Outreach and Enrollment Summits 2015: Looking Back, Looking Forward

The third open enrollment period for the New York State of Health begins on November 1, 2015, and the Healthcare Education Project and HCFANY member organizations are already busy preparing.

Building on two successful years of enrollment summits, this year’s 8 regional summits will continue to bring together stakeholders and community leaders to develop coordinated plans for outreach and open enrollment in 2015.

Navigators, health advocacy groups, health insurance plans, community groups, healthcare facilities, Certified Application Counselors, unions and small business representatives will come together to examine best practices, and share strategies, resources and partnerships to maximize enrollment in New York State of Health, the state’s insurance marketplace, taking into account the introduction of the Essential Plan in 2016.  Participants will be able to volunteer for a number of enrollment and outreach tasks, and get their organizations involved.

Over 2.1 million New Yorkers enrolled in a health plan through Feb 28, 2015. This surpassed the New York State of Health goal to enroll 1.1 million New Yorkers in the first three years, and we’re continuing to work towards coverage for all New Yorkers!

Below is a list of all 8 summits. Local groups should come to the summit that covers their region. Statewide groups are urged to send their local affiliates. Contact local coordinators listed below with questions and to RSVP.



Thursday, Sept. 17, 2015 • 9:00 am – 12:00 noon

Ramada Inn Conference Center, 542 Route 9, Fishkill (exit 13 off I-84), NY 12524

To register: Visit http://hudsonvalleysummit.eventbrite.com.



Friday, Sept. 25, 2015 • 12:00 noon – 3:00 pm

1199SEIU Auditorium, 310 W. 43rd St., NY, NY 10036

To register: Visit http://bronxmanhattansummit.eventbrite.com.



Monday, Oct. 5, 2015 • 10:00 am – 1:00 pm

1199SEIU, 100 Duffy Avenue, Suite 300W, Hicksville, NY 11801

To register: Email Luis Valenzuela at Luis.Valenzuela@1199funds.org.


CENTRAL NEW YORK (Binghamton, Syracuse)

Tuesday, Oct. 6, 2015 • 1:00 – 4:00 pm

Southern Tier Independence Center, 135 E. Frederick St, Binghamton, NY 13904

To register: Contact Mary Clark at 607-723-0110 or by email at cny2015summit@gmail.com.



Tuesday, Oct. 6, 2015 • 10:00 am – 1:00 pm

Staten Island Mental Health Society, Safir Auditorium, 669 Castleton Ave, Staten Island, NY 10301

To register: Email Nicole O’Loughlin at Nicole.O’Loughlin@1199funds.org or call (917)543-3200.



Thursday, Oct. 8, 2015 • 12:30 pm – 4:00 pm

SEIU Albany, 155 Washington Ave., Albany, NY 12210

To register: Visit http://citizenactionny.org/capitalregionsummit2015 or email Sara Couch at sara.couch@1199fund.org or call 518-222-1711.


WESTERN NEW YORK (Buffalo, Rochester)

Thursday, Oct. 8, 2015 • 9:00 am – 12 noon

1199SEIU Conference Room, 2421 Main Street, Buffalo, NY 14214

To register: Contact Bill Covington by phone at 716.995.3705 or by email at hepbuffalo@gmail.com.



Wednesday, Oct. 21, 2015 • 10:00 am – 1:00 pm

Bedford Stuyvesant Restoration Plaza, 1368 Fulton St, Brooklyn, NY 11216

To register: Email Marcelle Dinnall at Marcelle.Dinnall@1199funds.org or Jennifer Clarke-Craig at Jennifer.Clarke-Craig@1199funds.org.    


This event series is being held in cooperation with New York State of Health, www.nystateofhealth.ny.gov



Citizen Action of New York • Community Health Care Association of New York State (CHCANYS) • Community Service Society of New York • Healthcare Education Project (1199SEIU/GNYHA) • Health Care For All New York • Make the Road NY • Raising Women’s Voices-NY

By Andrew Leonard, Sr. Policy Associate for Health, Housing and Income Security, Children’s Defense Fund – NY


Starting this November, many low- and moderate-income New Yorkers will be able to enroll in a new comprehensive and affordable health insurance product, known as the Essential Plan. Without a doubt, the New York State of Health Marketplace has been a huge success in New York State, enrolling over 2 million people in coverage, many for the first time! Yet, despite these significant gains, some New Yorkers find themselves without insurance or struggling to afford the private insurance have, even with financial assistance from the Marketplace. Many of these individuals will be newly eligible for the Essential Plan.

o-BEST-HEALTHCARE-facebookLike Qualified Health Plans, the Essential Plan will cover all of the ten Essential Health Benefits, including emergency services, inpatient hospitalization, primary care, urgent care, sick visits, lab work, radiology, reproductive health care and more.

Those who qualify for the Essential Plan will pay a premium of either $0 or $20, depending on their income. There will be no deductible, but some consumers may be required to pay a small co-pay for services like doctor visits, hospital stays, and prescription drugs.

