Guest blog by Max Hadler, Health Advocacy Specialist at The New York Immigration Coalition
Despite the major health care coverage gains achieved under the Affordable Care Act, more than 450,000 New Yorkers remain uninsured because their immigration status makes them ineligible for affordable coverage. As a result of the continued failure to approve federal immigration reform or lift health coverage restrictions on many groups of immigrants, it continues to fall to state and local governments to pick up the slack. Health Care For All New York has responded to the dire lack of coverage options for immigrants by launching the Coverage 4 All campaign under the leadership of two of the coalition’s member organizations, Make the Road New York and the New York Immigration Coalition.
The campaign’s mission is to obtain affordable coverage options for all New Yorkers, regardless of immigration status. A shorter-term goal is to expand coverage to a smaller group of immigrants who are “permanently residing under color of law” (PRUCOL). These are people whose presence in the U.S. is known and may be unauthorized, and who have received confirmation from the federal government that it has no intention of deporting them. In New York, immigrants who are PRUCOL are eligible for state-funded Medicaid when they meet the income requirements (less than $16,242 annual income for a single person). However, the same people are not currently eligible for the Essential Plan, New York’s low-cost, comprehensive coverage program for low-income residents whose incomes are too high for Medicaid (up to $23,540 annually for a single person). This restriction runs counter to New York’s history of providing coverage to many immigrants who are excluded from federally-funded programs.
Most immigrants who are PRUCOL are young adults who grew up in the U.S. and have Deferred Action for Childhood Arrivals (DACA) as a result of President Obama’s 2012 executive order providing them two-year work authorizations and a reprieve from deportation. These young people are encouraged to work as a result of their DACA status but are then faced with a dearth of affordable coverage options when their incomes increase beyond the Medicaid threshold because they are ineligible for the Essential Plan and prohibited from accessing tax credits through the New York State of Health insurance marketplace.
To begin to remedy these coverage gaps, the New York State Assembly is working to expand Essential Plan eligibility to include immigrants who are PRUCOL. The Assembly included $10.3 million in its 2016-17 budget to provide this coverage, but the funding was ultimately cut in budget negotiations. Assemblymembers Richard Gottfried and Marcos Crespo have since introduced legislation that would expand Essential Plan eligibility to include immigrants who are PRUCOL. Bill A10054 was successfully voted out of the Assembly Health Committee on May 17 and is now awaiting a vote by the Ways and Means Committee. HCFANY has submitted a memorandum of support for the bill. Others are encouraged to submit their own memorandums and to borrow language from the HCFANY memo as needed. Please contact me at the New York Immigration Coalition if interested in registering your support (firstname.lastname@example.org).
Narrow networks, high deductible plans, and increased cost-sharing can turn up the pressure on consumers to make careful health care purchases. But right now, consumers don’t have the tools to manage this increasing financial responsibility.
This was illustrated in a recent report by the Pioneer Institute, whose researchers called 54 hospitals to ask for the price of an MRI of the knee. Eleven of the hospitals they called are in New York City. The report is a great read, but many people who have tried to research how much a procedure would cost ahead of time already know what’s in it – the researchers were put on hold, hung up on, transferred again and again, and asked to come up with obscure billing codes that are familiar to hospital billing departments but not to consumers trying to shop around for a good price.
The researchers posed as self-pay consumers who were not using insurance – so the difficulty was not due to the challenge of navigating various plans or types of coverage. Hospitals around the country simply could not tell prospective patients what price to expect for this common procedure.
A couple of New York’s hospitals performed very well. Mount Sinai and NYU Langone performed well on all six of the measures – both were able to provide the information with minimal effort on the part of the callers. But the rest failed in ways that really matter for people trying to shop around. At five of the hospitals, researchers had to call six or more times to get their questions answered. Four of the hospitals were never able to completely answer their questions – at three of those hospitals they were unable to answer even after being given a billing code.
If consumers are going to shop around for health procedures, they need accurate information. As the Pioneer Institute points out, both federal and New York state law require hospitals to make standard charges available to consumers. But we’re still a long way from having access to that information.
And what the Pioneer Institute study did not look into but is absolutely vital for making these decisions is information about the quality of services. The researchers identified huge variations in the price of an MRI among the NYC hospitals – from $428 all the way to $4,544. Similarly huge variations exist for other procedures that pose greater risks to patients. Quality information provides the context necessary for using cost information sensibly – neither the cheapest nor the most expensive option might be the best choice. The key word is value – even if the problem of price transparency is solved, prices don’t mean very much if they can’t be connected to performance.
Here’s the quick summary of how we did:
Comprehensive coverage for immigrants
HCFANY Recommendation: Provide $10.3 million in State funding to offer Essential Plan (EP) to legal immigrants who are barred from federally-funded EP.
Full funding for Community Health Advocates (CHA)
HCFANY Recommendation: Provide $4 million in funding for CHA to help people with their insurance problems and access to health care problems, when they occur.
Result: The final budget included $3.25 million for CHA–$2.5 million from the Executive and $750,000 from the Assembly. Due to the intricacies of State contracting, this means that the CHA program faces an 18% cut from the past year.
Prior Approval of insurance plan rate increases
HCFANY Recommendation: Reject a Senate One House bill proposal to repeal the State’s right to review proposed insurance premium increases.
Health Guaranty Fund
HCFANY Recommendation: Support with modifications the Senate and Assembly stand-alone bill which sought to set up a Health Guaranty fund to reimburse providers in the wake of a health plan closing (e.g. Health Republic).
Result: The budget establishes a fund that will be financed through “settlement funds” to reimburse providers. The process for distributing the funds is unknown and it appears to include no public representation and/or public reporting on the distributions.
Medicaid beneficiary protections
HCFANY Recommendation: HCFANY opposed the following threats to Medicaid beneficiaries: elimination of spousal/parental refusal, reduction of resources that spouses of people in MLTC or nursing homes can keep, and the repeal of “prescriber prevails.”
Result: None of these proposals made the final budget. That means spousal/parental refusal remains intact, spouses of people in MLTC or nursing homes will not see a cut in the amount of resources they can keep, and “prescriber prevails” will continue to be available in Medicaid.
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 email@example.com.