More New Yorkers than ever turned to NYSOH for affordable health coverage at the beginning of 2020. The latest NY State of Health (NYSOH) report shows that 25 percent of New Yorkers (4.9 million) enrolled in health coverage through the NY State of Health during 2020’s Open Enrollment Period. This represents a 150,000 increase over 2019. The report documents enrollment between November 1, 2019 and February 7, 2020. Enrollment through NYSOH has increased every year since it was created, an indication of the need New Yorkers have for health coverage.
Most New Yorkers who used NYSOH enrolled in public plans like Medicaid (3.4 million), Child Health Plus (452,000), and the Essential Plan (797,000). Medicaid and the Essential Plan cover New Yorkers who earn up to 250 percent of the federal poverty level. Child Health Plus covers New Yorkers under the age of 19 with subsidies for families at lower incomes. About 273,000 New Yorkers used NYSOH to purchase private health insurance (Qualified Health Plans or QHPs), 60 percent with financial assistance through premium subsidies. QHP enrollees continued to show a preference for lower-cost options, with Bronze and Silver plans (plans with lower premiums) being the most popular throughout the State. Increasing premium costs are likely the cause of this trend towards lower premium plans, but those lower premiums come with higher deductibles. Even insured New Yorkers report struggling to afford health care – the trend towards enrollment in plans with lower premiums but higher cost-sharing is an important one for advocates to monitor.
Assistors continued to play a key role in the success of last year’s Open Enrollment period, with around 80 percent of last year’s enrollments being conducted by assistors. Navigators, who are trained and certified by the state, are available to provide assistance all across New York – you can find help in your own community by calling 888-614-5400.
NYSOH has proven itself resilient over the years, from the early days when it was unclear whether or not consumers would use it at all through the Trump era when federal policy changes hurt Marketplaces in other states. In the months after this report covers, NYSOH took steps to ensure that New Yorkers were able to keep enrolling in health coverage even as millions lost their jobs or experienced other disruptions during the pandemic. Preliminary data shows that between February 2020 and February 2021, an additional 885,000 New Yorkers used NYSOH to obtain health insurance, and now a record 5.8 million people are enrolled through NYSOH—nearly a third of the state’s entire population. This was only possible because of the investments New York has made over the years towards building a strong, integrated Marketplace where consumers have lots of help available to make the best choices for themselves.
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.
Everyone is experiencing enormous upheaval right now and many people are losing their jobs and with it their health insurance. Here’s a summary of actions New York State has taken to keep people covered during the pandemic.
- Medicaid discontinuances are halted. If you have Medicaid, you will not be disenrolled. If you get a discontinuance letter, contact your local district office or the NY State of Health – you will be reinstated. Thanks to the Families First Coronavirus Relief Act, this is now also a federal policy – but New York did it first!
- Medicaid, Essential Plan, and Child Health Plus renewal dates are being pushed back by four moths. If you were supposed to renew in March, April, May, or June, you no longer have to do so.
- If you are uninsured, you have special permission to buy a plan through the New York State of Health (link) until April 15. A lot of people are experiencing job and income losses – you may be eligible for help that you weren’t previously eligible for. Ask for help figuring out what your options are – the New York State Navigator program is running full speed ahead! Your insurance will start on April 1.
- There is no cost-sharing (such as co-pays) for in-network telehealth services, whether related to COVID-19 or not (link). Insurers must cover telehealth services if those services would be covered during a physical interaction. This will help people stay at home and avoid unnecesary physical interactions.
- There is no cost-sharing for COVID-19 tests. If you cannot get a test in-network, insurers must cover the test out-of-network.
Things are moving quickly! As always, if you need help getting insurance or using your insurance, the Community Health Advocates program (link) is available.
Post by Bob Cohen, Policy Director, Citizen Action of New York
A hospital stay can be among the most stressful events in the life of many people. And for some, the stress can continue after you are discharged – due to the simple fact that all too many hospitals simply are unable to present you with a clear bill telling you what you owe. This can lead to months or even years of phone calls, letters and emails to resolve the dispute, and other consequences like collection lawsuits and wrecked credit.
When you buy a new refrigerator, you generally get a single bill at the store: not one bill for the refrigerator when you buy it, and six months later, for the ice tray. Not so with hospitals. As HCFANY’s new publication, Patients Need Clear Hospital Bills – Not the Runaround! says, all too many patients “receive bills months after their visit, or from doctors or other providers not affiliated with the hospital or who the consumer didn’t remember seeing … Many consumers don’t contest questionable hospital charges and just give up.”
New state legislation known as the Patient Medical Debt Protection Act (A8639/S6757), lead sponsored by Assembly Health Committee chair Richard Gottfried and Senate Health Committee chair Gustavo Rivera, Finance chair Senator Liz Kreuger, and Insurance chair Neil Breslin, addresses the hassles consumers face due to unclear and deceptive hospital bills. The legislation requires that consumers get a single consolidated, itemized bill or statement from the hospital detailing the specific services the patient received during their hospital visit and what you actually owe (vs. your health insurer) within seven days of their discharge or at their request. And the charges would have to be based on standard price data for procedures like a hip replacement.
This critical omnibus legislation addresses a number of other consumer problems with hospital bills, like high interest rates on amounts owed, and large “facility fees” – charges added to bills that do not represent medical services. HCFANY will be campaigning hard to get this legislation passed in 2020. Visit this page for ideas on how you can help: https://wethepatientsny.org/wtp_campaigns/one-visit-one-bill/!