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Do YOU understand the new coverage choices under the ACA?

Posted on February 25, 2013 by Arianne Slagle

Coverage choices

Thanks to the Affordable Care Act (ACA), more than 1 million uninsured  New Yorkers will newly have access to affordable health insurance options starting this fall.  That’s a lot of folks who will need to wade through a lot of new information in the coming months.

HCFANY will be holding a briefing in New York City on Thursday, March 7th at the Interchurch Center from 9:00 am – 11:30 am to go over the necessary public outreach and enrollment efforts that will need to happen in order to ensure that the greatest number of New Yorkers benefit from the ACA.  Specifically, we will be going over the following questions:

  • How will New Yorkers learn about new health coverage options?
  • How is New York State going to reach out to and sign up the uninsured?
  • What will individuals, families, and small employers in New York l need to know?
  • What’s to be gained if we do it all right  (…and at risk if we don’t)?
  • What can our elected officials do to help make it go smoothly?
  • How can groups across New York contribute and participate?

This meeting is open to all New York members, allies, colleagues and new friends in the NYC area.

For more information, or to RSVP, click here!

 

Filed under: ACA, Comprehensive Coverage, Employer Sponsored Health Insurance, Insurance reform, Medicaid, New York Health Benefit Exchange, New York Health Reform, Underinsured, Uninsured, young adult | Tagged: , , | Comments Off

Don’t leave New York’s low-income families out in the cold!

Posted on February 12, 2013 by Arianne Slagle

Baby, it's cold outside!

The Governor’s proposed 2013-2014 Executive Budget aims to get rid of New York’s Family Health Plus (FHP) program by closing off enrollment by the end of this year.  Enrollees who earn below 138% of FPL (about $26,000 per year for a family of three) will get the current Medicaid benefit (with the exception of long-term care).  Parents up to 150% of FPL (about $28,000 for a family of three) will get subsidized coverage on the forthcoming Exchange.

However, eligible folks who aren’t able to enroll by the cutoff date, or whose income shifts into the eligible range after the cutoff date will be out of luck.  These folks will have to look for affordable coverage on the Exchange.

The Exchange will provide premium tax credits to help lower the cost of insurance for most low- and moderate-income folks who purchase coverage on the Exchange.  But, it will still be too expensive for many families.  For example, a family of three earning 150% of FPL will still have to come up woth $1,099 per year on their own for coverage on the Exchange whereas the same family would have gotten free coverage with very low cost-sharing through FHP.

But there is a solution to this affordability problem.

  • First, we ask the State to apply for an 1115 waiver – similar to those being pursued by Massachusetts and Vermont – to provide an affordability wrap for premiums and cost sharing for folks up to 200% of FPL not eligible for Medicaid.  This would help to get out-of-pocket costs on the Exchange down as close as possible to FHP levels. If NY can’t get federal matching funds, the State should earmark a portion of the $2.5 billion in State Medicaid savings under the ACA for this.
  • Next, New York should lay the foundation for a Basic Health Plan (BHP) by authorizing establishment of this program starting in 2015.  The ACA gives states the option of creating a federally-funded BHP to cover adults up to 200% of FPL not eligible for Medicaid.  This program would result in State savings of between $500 million and $1 billion each year.

This is a big opportunity for State lawmakers to ensure affordable coverage is available to the individuals and families who need it most.  And, when federal funds or state savings are factored in, it would require little or no additional cost to the State.

Quite simply, it’s the right thing to do.

 

 

Filed under: ACA, Affordable, Comprehensive Coverage, Governor Cuomo, Insurance Exchange, Insurance reform, New York State Budget, State budget | Tagged: , , , , | Comments Off

The Basic Health Plan sounds like the right choice

Posted on February 1, 2013 by Arianne Slagle

The choice is pretty darn clear

Under the ACA, states are allowed the option of creating a Basic Health Plan (BHP) for low-income adults who earn too much to qualify for Medicaid.  Ordinarily, if these folks don’t have employer-sponsored coverage then come 2014 they will be able to buy insurance through the Exchange with the help of federal tax credits.  But, even with the tax credits this coverage may still be too expensive for them. The BHP then would act as a bridge between the free or low-cost Medicaid coverage and the higher priced options available on the Exchange.

Don’t be fooled by the name though - there is nothing “basic” about it.  According to the ACA, BHP coverage must be as affordable and comprehensive as what these adults would have gotten on the Exchange.  In New York, coverage would likely resemble that of the Family Health Plus program.

New York currently offers public coverage to low-income adults through its Family Health Plus program, the cost of which is split with the federal government.  New York also pays for Medicaid coverage for low-income immigrants without help from the federal government.  Through the BHP program, New York would be able to cover both of these groups and have the federal government pay for it all.  This would save the state between $500 million and $1 billion per year.

