HCFANY Budget Update: What We Won and What We Lost

HCFANY worked hard this year on a series of important priorities during this budget session. Governor Cuomo’s statement on the final enacted budget can be found here.

Here is a quick summary of how we did:

Full funding for Community Health Advocates (CHA)

HCFANY Recommendation: Provide $4.75 million in funding for CHA to help people and small businesses obtain, use, and keep their health insurance coverage.

Result: The final budget included $3.5 million for CHA – $2.5 million from the Executive and $1 million from the Assembly. The total funding is an increase of $250,000 from the past year.

Expansion of Child Health Plus (CHP) to Age 29

HCFANY Recommendation: Increase the age limit for CHP from 19 to 29 to create an affordable coverage option for young adults who are not eligible for subsidized health insurance because of their immigration status.

Result: This measure was not included in the enacted budget.

Essential Plan Premiums and Cost-Sharing

HCFANY Recommendation: HCFANY opposed increasing premiums and cost-sharing for consumers enrolled in the Essential Plan (EP), New York’s Basic Health Program for consumers with incomes just above the Medicaid limit.

Result: There were no changes to EP premiums, and there will be no increases in cost-sharing through at least March 2018.

Medicaid Beneficiary Protections

HCFANY Recommendation: HCFANY opposed the following threats to Medicaid beneficiaries: (1) increase in copayments for preferred, non-preferred, and over-the-counter drugs; (2) elimination of spousal/parental refusal, a reduction of resources that spouses and parents of people in managed long-term care or nursing homes can keep; and (3) repeal of “prescriber prevails.”

Result: (1) The budget increased copayments for preferred prescription drugs from $1 to $2.50 and decreased copayments for non-preferred drugs from $3 to $2.50. There were no changes to copayments for over-the-counter drugs; (2) there were no changes to spousal refusal; and (3) there were no changes to “prescriber prevails.”

Enhanced Reimbursement for Safety Net Hospitals

HCFANY Recommendation: Provide an enhanced reimbursement rate for hospitals that: (1) have at least 50 percent Medicaid or uninsured patients; (2) have at least 40 percent of inpatient discharges covered by Medicaid; (3) have no more than 25 percent of patients commercially insured; and (4) are facilities that are part of the state’s five public health systems or federally designated as critical access or sole community hospitals.

Result: The final budget includes $40 million for safety net hospitals that meet the criteria above for fiscal year 2018.

Health Care Regulation Modernization Team

HCFANY Recommendation: Designate at least 20 percent of the seats on this team for health care consumers or advocates and require consumer representation on all team subgroups. Limit the team’s role to making recommendations that would then be taken up by the legislature.

Result: The Health Care Regulation Modernization Team was not included in the final enacted budget.

UrgentLate last month, the American Health Care Act (AHCA), which would have devastated the Medicaid program and left millions uninsured, was pulled from the House floor. According to an article in today’s New York Times, the majorities in Congress are discussing a proposal to move forward with the bill.

In addition to all of the harmful provisions in the original AHCA, the new proposal would eliminate community rating, which requires insurers to charge the same price regardless of health status, and the requirement that insurers cover a standard minimum benefits package, known as the Essential Health Benefits. These two changes would effectively get rid of the protections for people with pre-existing conditions and allow insurers to put annual and lifetime caps on payment for covered benefits.

There could be a vote to pass a new bill with these amendments as early as this Friday. Please call your Members of Congress at 844.898.1199 and tell them “Don’t take away our health care.”

Red AlertYesterday, Members of the House of Representatives introduced Affordable Care Act (ACA) repeal and replacement legislation in the Ways and Means and Energy and Commerce Committees. According to a blog post from Health Affairs, the committees will begin markup of the bills tomorrow, March 8, and the House is hoping to pass a repeal and replacement bill in the next three weeks.

The two bills would not repeal the ACA entirely. They would leave in place many of the ACA’s insurance reforms including: coverage for people with pre-existing conditions; guaranteed availability of coverage; coverage of young adult children under their parents’ health plans until age 26; and annual out-of-pocket maximums. The bills would also leave in place certain consumer protections including the ban on discrimination on the basis of race, nationality, disability, age, or sex.

