Last week, The Atlantic published an article entitled “The Unconscionable Difficulty of Getting Health Insurance for a Newborn.” The article tells the story of contributing writer Ester Bloom and her difficulties getting immediate Child Health Plus (CHP) insurance coverage for her newborn son. Coverage for Bloom’s son did not begin until six weeks after his birth, and in the interim she instead had to pay for much more expensive individual coverage through the Marketplace.
However, the original article neglected to mention the passage of Bill S4745/A7155 in December of 2015, which allows babies born into low and middle-income families eligible for Child Health Plus from the day they are born. Under this law, which takes effect January 1, 2017, parents who apply before the baby is born, or within 60 days of birth, will have CHP coverage for the newborn from the date of birth. Those who submit an application more than 60 days after the birth will be covered from the date of application. This law addresses the 45 day gap between parent application and newborn enrollment in CHP that Bloom describes in the article. For more details please see HCFANY’s original blog post from December 28, 2015.
We were excited to see a correction published on June 21, which included information about the law and how it will improve coverage for newborns under CHP.
This article also highlights the many challenges that consumers face when navigating the health insurance system as well as the importance of the trained assistance that health care Navigators, Certified Application Counselors, and Community Health Advocates can provide. New York State has been a leader in offering consumer assistance through these programs.
Parents who would like to enroll a child in CHP can do so through the New York State of Health Marketplace or by connecting to the Community Service Society Navigator Network at (888) 614-5400 or through their website.
Hospitals have been consolidating at increased rates over the last five years. Merger and acquisition transactions grew from 66 transactions in 2010 to 112 in 2015. Earlier this month, the MergerWatch Project released the results of a national survey, which concluded that current state hospital oversight programs are inadequate to protect consumers’ access to needed health care services in their own communities.
By analyzing current Certificate of Need (CON) laws for hospital oversight, MergerWatch found that only 35 states and the District of Columbia actually have a Certificate of Need Program in place. California has a similar procedure through the Office of the Attorney General. In states that do have CON Programs in place, the majority do not require CON review for affiliations that do not involve formal sale, purchase, or lease or for hospital closures.
These less formal affiliations can still lead to a loss of access to critical health care services for consumers. In Sierra Vista, Arizona, for example, women lost access to many reproductive health services, including tubal ligation, when a nearby secular hospital joined a Catholic hospital system in 2010. Women in need of such services are sent to the nearest non-religious hospital, which is 80 miles away.
MergerWatch also developed a grading system based on whether a state’s hospital oversight program meets certain criteria including when CON review is required, CON review standards, and effective engagement with affected consumers and the public. Under this grading system only six states receive an A or A-. New York State receives a B grade overall.
Many existing CON Programs are not consumer friendly and make it difficult for consumers to access material information about hospital transactions and how they will impact their access to health care. Notably, only nine states require consumer representation on the CON reviewing body, and only six states require a separate public hearing for each CON application.
The final section of the report outlines model policies for state oversight of hospital transactions and action steps for advocates to take ensure that consumer interests are protected.
Access the full report here.
Last month, we told you about the rate review process, which happens every year when health insurance companies submit requests for rate increase or decreases to the state Department of Financial Services (DFS). New York’s carriers were asking for some pretty big increases this year – about 18 percent on average across the individual and small group market. But as we explained, those are just requests. DFS has final say, and will release its decisions in the next few weeks.
The rate review process requires a tricky balancing act. Sometimes a rate increase is needed to make sure that the insurance company can stay in business. But consumers have to be able to afford coverage. In New York, consumers contribute to this process by telling DFS how premium costs affect their lives (you can look at all the comments people sent in on the DFS website).
HCFANY participates each year by reviewing all the applications and drafting formal comments. We will post the results as soon as they are released by DFS. But in the meantime, you can look through our letters, all of which are below.
- NorthShore LIJ CareConnect
Across the nation, many insurance companies are asking for big rate increases this year – but in New York, you have the right to weigh in on whether they receive them.
Every year, health insurance companies that sell products in New York must ask for permission from the Department of Financial Services (DFS) to change their rates. This year, the companies that sell plans to individuals through the New York State of Health are asking for an average 22 percent increase. For small group plans, the average request is for a 16 percent increase. There’s a big range, including some requests to decrease premiums. Your insurance company is required to notify you of their request – so keep an eye out for their letter!
DFS carefully reviews the requests, balancing the need to keep premiums affordable for consumers with the need to keep insurance companies financially healthy. One of the things DFS weighs is comments from the public. It is important for state officials to hear from all types of consumers about the effect a premium change would have on their households or businesses.
Not every state asks consumers what they think about insurance rates – New Yorkers should take advantage of this public process! Last year, the rate review process resulted in a 3 percent lower premium rate, which translated to $430 million in consumer savings.
HCFANY carefully reviews the rate filings every year and sends our own detailed comments (you can look at our letters from last year here). We’ll post this year’s letters on our website when they are complete. But you don’t have to wait for that or do an in-depth review of the applications for your comments to be valuable. You can simply go to this link and fill out the form provided by DFS. If you’d like some help thinking about what kinds of comments to write, you can look at our templates or look at comments written by other consumers last year. Those are available at this link, along with approved applications from last year and the pending applications for 2017. Comments are due by June 17.