Sounds great, right? Problem is, the federal government still hasn’t released guidance on this program, and isn’t planning on doing so anytime soon.  Unfortunately, state policymakers won’t commit to the program until they are sure of all the details.  So, until that happens, it is unlikely that New York will get any of the cost-savings and affordability protections that the BHP has to offer.

HCFANY has created a policy brief on this issue to explain it in detail, urge federal policymakers to release BHP guidance, and provide recommendations to state policymakers. 

Click here to read HCFANY’s policy brief, titled “The Basic Health Program Option in the Affordable Care Act.”

 

Filed under: ACA, Affordable, Comprehensive Coverage, Federal health reform, Immigrants, Insurance Exchange, Insurance reform, Medicaid | Tagged: , | Comments Off

The importance of getting the word out

Posted on January 29, 2013 by Arianne Slagle

Listen up!

Implementation of New York’s health benefit Exchange is now well underway, and policymakers are estimating that over one million New Yorkers will enroll in some form of health insurance through the Exchange.  Yet, the vast majority of New Yorkers still don’t understand what the Exchange is or what it will do.  Many others have not even heard about it yet.

With the Exchange set to start accepting enrollment applications in October of this year, it is quickly becoming clear that the State is in dire need of a public engagement campaign. 

What it boils down to is that there are currently around 2.8 million New Yorkers who are uninsured.  The Exchange is, above all, being created so that these folks will be able to find and enroll into quality, affordable health coverage.  But, how can the State policymakers who are designing and implementing the Exchange know that they are building a system that will work for New York’s uninsured, without actually asking them about it?

At the same time, in order the reach its goal of getting one milion New Yorkers enrolled through the Exchange, the State will have to find a way to get these one million New Yorkers informed about the Exchange, motivated to pursue coverage through it, and able to use the system. 

That’s a lot to accomplish in just 8 months!

HCFANY has put together a short policy brief on this issue, with recommendations for State policymakers on how to get the public engaged and informed about the NYS Exchange.

Click here to read the HCFANY policy brief titled “Reaching One Million More New Yorkers: A Successfulc Enrollment Campaign for the Exchange.”

 

 

Filed under: ACA, Comprehensive Coverage, Federal health reform, Insurance Exchange, Insurance reform, New York Health Benefit Exchange, Public Health, Uninsured | Tagged: , , , | Comments Off

Update on the NYS Health Benefit Exchange

Posted on January 25, 2013 by Arianne Slagle

Yesterday, the NYS Exchange hosted a webinar briefing for members of the State’s Regional Advisory Committees.  The webinar provides an update and timeline on the forthcoming health plan invitations to participate in the Exchange, and the Navigator program.

The presentation also includes a draft of the standard plan designs that will be offered on the Exchange for individual coverage so you can see the differences in the “precious metal” product tiers and cost-sharing associated with each.

Click here to view the presentation slides.

Filed under: ACA, Comprehensive Coverage, Consumer Assistance, Federal health reform, Insurance Exchange, Insurance reform, New York Health Benefit Exchange, State Department of Health | Tagged: , , , | Comments Off

New York Rising

Posted on January 10, 2013 by Arianne Slagle

Its a fine view from up here!

Governor Cuomo gave his annual State of the State address yesterday, and we at HCFANY were generally pleased to see the inclusion of the state’s health benefit Exchange in the Governor’s progressive agenda.

Much of the speech focused on the state’s economic revitalization, and we believe that a consumer-friendly Exchange will do much to further economic growth in New York.  We know that the Exchange will lower health insurance costs significantly for consumers and small businesses, and that’s money in people’s pockets.  The added preventive care benefits provided by the Affordable Care Act will also help to lower health care spending for our state in the long run.

The Governor also said he wanted to restore New York to its “rightful place as the progressive capital of the nation” and that the forthcoming health benefit Exchange will help make our state’s health care system the “finest in the nation.”  We know that the Exchange will help more than one million uninsured New Yorkers afford health insurance coverage.  HCFANY will be working hard this year to make sure that implementation of the Exchange is as consumer-friendly as possible so that it may indeed be the finest in the nation!

HCFANY issued a short statement on the Governor’s State of the State address, which you can read by clicking here.

You can also read the Governor’s full State of the State book, which includes his prepared remarks as well as background information.

 

Filed under: Affordable, Governor Cuomo, Insurance Exchange, Insurance reform, New York Health Benefit Exchange, New York State Politics, Public Health, Women | Tagged: , , , , , | Comments Off

Single young men just got a little healthier, thanks to the ACA

Posted on January 9, 2013 by Arianne Slagle

A new study published in Health Affairs last week finds that young adults aged 19-25 have experienced significant gains in health insurance access since the passage of the ACA.  The law, which allows young adults to stay on their parents’ insurance plans until the age of 26, is estimated to have increased health insurance coverage to over 3 million young adults in its first year alone.

