Guest post by Mark Hannay, Director, Metro New York Health Care for All Campaign. New York’s fifth open enrollment period began this past Wednesday, November 1. This is the period during which people can renew or sign up for private health insurance coverage through the Marketplace.  Here in New York, the New York State of Health (NYSOH) marketplace will be open for business through January 31, 2018.

To help everyone get ready for open enrollment, members of HCFANY partnered again this year with the Healthcare Education Project to organize a series of ACA Outreach and Enrollment Summits across the State, which took place last month. These summits bring together enrollment assistors, health plan representatives, advocates, hospital outreach staff, community health centers, and non-profit community-based organizations. Summits were held in Buffalo, Albany, New York City, and Long Island.

Each of the summits began with a presentation from NYSOH, which discussed the gains New York has made so far under the ACA and their outreach and promotional plans for open enrollment.  One of the key messages they stressed during their remarks was that, in spite of the federal debate over the future of the ACA, nothing has changed, the ACA remains the law of the land, and NYSOH will be open for business as usual.

NYSOH also emphasized that affordable coverage is available and that many New Yorkers may qualify for financial assistance. They identified geographic areas where the uninsured rate remains above the state average which will need special focus and described the online resources available for stakeholders to use in their own outreach and enrollment.

For the first time this year, the closing section of each summit focused on key policy issues and advocacy strategies concerning the “unfinished business” and looming threats to various national health care programs. These issues include potential drastic funding cuts to Medicare, Medicaid, and the ACA, the need to renew funding for the Children’s Health Insurance Program (CHIP) and federally-qualified community health centers, attacks on funding for family planning, and restoring needed funding to the Disproportionate Share Hospital (DSH) program that helps pay for care for the uninsured, particularly at public hospital systems across our State.

NYSOH Presentation 2017 Enrollment Summits

Guest post by Ann Danforth, Progressive States Advocacy and Policy Manager at Raising Women’s Voices-NY.

In their latest attack on women’s health, the Trump Administration released two new rules that weaken the Affordable Care Act (ACA)’s birth control benefit. The interim final rules (see here and here), which went into effect immediately, allow employers to deny their employees birth control coverage because of an employer’s moral objection to birth control. In addition, the rules expand the scope of employers who can cite religious objections for denying their employees birth control coverage. Luckily, here in New York, many (but not all) women will be protected by new state regulations that require insurers to cover birth control with no cost sharing.

The ACA guarantees coverage for a set of women’s preventive health care services, which through federal regulations issued by the Obama administration, include birth control. As a result, employers are required to cover all methods of FDA-approved birth control for employees with no cost sharing. Under the Obama administration, houses of worship were exempt from the requirement to cover birth control for their employees. An accommodation ensured that women who work for a narrowly-defined group of employers that object to providing coverage on religious grounds still had access to seamless birth control coverage.

The Trump Administration’s recent actions expand the exemption to include all employers, universities, and insurance companies, and make the accommodation optional. Now, instead of an accommodation that protects employers’ religious views and women’s access to vital health care, these new rules simply allow almost any employer to refuse to provide birth control coverage to their employees for either moral or religious objections to contraception.

While not all employers will choose to deny contraceptive coverage to their employees, these rules create sweeping new exemptions that put women’s coverage at risk, and roll back important gains in women’s health. Thanks to the ACA, 62.4 million women have insurance coverage for their birth control with no out-of-pocket costs. The percentage of women with employer sponsored insurance who were paying out-of-pocket expenses for birth control pills fell from 1 out of every 4 women before passage of the ACA to just 1 out of every 28 women in 2014. And in 2013 alone, women saved $1.4 billion in co-pays and deductibles on birth control pills.

