HCFANY’s Policy Agenda

Covering Immigrants

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:

  • New York State should cover immigrants who have had COVID-19 but are excluded from public health insurance because of their status. A1585/S2549 would do this by allowing all income-eligible people who have had COVID-19 enroll in the Essential Plan, regardless of their immigration status. Read HCFANY’s memo in support of this bill here.
  • The State could provide coverage to more immigrants 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 2020 through such a program. A880/S1572 would create this program. Read HCFANY’s memo in support of A880/S1572 here.

For more, 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.

Ending Medical Debt

Over 50,000 New Yorkers have been sued by hospitals in the past five years – despite the fact that all of New York’s hospitals are non-profit charities. This practice continued even during the pandemic: nearly 4,000 of these lawsuits were filed between March and November 2020. New York State could end medical debt by ensuring fair medical billing practices.

  • The Patient Medical Debt Protection Act (A3470A/S2521A) would require all hospitals to provide one itemized bill, hold consumers harmless for surprise bills resulting from plan misinformation, ban facility fees, standardize hospital financial assistance forms and policies, and outlaw patient financial liability waivers. It would also cap the interest rate that can be charged on medical debt at the federal funds rate, much lower than the 9 percent currently charged by some New York hospitals. Read HCFANY’s memo in support of A3470A/S2521A here.

Learn more about medical debt lawsuits in New York by reading the Community Service Society of New York’s “Discharged Into Debt” report and a follow-up report on lawsuits filed during the pandemic. Use this map to find out if your county is a medical debt hotspot.

Take action to end medical debt by reaching out to your legislator here.

Read this letter of support signed by 28 organizations asking the Legislature to enact A3470A/S2521A.

For more information on the Patient Medical Debt Protection Act (A3470A/S2521A), read our Questions and Answers sheet here.

Certificate of Need

Consumers do not have sufficient opportunities to weigh in when hospitals change hands or close. The result is that people of color and people with low- or moderate-incomes are losing access to health care infrastructure. 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.

  • A191/S1451 would require hospitals to include a health equity impact assessment with applications to make major infrastructure changes. Read HCFANY’s memo in support of A191/S1451 here. Read a letter of support signed by advocates from all over New York here.
  • A1148/S1856 would require all hospitals to have a community advisory board and community service plan. Read HCFANY’s memo in support of A1148/S1856 here.
  • A4071/S870 would increase the number of consumers on the Public Health and Planning Commission. This bill passed the legislature but was vetoed by the Governor. Read HCFANY’s memo in support of A4071/S870 here.
  • A2986/S5144a would create more transparency and opportunities for community input when hospitals submit applications to close. Read HCFANY’s memo in support of A2986/S5144a here.

For more information:

  • 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.
  • Read this report to understand how a lack of state planning leads to racial and ethnic health disparities.

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.
  • Read this letter of principles signed by New York advocates on indigent care pool funding and protecting safety-net providers.

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 2020. 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.

Network Adequacy

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 2020:

  • 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.

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