So, this is not entirely news to us, as we have known for some time that young adults have been coming out in droves to sign up for their parents’ health insurance.  But, the Health Affairs study dug a little deeper by using data from two nationally representative surveys to compare health insurance status and health care access for young adults 19-25 with those aged 26-34 between 2005 and 2011 (remember, this provision of the ACA went into effect in 2010).  Researchers found that overall, the largest gains in insurance were made by unmarried adults, men, and nonstudents.  It also found that the number of young adults who delayed getting health care and those who did not receive care because they couldn’t afford it has gone down significantly since the passage of the new law.

Young adults in the 19-25 age group have historically had the lowest rate of insurance coverage out of all of the age groups.  However, the passage of the ACA seems to have stymied this trend by bumping up the rate of  insurance coverage and access for this group so that it now more closely resembles that of other adults in older age categories.

So, in a nutshell - the ACA is working!

The article is titled “The Affordable Care Act Has Led to Significant Gains in Health Insurance And Access To Care For Young Adults” and can be found on the Health Affairs website by clicking here.

 

Filed under: ACA, Federal health reform, Insurance reform, Public Health, Uninsured, young adult | Tagged: , , | Comments Off

Register Today for the HCFANY Annual Meeting!

Posted on January 4, 2013 by Arianne Slagle

Click here to register!

Yes, it’s a a new year and that means its time for the HCFANY annual meeting! Join us on January 17, 2013 in Albany to celebrate our success over the past year and strategize how, together, we can work with New York State to develop a Health Insurance Exchange that will achieve our long-term goal of quality, affordable health care for all New Yorkers.  

The meeting will take place in the “Well” of the Legislative Office Building (LOB) in Albany from 11 am – 3:30 pm (coffee and registration at 10:30 am).  Our tentative agenda for the day includes:

  • Advocacy goals for 2013 - What we need to accomplish next for New York
  • Update on ACA implementation in New York (Exchange staff has been invited)
  • Our annual “Advocate of the Year” Award 
  • How to talk about ACA implementation to policymakers, the media, and the public 
  • Upcoming workgroup sessions: Help us plan our 2013 activities 

Click here to register!

 

 

Filed under: ACA, Federal health reform, Governor Cuomo, Insurance reform, New York Health Benefit Exchange, New York Health Reform, New York State Budget, New York State Politics, Small Business, State budget, State Department of Health, Underinsured, Uninsured, Women, young adult | Tagged: , , , , , , | Comments Off

Blindsided by Bills

Posted on November 20, 2012 by Arianne Slagle

Connor is a 68-year-old Westchester resident with heart problems, insured in a preferred provider organization (PPO). He had a stent put in last year, and when he was experiencing extreme shortness of breath he rushed to his local in-network hospital. The heart problem was too severe to be treated there, so he was transferred to a major academic medical center nearby, also in-network. After observation and testing, his treatment team decided that he needed emergency open heart surgery to implant a special pump. Though he was at an in-network hospital, neither the surgeon nor his assistant was in-network. The surgeon billed $71,000, out of which Connor’s insurer’s out-of-network benefit paid $29,000. The assistant billed $35,000, out of which Connor’s insurer paid $6,737. In total, Connor was left owing more than $70,000 for his surgery, even though he had “good insurance” and went to in-network facilities for his emergency treatment.

Connor is one of many New Yorkers who have been blindsided by balance billing, when patients are charged the difference of what an insurer agrees to pay a provider.

The problem of “surprise” out-of network medical billing has recently gained attention in the press, including an article in today’s New York Times. Earlier this year, the New York State Department of Financial Services released a report, An Unwelcome Surprise: How New Yorkers Are Getting Stuck with Unexpected Medical Bills from Out-of-Network Providers. 

This year, Health Care For All New York made a statement on out-of network billing, including recommendations: New York should protect insured consumers from “Surprise” out-of-network billing, require all insurers to have adequate networks and offer a reasonable mechanism to go out-of-network when medically appropriate, and ensure transparency about billing from health providers and plans.

Visit Community Health Advocates  for the Out-of-Network DIY Appeals Packet if you think your plan is not reimbursing you enough for out-of-network care.

Filed under: Affordable, Balance billing, Employer Sponsored Health Insurance, Insurance reform | Comments Off

New York continues to move forward with Exchange implementation

Posted on August 24, 2012 by Arianne Slagle

And when I say “move forward,” what I really mean is full steam ahead.  Yesterday the State announced that it had received an additional $95 million in federal funds to continue to build up New York’s forthcoming Health Insurance Exchange.  This money will primarily be used to finance a lot of of the back-end operations, including the IT system and databases.

The State applied for this funding back at the end of June – you can click here to read the state’s full project narrative for these funds.

 

 

Filed under: ACA, Federal health reform, Insurance Exchange, Insurance reform | Tagged: , , , | Comments Off

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