CURRENT ACTION ITEMS
- Get covered! If you buy your own insurance, you can still enroll – if you enroll by January 15, your coverage will start on February 1. If you enroll by January 31, your coverage will start on March 1. Don’t assume you aren’t eligible for help without making an account at the New York State of Health and finding out for sure! Learn more about getting health insurance in New York here and here.
- Have you ever had to tell a hospital that you can’t pay your bills? What happened next? Share your story about trying to get financial assistance at a hospital here. Join HCFANY and other leaders on a webinar Friday, January 11 at noon to learn more about action steps to make sure that hospitals are held accountable when receiving indigent care funds from the state.
- Sign up for alerts from Coverage4All, HCFANY’s campaign to make sure all New Yorkers have access to health insurance regardless of their immigration status. Join us in Albany on January 15 to demand state action that covers all immigrants! Register for the day of action here.
- Register for HCFANY’s Winter Meeting, which will be held on January 18 in Albany. It’s a great chance to catch up on what’s happening in Albany and to meet other advocates from all over the state!
- Share your story! How has Medicaid or the ACA affected your life? Let us know using our story forms: –Medicaid –The ACA Your stories help us educate leaders about why Medicaid and the ACA matter to New Yorkers.
CURRENT FEDERAL ISSUES
Texas v. Azar
A judge in Texas ruled that the ACA is unconstitutional (you can read his ruling here). He did not issue an injunction, which means nothing has changed for consumers.
- Legal experts agree that the ruling will not stand up to appeals. This includes the lawyers who sued the Obama administration in the cases that went to the Supreme Court in 2012 and 2015. In an op-ed they called the decision “shocking” and said that the judge had made “a mockery of the rule of law.”
- The federal Department of Health and Human Services, which administers the ACA, has said that they will continue to fully implement the law.
- If the ACA were thrown out in its entirety, the effects would be devastating in New York. The Empire Justice Center wrote a helpful summary of the number of people in New York who have insurance because of the ACA and how much funding the State gets through the ACA.
The Department of Homeland Security (DHS) proposed a new point system for new arrivals or current residents who want to obtain a green card. The points system is meant to predict whether or not a person will use programs like Medicaid, subsidies for Medicare Part D, SNAP, or housing assistance at any point in the future. It would deny entry or green cards to people based on their age (being a child or being elderly), income, education, and health. The comment period is now closed and we are waiting for DHS to take the next step.
- The full text of the rule is available through the federal register.
- The public showed their opposition by posting a record-breaking 210,000 comments on the rule. Read HCFANY’s comments here. You can learn more about the next steps here.
CURRENT STATE ISSUES
HCFANY’s complete 2019 policy agenda is available here.
Over 400,000 New Yorkers remain uninsured because of their immigration status. HCFANY is working to close this coverage gap through the Coverage4All campaign. There are two immediate steps New York could take:
- The State could provide coverage to a portion of this population by allocating $532 million to create a state-funded Essential Plan for New Yorkers who are currently excluded because of their immigration status. The Essential Plan covers people who earn up to 200 percent of the federal poverty level. HCFANY estimates over 111,000 people could gain coverage in 2019 through such a program.
- The Trump Administration is ending Temporary Protected Status for thousands of New Yorkers, many of whom have lived in New York for decades and made it their permanent home. The State should offer state-funded Medicaid to these residents by enacting A10607/S7569-A.
For more background, see “How Can New York Provide Health Insurance Coverage to its Uninsured Immigrant Residents?,” from the Community Service Society of New York, a HCFANY Steering Committee member.
New Yorkers still face many barriers to care because of network problems, including narrow networks, networks that change mid-year, and an inability to get accurate information on their plans’ provider network. The Leonard Davis Institute of Health Economics has found that networks are getting smaller in New York, even though in many other states they are growing. In 2017 they found that 38 percent of the plans available in New York’s individual market would be considered narrow using their criteria (the ratio of the number of physicians participating in a network divided by the total number of physicians in that market). You can learn more about network adequacy from Families USA here, and from the National Association of Insurance Commissioners here.
HCFANY has three recommendations on network adequacy for 2019:
- New York’s landmark “Surprise Billing” law should be amended to hold consumers harmless when they receive incorrect information from plans or providers about a provider’s network status. (Learn more about the current surprise bill law here and here).
- Health plans should be required to maintain provider contracts for an entire plan year, except for cause. Consumers who enroll in a plan because of its network should know that their network will remain in place.
- Current tests of network adequacy should be improved by adding standards based on minimum appointment availability. Consumers should have the right to go out of network if they cannot get appointments with accessible providers that can communicate in their language within the adopted appointment availability time frames.
Affordable Health Insurance
The Affordable Care Act cut premiums in New York’s individual market in half. However, many people still struggle to afford health insurance. New York should take steps to make private coverage more affordable for consumers in 2019. It should also make sure there are robust public alternatives.
- The Essential Plan is a popular health program that offers coverage for at most $20 a month with no deductible. The cutoff for Essential Plan eligibility is 200 percent of the federal poverty level, which is only about $25,000 a year. When New Yorkers earn more than that, they have to buy coverage through the Marketplace which can cost $150 or more a month and has deductibles that are over $1,300 – even with financial assistance. New York could ease this affordability cliff by allowing people who earn between 200 and 250 percent of the federal poverty level to choose between buying a private plan or enrolling in the Essential Plan. HCFANY estimates that subsidizing this buy-in to create a gradual price increase would cost around $132 million and provide coverage at $50 a month to around 116,000 people.
- New York should explore a state premium assistance program for people who buy private plans and do not qualify for public programs.
Indigent Care Pool
The Hospital Financial Assistance Law requires hospitals to offer financial assistance to low-income, uninsured patients. HCFANY is fighting to make sure that the law is implemented fully and to improve aspects of the law to make sure it works well for consumers. At a minimum, HCFANY hopes that the funding can be better targeted to the hospitals that provide the most financial assistance to patients who can’t pay.
- Read this report from the Community Service Society of New York, a HCFANY Steering Committee Member, on New York’s Indigent Care Pool. That report updated an earlier one, available here.
Certificate of Need
Consumers do not have sufficient opportunities to weigh in when hospitals change hands or close. This process is regulated by New York’s certificate of need laws, with oversight by the Public Health and Planning Commission. HCFANY is working to make this process work better for consumers.
- Read this report by Steering Committee member Merger Watch to learn more about certificate of need in New York and how it could be improved for consumers.
- Check out this page by the National Conferences of State Legislatures to learn more about how certificate of need works in other states.