Report by MergerWatch Shows Current State Oversight Inadequate to Protect Community Access to Health Care

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Hospitals have been consolidating at increased rates over the last five years. Merger and acquisition transactions grew from 66 transactions in 2010 to 112 in 2015. Earlier this month, the MergerWatch Project released the results of a national survey, which concluded that current state hospital oversight programs are inadequate to protect consumers’ access to needed health care services in their own communities.

By analyzing current Certificate of Need (CON) laws for hospital oversight, MergerWatch found that only 35 states and the District of Columbia actually have a Certificate of Need Program in place. California has a similar procedure through the Office of the Attorney General. In states that do have CON Programs in place, the majority do not require CON review for affiliations that do not involve formal sale, purchase, or lease or for hospital closures.

These less formal affiliations can still lead to a loss of access to critical health care services for consumers. In Sierra Vista, Arizona, for example, women lost access to many reproductive health services, including tubal ligation, when a nearby secular hospital joined a Catholic hospital system in 2010. Women in need of such services are sent to the nearest non-religious hospital, which is 80 miles away.

MergerWatch also developed a grading system based on whether a state’s hospital oversight program meets certain criteria including when CON review is required, CON review standards, and effective engagement with affected consumers and the public. Under this grading system only six states receive an A or A-. New York State receives a B grade overall.

Many existing CON Programs are not consumer friendly and make it difficult for consumers to access material information about hospital transactions and how they will impact their access to health care. Notably, only nine states require consumer representation on the CON reviewing body, and only six states require a separate public hearing for each CON application.

The final section of the report outlines model policies for state oversight of hospital transactions and action steps for advocates to take ensure that consumer interests are protected.

Access the full report here.

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Guest blog by Caroline Davidson, LGBT Outreach Intern for Raising Women’s Voices-NY. LGBT health coverage and care have improved in recent years, but a surprising number of individuals still are unaware or unsure of how to apply for coverage. Once insured, LGBT people can have trouble finding LGBT-competent providers, and can encounter other roadblocks and frustrating delays using their health plans to get the care they need.

To address this need, Raising Women’s Voices-NY (as co-chair of the HCFANY LGBT Task Force) has developed an LGBT outreach team called REACHLGBTIt’s dedicated to meeting LGBT individuals where they’re at – to listen to their needs, get them referrals and hear their stories to understand needed policy changes. The outreach team has been attending LGBT- and youth-focused events, including Queens Pride and Brooklyn Pride. You can find Team Member Jacob Barela at Harlem Pride this Saturday, June 25, from noon to 6 p.m. The event is taking place in Jackie Robinson Park (entrance is at 148th and Bradhurst Avenue).  The team will also be at the ROAR youth event next Wednesday, June 29, from 5:30 to 7:30 p.m. at Manhattan’s LGBT Center, 208 West 13th Street.

Here are some of the key messages the REACHLGBT outreach team members are sharing:

  • Health plans may NOT…

–discriminate against LGBT people

–refuse to cover medically-necessary gender transition services

–deny coverage to anyone based on a pre-existing condition (like HIV/AIDS)

  • ALL health plans must cover emergency care, doctor visits, prescription drugs and preventive care.
  • You can get free application help from an LGBT-friendly enrollment assistor.
  • You can apply year-round for FREE or LOW-COST health coverage through Medicaid, the new Essential Plan, or Child Health Plus.

Team members have been making a special effort to connect with LGBT adolescents and young adults about the care they need. Outreach workers like Caroline Davidson, in the photo at right, have thoroughly enjoyed the opportunity to work on the ground with LGBT folks. “While wanting health insurance or care might not be someone’s idea of a ‘glamorous’ pride, it is a highly RWV-NY_LGBTBlogPhoto2.pngnecessary part of being LGBT,” Caroline says. She notes that 60 percent of the LGBT New Yorkers reached so far through these outreach events have been young people ages 16 to 24.

Many of the individuals who approach the REACHLGBT table are looking to get enrolled in health insurance because they are new to New York City or had a recent life event resulting in the need for coverage. The team provides referrals to LGBT-competent navigator agencies, including organizations that belong to the HCFANY LGBT Task Force. For those young people who already have insurance, many of the questions posed to the outreach team concern how to find LGBT-competent health providers, where to obtain care for gender transition services, and how to understand the rights of transgender or gender nonconforming people in society. As outreach workers point out, tabling is a great chance to not only give individuals information, but also to hear their information and perspectives.

