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.
As we celebrate the holidays and ring in the New Year, we now have more reason for merriment – Governor Cuomo has just signed legislation that gives pregnant women the right to enroll in Qualified Health Plans through the State’s Marketplace at any time during the year! Until now, pregnant women had to wait to apply for health insurance until the annual open enrollment period. HCFANY is proud to say that New York is the first state in the nation to adopt such an important law, demonstrating leadership in promoting access to health insurance for all!
The passage and signing of S5972/A6780 is significant and commendable because having health insurance during pregnancy can improve the health of mothers and their babies. Timely, quality pre-natal care can decrease the likelihood that a pregnant women will face health problems or that her baby will be born premature. According to the March of Dimes, nearly 9% of babies born in New York State are pre-term, which puts them at risk for many health problems. The new legislation should help decrease that percentage, assuring that more babies in New York get a healthy start in life.
The new special enrollment period may also significantly decrease healthcare costs for pregnant women who sign up for health insurance. Charges for pre-natal care and hospital care can be daunting for uninsured women. The costs quickly add up due to numerous pre-natal visits, ultrasounds, blood work and screening tests. Giving birth in a hospital is very expensive. On average, health insurance companies pay $9,800 for a normal delivery and $15,000 for a c-section, according to the International Federation of Health Plans. As of today, women in New York State will not have to worry about the full cost of pre-natal care and giving birth. Thanks to the new law, they will be able to access the full array of health services needed for a healthy pregnancy, birth and healthy baby.
HCFANY applauds New York State lawmakers and Governor Cuomo for working to protect the health of mothers and babies. You can read the governor’s press release here. Pregnant women will now be able to enroll on the Marketplace as soon as a doctor confirms they are expecting by going to the New York State of Health Marketplace. Women can also contact the Community Service Society Navigator Network for free enrollment assistance.
Already more than two million New Yorkers have gained affordable health coverage through the NY State of Health marketplace, but there are still some people (namely women!) who may find themselves left behind. First-in-the-nation legislation providing special insurance enrollment options for pregnant women passed both the State Assembly and State Senate a few weeks ago and awaits the Governor’s signature.
In the past, moderate- and higher-income uninsured women who become pregnant had to wait to enroll in private health insurance. Low-income women can enroll in Medicaid at any time, but their higher-income counterparts can be left without affordable prenatal and maternity care. Lack of coverage can lead poor health outcomes for mom and baby. Improved maternal and child health outcomes support the New York State Prevention Agenda, and it’s the right thing to do.
Senate Bill 5972/Assembly Bill 6780-B creates a special enrollment period (SEP) for uninsured women who become pregnant and seek coverage outside of the open enrollment period. HCFANY urges Governor Cuomo to sign it into law. You can send a message here or call 518-474-8390 to ask him to sign S.5972/A.6780-B today!