Guest post by Heidi Siegfried, MSW, J.D., Project Director of New Yorkers for Accessible Health Coverage.
Survey results were released last week showing that a majority of New Yorkers living with chronic or rare medical conditions have had the experience their insurance company changing their drug coverage in the middle of the year. They do this by eliminating a drug from the formulary or changing the co-pay – a practice that raises costs on consumers and can disrupt their medical treatment.
On behalf of 36 patient and provider groups, Global Healthy Living conducted a survey that found that nearly two–thirds (65%) of New York residents with chronic illnesses had to switch to a different medication than the one that was prescribed due to a change in coverage.
- 54% had to try multiple medications before finding another medication that worked for them
- 72% reported that their new medication worked somewhat or much worse than the originally prescribed medication
- 51% experienced side effects after switching
- 35% reported seeing their health care provider or going to the emergency room due to the complications following a switch
- 10% reported being hospitalized after a switch
Disrupting the continuity of care and delaying effective treatment can result in detrimental life threatening consequences and can actually lead to more medical complications, expensive hospitalizations, emergency room use, and higher health care costs. It can also discourage consumers from continuing with needed treatment due to side effects or because drug failure erodes their trust in medication. Few health plans have robust exceptions or appeals processes to protect consumers who may depend upon particular drugs for their care when formularies are changed. However, it this happens to you and you need help to use your plan’s appeal process, you can contact Consumer Health Advocates for assistance.
Patient and Consumer Advocates like Center for Independence of the Disabled, doctors, and legislators are calling for passage of legislation, S5022-C (Serino)/A2317-C (Peoples-Stokes) to prohibit insurance companies and pharmacy benefit managers (PBMs) from switching drug coverage in the middle of the year when patients cannot change their health insurance until the next open enrollment period. The Assembly passed the legislation earlier this year and has approved it the last four years.
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.
Yesterday afternoon, the Senate released a tax bill that would eliminate the penalty for not having health insurance established under the Affordable Care Act (ACA). The non-partisan Congressional Budget Office (CBO) estimates that repealing the individual mandate would cause 13 million people to lose their health insurance by 2027, including 4 million in the first year alone.
Without the individual mandate, younger, healthier people would lack incentive to purchase health insurance and would exit the individual market. This means that the people that remain in the individual market will be older, in poorer health, and require more expensive care, which will increase premiums. The CBO estimates that premiums would increase by about 10 percent in most years between 2018 and 2027, which could make it more difficult for people to afford health insurance in the future.
Congress could vote on this bill as early as tomorrow. Please call 202.224.3121 and tell your member of Congress to vote no on this bill that could hurt millions of people’s access to health care. You can choose to be connected to your Senator or your Representative.
Information on New York Targets:
- Representatives Zeldin, King, Donovan, and Stefanik have all said that they will vote “NO.” Please thank them and encourage them to stand strong!
- Representatives Faso, Tenney, and Katko are leaning toward voting “NO.” Please help push them to a definitive “NO” vote.
- Representatives Collins and Reed are supporting the bill.
Guest post by Ben Anderson, Director of Health Policy at Children’s Defense Fund-NY. Here we are 39 days and counting since the September 30th deadline for Congress to fund the Children’s Health Insurance Program (CHIP), and yet families of the 350,000 New York children who depend on CHIP for coverage are still waiting for Congress to act. Sadly, once again children are being held hostage to political debates.
Created specifically for children, CHIP’s benefits and provider networks are designed to ensure children in working families who are not eligible for Medicaid have access to child-appropriate services, providers, specialists, and facilities. Despite bipartisan support for a strong, five-year extension of CHIP in both the House of Representatives and the Senate, debate continues about how to pay for CHIP and the extension of other important health programs.
Last week, the House of Representatives passed the Championing Healthy Kids Act, a bill that includes the same strong, bipartisan five-year extension of CHIP that the House Energy and Commerce and Senate Finance Committees approved and that most child health advocates strongly support. However, the bill passed by the House pays for the extension of CHIP and other critical health programs for vulnerable populations with offsets that would cause undue harm to children and families. These provisions passed over the objections of many in the House and are jeopardizing the bill’s passage in the Senate.
The sad irony is that Congress is bickering over how to fund CHIP and other programs in the bill, when the total cost for these programs is merely 1% of the amount Congress will add to the deficit to provide tax cuts to the wealthiest individuals in America. The senselessness must end. We’re so close to the finish line. There is bipartisan support for CHIP. Senate and House members, Republicans and Democrats alike, agree on what we need to do for children’s health. Congress needs to finish its homework and reach a bipartisan consensus on funding CHIP.