Making Sense of Delivery System Reform

The Affordable Care Act made a lot of changes – and improvements – to health insurance. But it was also meant to encourage changes in how health care is delivered – the care you get at the hospital, doctor’s office, pharmacy, and other places where people get health care.

Many people have frustrating experiences with health care that go beyond how it’s paid for. Maybe you can’t make an appointment without skipping work, or can’t get your prescription filled on time because of communication problems and end up skipping doses. Maybe you had to get a test done twice because re-doing it was easier than transferring your records to a new physician. Delivery system reform is meant to make the experience of getting health care better – in an ideal world, there would be seamless delivery system that lets doctors and patients focus on their health, not logistics.

HCFANY has produced a new issue brief to help consumers understand what is happening. Delivery system reform could be a great thing for everyone, but changing systems is always hard. A lot of stakeholders have learned to succeed under the status quo, and are afraid of changing how they do business. Consumers need to educate themselves about how delivery reform can benefit them and use their knowledge to encourage reform that benefits patients.

RWV Guest Blog Image UninsuredGuest blog by Lois Uttley, MPP, Director of Raising Women’s Voices-NY. Six years after the Affordable Care Act (ACA) was signed into law and three years after the ACA insurance marketplaces opened, the nation’s uninsured rate has dropped to the lowest level ever recorded. Between 2010 and 2016, the percentage of people without health insurance fell by nearly half, from 16 percent to 8.6 percent. The sharp decline is illustrated in this chart from Vox. The previous low of 9.1 percent was recorded in 2015.

The new numbers were released last week by the National Center for Health Statistics, and are based on the National Interview Survey conducted during the first quarter of 2016. The survey uncovered some important variations among population groups when it comes to health insurance. For example:

  • Only 5 percent of children 17 and younger are now uninsured. Of those, 42.1 percent had public coverage and 54.9 percent had private coverage.
  • Hispanic adults had the greatest decline in un-insurance, going from 40.6 percent in 2013 to 24.5 percent in 2016. But that reduced rate was still much higher than the 2016 rates for non-Hispanic Black (13 percent), white (8.4 percent) and Asian adults (6.7 percent).

States Fully Implementing the ACA Show Biggest Drop In Uninsured

The national survey data also reveal striking disparities between rates of un-insurance in states like New York that have fully implemented the ACA – by expanding their Medicaid programs and creating their own health insurance exchanges, or marketplaces – and those that have refused to do so because of conservative political opposition.

First, let’s look at the impact of a state’s decision to expand Medicaid. In the expansion states, the percentage of uninsured adults (ages 18 to 64) dropped by half — from 18.4 percent in 2013 to 9.2 percent in 2016. By contrast, in non-expansion states, the uninsured rate fell somewhat – from 22.7 percent in 2013 to 16.7 percent in 2016 — but still remained high.

Next, let’s look at the difference in uninsured rates between states that opened their own marketplace (or partnered with the federal government to create a marketplace) and those states that refused to do so, and instead defaulted to having a federally-run marketplace. There have been significant declines in uninsured rates in states with their own marketplaces (from 18.7 percent in 2013 to 9.1 percent in 2016) and in partnership marketplace states (from 17.9 percent in 2013 to 8.2 percent this year).

The survey found a different story in the states with federally-run marketplaces. Although even those states experience a drop in the uninsured rate (from 22 percent to 14.5 percent), the 2016 percentage of residents who remain uninsured is much higher than in the other states.






Hearing Location

The New York State Department of Financial Services is holding a hearing on September 8 to learn more about how New York could be affected by a merger between Anthem and Cigna. Any interested person can submit comments in writing, or even better, attend a hearing on the issue this Thursday in downtown Manhattan. The hearing starts at 10:00AM, on the 6th floor at 1 State Street.

HCFANY has expressed concerns about this merger before, and will do so again on Thursday. The hearing is completely open to the public (you can review the public notice here). Anyone can testify by signing up in advance (just email, and put “ANTHEM-CIGNA 2016 HEARING” in the subject line).  HCFANY’s testimony recommends that DFS reject the merger, for the following reasons:

  1. The Anthem-Cigna merger will reduce competition in New York State.
  2. Competition produces better services at lower costs, even in the complicated world of health insurance.
  3. Remedies or conditions used by regulators in past health insurance mergers have failed to truly protect consumers.

You can read our talking points here for help in crafting your testimony, but the important thing is to tell your own story – DFS wants to hear from you! HCFANY believes this merger will make issues like customer service and affordability even more difficult for New Yorkers, and we think New Yorkers should let DFS know how those problems are affecting them. Even if you do not want to speak in public about the merger, it is important for consumers to attend the hearing – it shows DFS that we care about this issue. If you cannot attend, you can also submit written testimony up until September 15.

The majority of non-elderly Americans get their health coverage through employer sponsored plans, but the ways those plans provide financial protection is changing. According to a new survey by the Kaiser Family Foundation, employers are increasingly relying on cost-shifting through high-deductible plans, higher premiums, and plans with larger co-pays. That means workers and their families have more to lose when healthcare costs spike.


Tools such as price transparency calculators and employee wellness programs are growing in popularity as consumers are pushed to treat healthcare purchasing decisions more like other household expenses. It may pay to shop around and avoid unnecessary office visits or procedures, but healthcare costs are not like other household purchases. Price tags don’t always communicate value, and high quality care is not one-size-fits-all. For some consumers paying more to get the care that suits their needs is the only viable option. The rise of narrow networks, which offer few choices of providers and hospitals in an effort to curb costs to insurers, exacerbates the problems these consumers face.


With wages increasing slowly, consumer advocates are on the alert for healthcare costs that prevent workers from seeking necessary, high-quality care. Nobody should forgo a trip to the doctor when they’re ill because they can’t meet their deductible or afford the copay. The American narrative of employer sponsor health insurance only works if employees aren’t impoverished the moment they need services.