because of their status, including many of the DREAMers who stand to lose their coverage when their DACA authorizations expire.
The DACA decision is only the latest attack on immigrant communities from the Trump administration. In this hostile environment, it is imperative that New York State take action to meaningfully protect and promote the health coverage of its immigrant residents.
*Anyone in New York City in need of mental health services should call NYC WELL, a hotline staffed by licensed counselors trained to help with anxiety, depression, and other issues. NYC WELL counselors have been specifically trained to work with call-ins related to DACA.