Making Sense of Delivery System Reform

The Affordable Care Act made a lot of changes – and improvements – to health insurance. But it was also meant to encourage changes in how health care is delivered – the care you get at the hospital, doctor’s office, pharmacy, and other places where people get health care.

Many people have frustrating experiences with health care that go beyond how it’s paid for. Maybe you can’t make an appointment without skipping work, or can’t get your prescription filled on time because of communication problems and end up skipping doses. Maybe you had to get a test done twice because re-doing it was easier than transferring your records to a new physician. Delivery system reform is meant to make the experience of getting health care better – in an ideal world, there would be seamless delivery system that lets doctors and patients focus on their health, not logistics.

HCFANY has produced a new issue brief to help consumers understand what is happening. Delivery system reform could be a great thing for everyone, but changing systems is always hard. A lot of stakeholders have learned to succeed under the status quo, and are afraid of changing how they do business. Consumers need to educate themselves about how delivery reform can benefit them and use their knowledge to encourage reform that benefits patients.

Yay BlogOnce again New York is leading the nation as one of only two states to implement a Basic Health Plan (BHP). As of January 31, 379,599 New Yorkers enrolled in comprehensive, affordable coverage through the New York’s BHP, branded the Essential Plan, which launched in 2016. A few weeks ago, the NY State of Health (NYSOH) released its report on the third open enrollment period, which ran from November 1, 2015 through January 31, 2016. HCFANY is excited to see so many consumers gaining access to health care through the EP in its first year.

The EP is meeting an important need for consumers in New York, particularly for those with incomes between 138 and 200 of the Federal Poverty Level (FPL). Before the implementation of the Essential Plan, individuals at this income level would only have been eligible to purchase Qualified Health Plans (QHP) with financial assistance, and many continued to face financial barriers to coverage. With the EP, low- and moderate income individuals can now receive coverage comparable to that of a QHP for a premium of $0 or $20 and no annual deductible. The average consumer saves over $1,100 compared to QHP coverage. This increased affordability has resulted in high enrollment levels for EP eligible individuals. According to NYSOH’s open enrollment report, 98 percent of individuals determined to be eligible for the Essential Plan enrolled compared to only 58 percent of individuals eligible for QHP.

Essential Plan coverage is also available to individuals under age 65 with incomes below 138 percent of the Federal Poverty Level (FPL) who are lawfully present in the United States, but have not met the five-year bar to qualify for Medicaid as well as lawfully present immigrants with incomes 138 to 200 percent of FPL.

Like Medicaid and Child Health Plus, individuals and families eligible for the EP can enroll throughout the year.

To enroll or learn more about the Essential Plan, contact NYSOH at (855)-355-5777 or 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 at Or contact Community Health Advocates at (888)-614-5400 or

CHP Picture

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.



Eighty representatives of HCFANY member groups gendand supporters came to Albany to network with other advocates, get updates on the fight for quality, affordable health care in New York, and plan strategy at HCFANY’s Annual Meeting on January 8.

Our guest speakers emphasized the continuing strong progress health reform is making, statewide and nationally.  Danielle Holahan, the Deputy Director of the NY State of Health, reported that the number of uninsured New Yorkers has declined by an estimated 700,000, lowering the uninsured rate to its lowest point in decades.  Jackie Cornell-Bechelli, the Regional Director of the U.S. Department of Health and Human Services, similarly pointed to major gains in enrollment on the national level.

However, as a panel of HCFANY leaders emphasized, there’s still more work for us do to ensure that all New Yorkers have health insurance, that the coverage and care we receive is of high quality, and that consumers can effectively use their coverage.  They outlined HCFANY’s Legislative Agenda for 2016, including:

  • state funding for Community Health Advocates, a program that helps consumers understand and effectively use their coverage and access care;
  • the creation of a new program to fund community groups and small business-serving groups to do outreach to consumers in “hard to reach” communities; and
  • funding to cover a small group of New York immigrants who are lawful residents but not covered under the new Essential Plan.

In the afternoon, participants broke into Planning Groups to develop strong campaigns to take action on HCFANY’s priority 2016 issues.  At the immigrant coverage breakout, advocates discussed the name and structure of this exciting new campaign and new partners we should reach out to. The outreach and consumer assistance breakout discussed best practices for reaching the uninsured.  The network adequacy group identified issues relating to network adequacy that diverse communities in New York experience, including rural communities and artists.  Finally, the payment and delivery system reform breakout talked about opportunities to bring consumer voices into the state’s transformation efforts, including organizing a caucus of consumer advocates participating in the payment and delivery system reform workgroups.

For more information on any of these initiatives, please contact Carrie Tracy at