Do YOU understand the new coverage choices under the ACA?

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!

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.”


For you!

A lot of folks think that 2014 is when the Affordable Care Act will really kick into effect, and yes, that is when the health insurance Exchanges will become fully operational.  And yes, those are a big part of the ACA.  But, they’re not the whole thing!

Many great things have already happened in the years since the law was implemented, including small business tax credits, a new coverage option for uninsured folks with pre-existing conditions, free preventive care, and allowing young people to stay on their parents’ plan until the age of 26.

And, 2013 will be no exception! There are more good things in store for us this year.  Here is a roundup of some of what’s to come:

  • More subsidies for seniors who hit the donut hole:  Seniors who hit the Medicare Part D coverage gap will now get federal subsidies for brand-name prescriptions (in addition to the 50% manufacturer brand-name discount that went into effect in 2011).
  • Improving Preventive Care:  State Medicaid programs that offer free or low cost preventive services will get increased federal funding to do so.  This means that low-income folks in many states will have better access to vaccinations, tests like colonoscopies and mammograms and routine screenings for high blood pressure, diabetes, and cholesterol.
  • Increased Medicaid payments to doctors: On January 1st, Medicaid payments for primary care doctors were brought up to Medicare levels. In New York, this will mean an estimated increase of 156% in Medicaid payments to doctors and will help to ensure low-income New Yorkers have sufficient access to doctors.  For more info on this, check out the Kaiser Family Foundation report titled, “How Much Will Medicaid Physician Fees for Primary Care Rise in 2013? Evidence from a 2012 Survey of Medicaid Physician Fees”
  • CHIP funding will be extended: the ACA will authorize funding for the Children’s Health Insurance Program (CHIP) through 2015 (extended from 2013).  In New York, this program is called Child Health Plus. This will allow roughly 400,000 kids in New York to keep their free or low-cost health insurance.

Of course, not all of the ACA changes happening in 2013 will be a clear-cut “goody.”  2013 will also see a number of tax changes, including an increase in Medicare taxes for higher income earners (in order to boost up the Medicare trust), an exise tax of 2.3% on the sale of medical devices, and changes to FSA limits.  For a full list of changes, check out the Kaiser Family Foundation’s Implementation timeline.


Nationally, the number of uninsured children decreased to 5.5 million in 2011 from 6.4 million in 2009, according to a new report by the Georgetown University’s Center for Children and Families. New York has contributed to that success by extending coverage to more children through Medicaid and Child Health Plus. The state has successfully reduced the number of uninsured children from about 205,000 in 2009 to about 181,000 in 2011.

“Children need health care coverage to grow and thrive so this is good news for New York and the nation,” said Joan Alker, Co-Executive Director of the Georgetown University research center.

New York has made progress but still ranks 6th in terms of states with the highest number of uninsured children in the nation. Half of all uninsured children live in Texas, California, Florida, Georgia, Arizona and New York.

“While the uninsured rate for New York children is heading in the right direction, we can do more toto ensure that every child has the coverage they need and deserve,” according to Kate Breslin, Executive Director of the Schuyler Center for Analysis and Advocacy.

About 96 percent of New York children have health care coverage while the success of Medicaid’s companion program, Medicare, has brought the insured rate for seniors up to about 99 percent.

In New York, school-age children are more likely to be uninsured than those age 6 and under.

“Most of New York’s uninsured children are already eligible for coverage through Medicaid or Child Health Plus but haven’t enrolled because they don’t realize they qualify or have been unable to overcome bureaucratic barriers to enrollment,” Lorraine Gonzalez, Director of Health Policy at the Children’s Defense Fund – New York.

New York is now working on making the enrollment process easier by removing unnecessary paperwork requirements and setting up an online application. Those improvements are expected to be completed by 2014 as part of the Affordable Care Act implementation.

“There’s been a lot of talk about all the help uninsured people can expect in 2014 but New York’s uninsured kids don’t have to wait that long,” said Kate Breslin. “They are very likely to be eligible for affordable coverage right now.”

To apply for public health insurance in New York, click here to find a Facilitated Enroller near you.

The Georgetown University Center for Children and Families (CCF) is an independent, nonpartisan policy and research center. Click here for the full report.