CURRENT ACTION ITEMS
- New York’s proposed budget invested nothing in expanding health coverage or making it better for New Yorkers. This is especially troubling considering new data that shows most New Yorkers STILL face enormous difficulties affording care. There’s still time this session to pass consumer-friendly legislation – click on the linkc below to read one-pagers about the bills we’re working on for the rest of this session.
- Certificate of Need: A4071/S870 would add patients to the Public Health and Health Planning Council and is waiting a signature from Governor Cuomo. A1148/S1856 would require a community-advisory board at all hospitals.
- S5145 would codify into State law independent consumer assistance programs that help New Yorkers fight back against unfair insurance practices.
- Affordable Prescription Drugs: A2969/S2849 would require health plans to maintain stable drug formularies during a plan year. A2970/S1705 would require pharmacy benefit managers to provide the State with information needed for better regulation.
- A264/S3171 would subject all emergency room charges to third-party arbitration so that consumers don’t end up paying for excessive charges through higher insurance premiums.
- Two important bills on immigrant coverage are making progress in the legislature: one to provide health coverage to all New Yorkers earning under 200% of the federal poverty level, including undocumented people (A5974), and one that preserves Medicaid eligibility for people with TPS even if the Trump Administration revokes their status (A3316). Both A5974 and A3316 passed the Assembly Ways and Means Committee.
- Share your story! Consumers are expected to make important and expensive decisions about care without having the right information. We are educating leaders about the problems consumers run into – tell us about problems you’ve had accessing care or paying for it 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. A5974/S3900 would create this 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 A3316/S1809.
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 governor’s budget includes a proposal to license pharmacy benefit managers (PBMs). This is an important step towards regulating prescription drug prices, and is already the case in many other states. Learn more about PBMs here.
- 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.
- A4071/S870 would increase the number of consumers on the Public Health and Planning Commission.
- A2986 would create more transparency and opportunities for community input when hospitals submit applications to close.
- 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.
CURRENT FEDERAL ISSUES
Changes to the Title X Family Planning Rule, commonly referred to as the gag rule, have gone into effect despite a massive outpouring of protest against them. The proposed changes have now gone into effect despite a massive outpouring against them. The rule allows family planning funds to be used for religiously-inspired birth control methods not supported by science and most dangerously, prohibits providers who receive Title X funding from talking to patients about abortion or referring their patients somewhere where they can get an abortion regardless of the circumstances. This will result in terrible choices for clinics: Planned Parenthood has already said that they will never withhold information from their patients, and so faces losing all of their federal funding.
- Learn more about the rule: You can read the comments HCFANY submitted in July as well as this blog post by Steering Committee member Raising Women’s Voices.
- You can sign an open letter protesting the rule here.
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.