Rate Review Comments are Due Soon – Check Out Ours!

Each year, the Department of Financial Services reviews applications from insurers in the individual, small group, and Medicare Advantage markets and decides whether rates should go up, down, or stay the same. This year, insurers are asking for an average increase of 11.7% in the individual market, which is too much for consumers to manage especially in the midst of the economic and health-related repercussions of the COVID-19 pandemic. Submit your comments here by July 5.

HCFANY found plenty of reasons in the individual market filings to reduce or even reverse those increase requests. Find your carrier in the list below to see what we had to say!

Consumers in New York have the chance to comment on requested premium increases in the individual and small group health insurance markets. The applications, where insurers justify their requests, are available through the New York State Department of Financial Services (DFS) (you can submit comments online here; see below for direct links to each individual application). Comments are due by July 5.

This process is called prior approval because in New York, the state must approve the changes insurance companies want to make to their premiums ahead of time. DFS reviews the applications to make sure that premium increases are linked to actual increases in costs, instead of things that insurers could do better at controlling.

In the individual market, the average request was 11.7 percent this year. The average requested increase was 11.4 percent in the small group market. Insurers attribute an average of 3.1 percent of the increases to the impact of the COVID-19 pandemic. Some plans cite COVID-related testing and treatment, increase in hospital costs, and the possibility of a vaccine next year as reasons to approve rate increases. It is also important to note that this year health care utilization dropped as consumers cancelled and postponed doctor’s visits and non-urgent surgeries because of the pandemic, while insurers continued to collect premiums.

DFS takes its regulatory duties seriously, and they want to hear from consumers about what it means for their families when premiums go up year after year. Last year, DFS decreased insurers’ requested rate for individual coverage from 9.2 percent to 6.8 percent, which saved consumers over $50 million. It also reduced rates for small group coverage from 12.2 percent to 7.9 percent, a 35% decrease that saved small businesses over $313 million.

HCFANY submits detailed comments every year – you can see the types of arguments we make in our letters from 2019 (link) and 2018 (link). However, consumer comments do not require as much detail as HCFANY provides. If you decide to comment, you can simply provide the name of your insurance company and plan and discuss how a rate increase would affect you. What changes would you have to make if your insurance company was allowed to increase their rates? Will you still buy insurance? We’ve written some longer instructions if you want more guidance (link), but the important thing is to speak frankly about your own experiences.

Comments are posted publicly. That means your comment won’t just inform DFS; it will be part of the bigger conversation occurring about the affordability of health care in New York. Consumers are not a big enough part of those discussions – we should take advantage of every chance we get to change that!

Individual Market Applications

Direct links are provided below for each insurance carrier that participates in New York’s individual market through our health insurance exchange. The narrative summary is a short (under ten pages) explanation for why the insurance company thinks it has to raise rates. The full applications are very long but links are provided for those who want to examine them more closely.

  • CDPHP Health Plan: Narrative Summary (link), Complete Application (link)
  • Excellus: Narrative Summary (link), Complete Application (link)
  • Fidelis (NYHQC): Narrative Summary (link), Complete Application (link)
  • Healthfirst PHSP: Narrative Summary (link), Complete Application (link)
  • HealthNow: Narrative Summary (link), Complete Application (link)
  • HealthPlus Empire: Narrative Summary (link), Complete Application (link)
  • HIP/Emblem: Narrative Summary (link), Complete Application (link)
  • Independent Health: Narrative Summary (link), Complete Application (link)
  • MetroPlus: Narrative Summary (link), Complete Application (link)
  • MVP Health Plan: Narrative Summary (link), Complete Application (link)
  • Oscar: Narrative Summary (link), Complete Application (link)
  • Unitedhealthcare of New York: Narrative Summary (link), Complete Application (link)

New York State’s budget included harmful changes to Medicaid – though many of those changes are delayed (see our joint statement with other Medicaid advocates here). The Medicaid cuts are going to be an on-going issue throughout the year. But outside the Medicaid budget, there were a few wins for consumers.

Full Funding for Consumer Assistance Programs

New York’s consumer assistance programs received full funding. These programs include the Community Health Advocates and the Community Health Access to Addiction and Mental Healthcare Program (CHAMP). Both programs provide free, independent help to make sure your health insurance works and that you can access care. Both are running full speed ahead despite social distancing – if you ever need help dealing with care denials or prior authorizations or even finding a doctor, give them a call! You can find more info about the Community Health Advocates here, and about CHAMP here.