Here in New York, an estimated 3,855,517 women between the ages of 18 and 64 have preventive services coverage, including birth control, with zero cost sharing thanks to the ACA. Fortunately, many New York women will still have guaranteed access to contraception with no cost sharing because of recently finalized New York State regulations. These regulations require coverage without co-pays for one type of contraception in each of the 18 FDA-approved categories (the federal ACA standard), and allow for the dispensing of 12 months of contraception after an initial three-month allotment (June 28, 2017 Register: Page 13, Notice of Adoption). Unfortunately, however, our state requirements do not reach “self-funded” insurance plans, which are regulated by the federal government, and not subject to the New York regulations. Because as many as 40 percent of New Yorkers have these self-funded plans, there are a number of New York women who will not be protected. The Trump Administration’s new rules have put us in a place where a woman’s zip code, employer, or income determine her ability to access the contraception she needs.

While our colleagues at the ACLU and the Center for Reproductive Rights have already filed lawsuits challenging the new rules, we must call on employers to stand up for their employees and publicly declare they will continue to provide contraceptive coverage. In addition, all of us who are employees can demand that our employers affirm they will continue providing contraceptive coverage. We will also continue to support legislation here in New York – the proposed Comprehensive Contraception Coverage Act – that would place even stronger contraceptive coverage requirements into state law.

Although it has no immediate effect, the executive order the President signed yesterday morning instructs several federal agencies to consider proposals that could destabilize the individual insurance markets established under the Affordable Care Act (ACA).

The executive order instructs relevant agencies to propose regulations that would:

• Expand the use of association health plans, which allow small businesses to group together to purchase health insurance;
• Allow more people to enroll in short-term limited duration insurance, which are exempt from ACA consumer protections, for longer periods of time; and
• Allow the sale of health insurance across state lines.

The expansion of association and short-term limited duration health plans would both create loopholes for younger, healthier consumers to purchase one of these plans instead of plans offered through the Marketplace. If younger, healthier people leave the Marketplace, premiums will rise for consumers that remain and may become unaffordable.

Selling insurance across state lines presents a different problem, especially for states like New York. New York has worked really hard to pass insurance regulations that protect consumers. Insurance sales across state lines would essentially allow insurance companies to choose their regulators, which would make insurance less available and less accountable to the needs of New Yorkers and consumers across the country.

If federal agencies do propose these rules as the President instructs, there will be an official notice of proposed rulemaking and at least a 30-day comment period before any new regulation would go into effect. It is therefore unlikely that any changes will take place before 2018.

This does not affect the upcoming open enrollment period, which will begin on November 1. If you or someone you know needs help enrolling in health insurance, please call (888) 614.5400 for in-person assistance in your area. Don’t forget, consumers enrolling in Medicaid, the Essential Plan, and Child Health Plus can enroll year-round.

You can check out additional resources on the executive order here.

A new proposal from Senators Lindsey Graham (R-SC) and Bill Cassidy (R-LA) that would devastate New York and the nation could pass as early as next week. An updated analysis from the Center on Budget and Policy Priorities (CBPP) estimates that New York State would lose more than $33 billion by 2027 under the Graham-Cassidy amendment – a last-ditch effort by the Senate to repeal and replace the Affordable Care Act (ACA) before September 30. CBPP says that beginning in 2027, Graham-Cassidy “would likely be even more damaging” than repealing the ACA without a replacement, which would have caused an estimated 32 million people to lose their health coverage.

The Graham-Cassidy amendment would:

• End Medicaid Expansion and Advanced Premium Tax Credits (APTCs) that help make insurance more affordable in 2020 and convert all funds to a block-grant.
• Require a state match to use any block-grant funds.
• End the Medicaid program as we know it, by capping how much states can spend on each Medicaid recipient.

Graham-Cassidy would replace the federal funding for Medicaid Expansion and APTCs with a block-grant to states. According to CBPP, this block-grant would include a 17 percent cut to current federal funding levels by 2026 and would not be adjusted based on the size of a state’s Medicaid population or changes in a state’s funding needs. New York would experience the second largest funding cut in the nation. There is also no requirement in the amendment that states use this money on health coverage. This block-grant would completely disappear in 2027.

Your Representatives in Congress need to hear from you. Please call 844.898.1199 and tell your Representative to vote “NO” on this devastating proposal.