Often people who approach the REACHLGBT table offer health services themselves or work for organizations that do, and are therefore looking to make connections. This has enabled the REACHLGBT team to build into an ever-growing referral database of individuals and organizations to which LGBT people can be referred for help. You can contact the REACHLGBT team at 212.870.2010 or info@RaisingWomensVoices.net

 

 

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Guest blog by Max Hadler, Health Advocacy Specialist at The New York Immigration Coalition

Despite the major health care coverage gains achieved under the Affordable Care Act, more than 450,000 New Yorkers remain uninsured because their immigration status makes them ineligible for affordable coverage. As a result of the continued failure to approve federal immigration reform or lift health coverage restrictions on many groups of immigrants, it continues to fall to state and local governments to pick up the slack. Health Care For All New York has responded to the dire lack of coverage options for immigrants by launching the Coverage 4 All campaign under the leadership of two of the coalition’s member organizations, Make the Road New York and the New York Immigration Coalition.

The campaign’s mission is to obtain affordable coverage options for all New Yorkers, regardless of immigration status. A shorter-term goal is to expand coverage to a smaller group of immigrants who are “permanently residing under color of law” (PRUCOL). These are people whose presence in the U.S. is known and may be unauthorized, and who have received confirmation from the federal government that it has no intention of deporting them. In New York, immigrants who are PRUCOL are eligible for state-funded Medicaid when they meet the income requirements (less than $16,242 annual income for a single person). However, the same people are not currently eligible for the Essential Plan, New York’s low-cost, comprehensive coverage program for low-income residents whose incomes are too high for Medicaid (up to $23,540 annually for a single person). This restriction runs counter to New York’s history of providing coverage to many immigrants who are excluded from federally-funded programs.

Most immigrants who are PRUCOL are young adults who grew up in the U.S. and have Deferred Action for Childhood Arrivals (DACA) as a result of President Obama’s 2012 executive order providing them two-year work authorizations and a reprieve from deportation. These young people are encouraged to work as a result of their DACA status but are then faced with a dearth of affordable coverage options when their incomes increase beyond the Medicaid threshold because they are ineligible for the Essential Plan and prohibited from accessing tax credits through the New York State of Health insurance marketplace.

To begin to remedy these coverage gaps, the New York State Assembly is working to expand Essential Plan eligibility to include immigrants who are PRUCOL. The Assembly included $10.3 million in its 2016-17 budget to provide this coverage, but the funding was ultimately cut in budget negotiations. Assemblymembers Richard Gottfried and Marcos Crespo have since introduced legislation that would expand Essential Plan eligibility to include immigrants who are PRUCOL. Bill A10054 was successfully voted out of the Assembly Health Committee on May 17 and is now awaiting a vote by the Ways and Means Committee. HCFANY has submitted a memorandum of support for the bill. Others are encouraged to submit their own memorandums and to borrow language from the HCFANY memo as needed. Please contact me at the New York Immigration Coalition if interested in registering your support (mhadler@nyic.org).

@mx_214The ACA has helped New York close the coverage gap by enrolling over 2.7 million New Yorkers into coverage. But some New Yorkers remain ineligible for these new options for affordable coverage because of immigration status limitations on affordability programs.

The Community Service Society, a HCFANY Steering Committee member, released a new report today that offers an in-depth analysis of costs, eligibility and coverage options related to providing affordable and high-quality health insurance to nearly a half million unauthorized immigrants living in New York who are uninsurable due to their immigration status.

The paper, “How New York Can Provide Health Coverage to its Uninsured Immigrant Residents,” describes three coverage options that would improve health coverage for a vulnerable segment of the state’s population while also closing the coverage gap left by the Affordable Care Act (ACA).

Despite the state’s expansive public insurance programs, there are as many as 457,000 unauthorized immigrants ineligible for coverage. Uninsured people are more likely to get sick and even die younger, and the cost of care can mean financial ruin for uninsured families. Treating uninsured patients also strains the budgets of community health care providers that treat them.

The policy paper investigates three coverage options that would extend health insurance to between 90,100 and 241,600 immigrants New Yorkers who are ineligible for Medicaid and Marketplace coverage due to their immigration status. Funding even the most ambitious of these proposals would result in a less than one percent increase in the state’s health budget of roughly $65 billion.

The report also points out a more modest policy fix that New York could enact this year, while the State considers the more comprehensive options outlined in the report. This option, the Essential Plan “Clean Up,” would extend Essential Plan coverage to about 5,500 lawful immigrants in New York with immigration statuses that would make them eligible for Medicaid in New York, but not for the federally-funded Essential Plan. These New Yorkers include young adults who qualify for Deferred Action for Childhood Arrivals status, also known as the Dreamers.