Other good CHAMP news – the budget created a fund to make sure that people who need assistance getting mental healthcare or addiction help can get the services they need. The fund will be filled using fines against health plans that do not follow the rules about ensuring access to those services. New York has had parity laws for a long time that require plans to treat mental healthcare the same as other healthcare – the fund will help hold plans accountable while providing resources to people who need care.

Protecting Patients from Medical Debt

Two parts of the Patient Medical Debt Protection Act made it into the budget (learn more about medical debt in New York here). One reduces the statute of limitations for medical debt court cases from six years to three. After six years, most people don’t have the same insurance or the records they need to defend themselves against hospitals in court. The budget changes the law so that these cases must be filed sooner, giving defendants a better chance to defend themselves. The second change closes a loophole in the state’s surprise medical billing law – now emergency charges by either the hospital or individual providers will be covered by the law. That means fewer unanticipated and unfair bills.

Making Prescription Drugs More Affordable

There were two actions on prescription drugs in the final budget. First, the budget caps co-pays on insulin at $100 every 30 days. There’s a lot more the state could do on prescription drugs (see S6492/A8533) but this will be a big help to people with insurance who depend on insulin. The budget also creates a drug accountability board that will help the Commissioner of Health investigate prescription drug price gouging.

Fair Hospital Funding

Finally, the enacted budget ends the transition collar for the state’s indigent care pool. The transition collar was part of a system that short-changed safety net providers and rewarded hospitals that provide little or no financial assistance to patients. Advocates have worked for years to improve how indigent care pool funds are distributed – and won some improvements six years ago. When the funding formula changes happened, the state instituted a transition collar to slowly phase them in. But the transition was extended every year – until now. Without it, New York will finally fully implement the formula improvements and move closer to a fair system. You can learn more about the indigent care pool and its history here.

By Bob Cohen, Policy Director, Citizen Action New York

The COVID-19 pandemic is exposing just how broken the US health care system is, including our inability to control disease outbreaks when many people simply cannot afford basic medical care. Patients should never fear seeking medical care because of cost, but for many New Yorkers that is the reality. And a new report by the Community Service Society highlights one of the worst outcomes for patients who cannot pay their medical bills – lawsuits filed against them by the hospitals they turned to for help. The report, “Discharged Into Debt,” finds that New York hospitals have filed over 30,000 debt collection lawsuits in the past five years. The study only looked at hospitals in 26 of New York’s 62 counties – which means the actual number of lawsuits is much higher.

New York State’s non-profit hospitals have a social mission. Legally, they are charities that pay no federal, state or local taxes and receive a total of $1.1 billion each year from the ICP. As a condition for receiving this funding, hospitals are required to offer financial assistance to patients without insurance.

The report, based on an examination of the New York State Ecourts public database and a sample of hundreds of individual case files, documented a number of abusive practices by New York hospitals. For example, hospitals claimed in legal papers that they were entitled to payment for unspecified items like “miscellaneous” and “ancillary procedures” charges. And, because New York allows hospitals to charge an outrageous 9% interest rate on outstanding bills and to tack on court fees on top of that, the median amount the hospital sued on was $1,900 but the median judgment amount was $2,300. In many cases, hospitals sued patients that were eligible for financial assistance without offering it, as required by law.

The report also found large racial disparities in the treatment of patients that owe medical debt, particularly upstate. In counties like Onondaga (Syracuse), Monroe (Rochester), Albany and Erie (Buffalo), a much higher proportion of people were referred to collections for medical debt in communities of color than white communities.

And, the study documents, patients were almost always totally outmatched by large collection law firms retained by the hospitals. Process servers often illegally serve relatives or co-tenants instead of patients, violating basic provisions of the U.S. constitution and in state laws designed to make sure people have reasonable notice of lawsuits so they can adequately defend themselves. And, 97% of the patients in the study were unrepresented and didn’t even attempt to respond to the lawsuit. The result is often wrecked credit, and unpaid judgments that threaten the financial futures of consumers and their families.

The CSS report adds to the case for passage of the Patient Medical Debt Protection Act (A.8639/S.6757), which addresses some of the most egregious medical billing practices.  Fixing these practices, including lawsuit abuses, is a critical step in fixing our broken health care system and making health care affordable to low and moderate income New Yorkers.