However, there are a number of provisions in the two bills that would harm consumers. These include:

Gutting Medicaid

  • Medicaid would be transitioned to a per capita cap program by 2020. This means that the federal government would provide a fixed amount of money to each state per enrollee, rather than a percentage of the total costs per enrollee.
  • Federal funding for Medicaid expansion would be eliminated.
  • States would be provided incentives to re-determine Medicaid eligibility more frequently. In New York, many Medicaid enrollees have 12-month continuous Medicaid coverage.

Undermining Coverage Gains

  • Individuals would no longer face a tax penalty for not having coverage. Instead, premiums would go up by 30 percent as a penalty for consumers who do not maintain continuous coverage during the 12 months preceding enrollment in a new plan.
  • Employers would no longer be penalized for not offering coverage to their employees and dependents.

Eroding Marketplace Affordability

  • States would be allowed to charge older consumers premiums 5 times greater than those of younger consumers. Currently, insurers are only allowed to charge only consumers 3 times as much as younger consumers.
  • The current income-based advanced premium tax credits would be replaced with tax credits based on age. This means that a low-income consumer would receive the same tax credit as a wealthy consumer in the same age bracket.
  • Cost-sharing reductions for eligible consumers with incomes under 250 percent of the Federal Poverty Level would be eliminated after 2019.
  • Plans sold through the Marketplace would provide less coverage for health services, and consumers would be responsible for more out-of-pocket costs.

Reducing Access to Family Planning Services

  • Planned Parenthood would lose federal funding for one year if the bills become law.

New York Representatives Chris Collins and Paul Tonko serve on the Energy and Commerce Committee, and Representatives Tom Reed and Joe Crowley serve on the Ways and Means Committee. If you or someone you know would be affected by the changes proposed in these two bills, please call your elected Representatives today at 1-866-426-2631.

Caucus WeekendGuest blog by Claudia Calhoon, MPH, Director of Health Advocacy at the New York Immigration Coalition.

A few weeks ago, HCFANY members served on the “Challenges and Opportunities of the Trump Era: Healthcare for Special Populations” panel at the New York State Association of Black and Puerto Rican Legislators’ 46th Annual Legislative Caucus Weekend. Senator Gustavo Rivera facilitated the panel, which included a distinguished selection of labor, health care providers, advocates, and social service providers including: District Council 37’s Henry Garrido, Therese Rodriquez of Apicha Community Health Center, and Wendy Stark of Callen-Lorde Community Health Center.

Claudia Calhoon from the New York Immigration Coalition and Amanda Lugg of African Services Committee represented HCFANY’s Coverage 4 All Campaign. Arline Cruz from Make the Road New York and Juan Pinzon from the Community Service Society spoke on behalf of funding for the Community Health Advocates, New York State’s Health Consumer Assistance Program.

The conversation focused on the ways that drastic federal changes in health and immigration policy will affect health access and coverage for low-income, LGBTQ, and immigrant populations. New York State residents from these groups will be profoundly affected by proposed reductions in federal financing for health care promised by ACA repeal and proposed Medicaid cuts. Increased immigration enforcement activities have recently created paralyzing fear among immigrant communities and have discouraged people from visiting hospitals or sending their children to school.

In particular, the panel focused on the importance of three critical initiatives:

  • Enhanced Safety Net Hospital legislation (A9476/S6948A), passed unanimously by both houses in 2016, that would create a new category of safety net hospital that reflects the actual quantity of indigent and low-income care provided and sustains those institutions;
  • Expanding coverage to young adults regardless of immigration status by raising the eligibility of the Child Health Plus program to age 29;
  • Fully funding the New York State’s Community Health Advocates consumer assistance program so that their sites may continue to distribute information in the face of potential change to healthcare.

In the face of these major changes, New York State has the opportunity to lead the nation by ensuring that its most vulnerable populations can access the full range of health care services from preventive to specialty care when they need them, as well as ensuring that they have the information they need to navigate and use their health coverage. It is also critical to strengthen the financial well-being of public hospitals and federally-qualified health centers across New York State that care for many immigrant and LGBTQ populations.

HCFANY looks forward to working with all its partners to protect health care access and coverage in the face of uncertainty and change on these and other priorities. Organizations interested in signing on to the Coverage 4 All campaign can do so here.