Some Budget Wins!

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.

Surprise bills are no more! Well, almost – but we’re close! (Click here for photo attribution)

New Yorkers were protected from $400,000,000 in unfair, out-of-network bills between 2015 and 2018 because of our surprise bill law. New York passed the law in 2015 after the state received hundreds of complaints over the years from people who had done everything they could to use in-network providers, but still ended up with huge bills.

The law is especially effective for people being billed for emergency services. Providers cannot bill patients for out-of-network emergency services that the patient could not avoid. Neither the provider nor the plan may charge patients for services in excess of the deductible, copay, or coinsurance amounts they owe according to their plan agreement. Patients are also protected in non-emergency situations when they are at an in-network hospital or ambulatory center and there is no in-network physician available, they are taken care of by an out-of-network provider without their knowledge, or an unforeseen medical issue arose that required unplanned medical care.

The patients’ insurance company and the provider have to figure it out without involving the patient whatsoever. In New York they do that through a third-party in a process called independent dispute resolution (similar to baseball arbitration). The law not only helps patients avoid unfair bills, it helps keep insurance premiums down because the dispute resolution process prevents insurers from having to pay excessive charges. And now that this process is in place,  providers working in hospitals have more incentive to join insurance networks and work out a system of payment through a regular network agreement. That means fewer surprise bills overall.

Our surprise bill law is missing some pieces. One of the most common types of surprise bills occurs after patients have been told by their plan and provider that the provider is in-network. If that information is wrong, the patient has no recourse. New York can fix that during this year’s legislative session.

Another problem is that states can only regulate some plans. Self-funded plans, which are usually plans people get through employment at very large companies, can only be regulated by the federal government. DFS recently required insurance companies to include what type of plan you have on every insurance card, which will help. The law also might not help you if your plan was issued outside of New York. New York has great regulators that do everything they can to protect consumers – but we need to make sure we have leaders in Washington that also care about patients and access to health care.

What should you do if you have a surprise bill? Ask for help! It can be hard for people to know if the law covers their bills or not. Community Health Advocates is a state program that connects you to counselors who can help figure it out – for free, and regardless of what insurance you have (if any). The counselors look at medical bills every day, so they can save you a lot of time – and maybe a lot of money! Their helpline number is 212-614-5400.

New York City health care leaders called for more city and state efforts to address health care affordability during a panel discussion this morning at the Community Service Society of New York. Speakers including Dr Mitch Katz, NYC Health + Hospitals President and CEO; Rodrigo Sanchez-Camus, Director of Legal Services at NMIC; Mark Levine, Chair of the NYC Council’s Health Committee; and Elisabeth Benjamin, Vice President of Health Initiatives at the Community Service Society of New York. David Sandman, President of the New York State Health Foundation, moderated. (You can view a recording of the event here).

Panelists discussed solutions including a single-payer system, a city-funded consumer assistance program, and an overhaul of medical billing practices that leave patients paying more than they owe out of confusion and fear. The event also served as a launch party for a new grassroots effort called We the Patients (read more here) that gives New Yorkers as opportunity to advocate against unfair health care practices.

The panel was inspired by a survey (available here) which found that 50 percent of people in New York City had taken steps like cutting a pill, not filling a prescription, or skipping a treatment because they could not afford it. Most of the people surveyed had insurance.

Those results show that New Yorkers need help using their health insurance and fighting unfair medical bills. New York pioneered a model for providing that help called the Managed Care Consumer Assistance Program (MCCAP). MCCAP provided technical assistance to people enrolled in Managed Care Plans, including direct advocacy with insurance plans and legal assistance for things like inappropriate claims denials. Today all New Yorkers have access to that assistance through the Community Health Advocates and Navigator programs. Panelists suggested that the City provide its own funding to boost those services because of the disproportionate impact the affordability crisis has on city residents.  

The panel also discussed the role of hospitals and unfair billing practices in New York’s health care affordability crisis. One of the examples included an almost $300 facility fee charged to a person for what should have been a free preventive mammogram because it was provided in a hospital-affiliated practice. Some of the solutions discussed include eliminating the use of facility fees, requiring consolidated and standardized bills, and requiring that all hospitals use standard financial liability waivers so that patients are protected from signing away their rights before receiving medical care. We the Patient’s first petition focuses on seven common billing practices that result in patients owing more than they should (you can sign the petition here).