The Essential Plan will be available to US citizens earning more than the Medicaid eligibility threshold, but less than 200% of the Federal Poverty Level (FPL) (e.g. a single person earning more than $16,242 but less than $23,540). Lawfully-present immigrants, such as green card holders and those seeking refugee status, will be eligible for Essential Plan coverage as long as they earn less than 200% of the FPL. That means that most lawfully-present immigrants below the Medicaid income threshold, currently eligible for state-funded Medicaid, will be transitioned to Essential Plan coverage.

Enrollment in the Essential Plan begins November 1, 2015 for coverage beginning January 1, 2016. From then on, eligible individuals will be able to enroll all year long, not just during the Marketplace’s Open Enrollment period. It’s an exciting time in New York State!

To enroll or learn more about the Essential Plan, contact the NY State of Health at (855)-355-5777 or www.nystateofhealth.ny.gov.

You can also get free one-on-one help from a Navigator or Certified Application Counselor, certified by NY State of Health, who serves your area: http://info.nystateofhealth.ny.gov/IPANavigatorMap. Or contact Community Health Advocates: (888)-614-5400 or http://www.communityhealthadvocates.org/.

The ACA makes insurance more affordable for people through a cost-sharing reduction (CSR) benefit. CSRs are available to consumers with incomes between 138% and 250% of the Federal Poverty Line ($27,311 to $49,475, for a family of three) who purchase Silver level plans. CSRs are sliding scale discounts on cost sharing, including deductibles, co-pays, and co-insurance. New analysis from Washington D.C.-based Avalere Health of nationwide Marketplace enrollment for 2015 shows that only 73% of enrollees eligible for cost-sharing reductions chose Silver level plans. Thus 2.2 million consumers forfeited this benefit.

According to Avalere’s analysis, “consumers may not be aware that CSRs are available and the benefits they offer. ‘Additional consumer education and more sophisticated decision support tools are likely needed to ensure that all patients are accessing the benefits available under the Affordable Care Act,’ said Elizabeth Carpenter, vice president at Avalere. ‘Specifically, consumers need tools that highlight the tradeoff between monthly premiums and out-of-pocket costs and demonstrate the benefits of cost-sharing reductions.’”

In New York, however, 78% of eligible enrollees chose plans that came with CSRs – 5% better than the national average. New York also saw a steep curve between the three CSR tiers: 97% of those eligible for the highest level of CSR subsidy – 94% actuarial value – enrolled in Silver plans; but only 62% of people eligible for the lowest level of CSR subsidy – 73% actuarial value – enrolled in Silver plans (see graph below). This suggests that New York consumers are making strategic enrollment decisions. New York’s 11,000 assistors, who disproportionately serve consumers with lower incomes, are likely a part of our success story.

CSR levels graph 2New York’s data also suggest that consumers eligible for the lowest level CSRs (CSR-III) – with a $1200 deductible – may still face affordability problems. These consumers may be choosing Bronze level plans to save money on premiums, or they may forgo CSRs altogether and “buy up” to Gold level plans.

Come 2016, consumers in the CSR-I and CSR-II bands will qualify for the Essential Plan (EP), which will have very low cost or no cost premiums and minimal cost sharing. This may underscore the affordability issues facing consumers eligible for the CSR-III subsidies, earning between $39,581 and $49,475, for a family of three.


By Bob Cohen, Esq., Policy Director, Citizen Action of New York and Public Policy and Education Fund


Well, there they go again. Presidential candidates Scott Walker and Marco Rubio have now outlined their plans to replace the ACA, repeating tired myths like the law has increased costs for consumers. While both candidate statements omit critical details, it’s clear that either proposal would be a disaster for consumers. And their rhetoric can deter consumers from exploring the new options for affordable coverage that are available.

candidateBoth proposals would repeal a law that has enrolled over two million New Yorkers, lowered costs by an average of 50% in the individual market, set higher standards for health plan quality, and reduced the chances that consumers will be stuck with massive medical bills. According to the Roosevelt Institute’s Richard Kirsch, this would have grave impacts at the national level. The country would “return to the days when insurance companies could deny coverage or charge higher premiums because of a pre-existing condition, charge women more for health insurance than men, and stop paying claims when people have high-cost illnesses.”

Both plans would force millions of people off Medicaid immediately and take away coverage from millions of young people who are on their parents’ plans, according to the Kirsch post. And the Walker plan would allow health insurance to be sold across state lines, threatening a “race to the bottom” in which states compete with each other to attract insurers by loosening consumer protections. New Yorkers could lose the hard-won consumer protections that our State has put in place over many years.

While attacks on the ACA have been less frequent in the past few months, the Walker and Rubio initiatives and continuing proposals in Congress to repeal or cut back the ACA make it clear that the law is not politically out of the woods yet. As New York State begins its third Open Enrollment period, health advocates need to practice how to explain the many benefits of the ACA in New York, and how to debunk the myths that continue to circulate.   Thankfully, as the latest Kaiser tracking poll data indicates, the law is now finally supported by a clear majority of Americans, as more and more get covered or know someone who did.