The season of giving is coming early for many New Yorkers seeking hospital care this year. As of last month, amendments to New York’s Hospital Financial Assistance Law (HFAL) will make it easier to apply for and cover more patients under financial assistance programs. The HFAL, also known as Manny’s Law, was implemented in 2006 in response to the death of Manny Lanza, 24. Lanza passed away after being denied life-saving surgery due to his uninsured status.

Financial assistance programs help many patients receive affordable care on a sliding fee scale based solely on their household income. This includes patients who are uninsured or those with insurance, but medical costs are a big strain on their income. Rising hospital prices in recent years have left many patients unable to afford the care they need, often leading them to incur medical debt. A 2023 Urban Institute reported that 740,000 New Yorkers had medical debt, with nearly half of them owing $500 or more. This updated HFAL will streamline the process and expand the eligibility of hospital financial assistance. New Yorkers will finally be able to have some more relief from medical debt and rising healthcare costs.

The following changes will be made to HFAL and medical debt in New York.

• All hospitals licensed by the New York State Department of Health (NYSDOH) are required to use a Uniform Hospital Financial Assistance form and inform patients of financial assistance availability in writing during registration and at discharge (regardless of the hospital’s participation in the Indigent Care Pool). Eligibility will not consider the patient’s immigration status. Before this amendment, many patients were never informed financial assistance existed and many hospitals requested information that was not legally required, like Social Security Numbers or tax returns, which often scared patients away from applying.
• Patient eligibility for financial assistance will be expanded for those uninsured and underinsured. Under the new law, being underinsured is defined as patients whose paid medical expenses, excluding insurance premiums, exceeds 10 percent of their income within the last 12 months. Uninsured patients will now qualify if their household earns up to 400 percent of the federal poverty level (FPL) and will receive free or discounted care based on a sliding scale (see the table below for eligibility guidelines based on household size and the payment sliding scale). These guidelines will be solely based on the FPL and are updated through the Poverty Guidelines | ASPE.
• Individuals can now apply for hospital financial assistance at any time.
• Hospitals may not sell patients’ debt to third party entities like debt collection agencies. Often these agencies use aggressive and threatening practices to make patients pay medical debt.
• Hospitals are prohibited from bringing lawsuits against patients earning up to 400 percent FPL to collect unpaid medical bills. And lawsuits to collect unpaid balances cannot be brought until 180 days after the first medical bill. Lawsuits have disproportionately affected people of color and low-income residents. For example, according to a 2024 Community Service Society of New York report, over a third of lawsuits filed by State-run hospitals were filed against patients who lived in zip codes where residents are disproportionately people of color. Additionally, nearly all these cases were filed against patients that should have been eligible for hospital financial assistance.
• To measure this impact, hospitals will report to the DOH the number of people that have applied for financial assistance annually including age, gender, race, ethnicity, and insurance status.

With this series of reforms, more New Yorkers will be able to receive affordable hospital care and reduce their chances of incurring medical debt. The HFAL was a landmark reform back in 2006 and has been far improved with these amendments.

Here’s a copy of the form hospitals must use now.

If you need assistance in applying for hospital financial assistance, contact Community Health Advocates at 888-614-5400.

Health insurers in New York are asking for rate increases again this year: in the individual market an average of 8.4 percent and in the small group market, an average of 12 percent. UnitedHealthcare of New York asked for the biggest increase in the individual market (27.1 percent), while HealthPlus (Empire) asked for the smallest (2.4 percent).

In New York, insurance premium changes in the individual, small group, and Medicare Advantage markets are subject to prior approval. That means the state has to review their justifications and decide if they are asking for a reasonable change. The data provided to the Department of Financial Services, which regulates health insurance in New York, are available publicly and the public is able to post their own comments. HCFANY submits comments each year assessing whether or not the carriers are asking for reasonable changes. If not, we ask the Department of Financial Services to reject their requests. You can see the letters we wrote last year here. DFS wants to hear from you, too! You can find a guide for submitting your own comments here. The comments are due by June 28 – you can find your insurance company’s application here.

The requests are much smaller this year in the individual market than they were last year. This reflects the success insurers had in 2018. Nationally, this was the most successful year yet for the individual insurance marketplaces created by the Affordable Care Act (ACA).[1] The ACA remains in place despite federal efforts to sabotage the law – and states like New York have worked hard to counteract that sabotage, which creates a more stable environment for insurers.

One sign of this success is that insurance companies owe customers about $800 million in rebates because their medical costs were so much lower than the premiums they collected. The ACA requires them to spend at least 80 percent of their income on medical services – instead, they only spent 70 percent. The average medical loss ratio for the major carriers applying in New York was 85.4 percent, just above the state’s minimum of 82 percent. Four New York carriers failed to meet the state threshold.

Even though the request is smaller than past requests, it is hard for consumers to manage any premium increase. New Yorkers increasingly report that they cannot afford health care, even when they buy insurance. Many New Yorkers get assistance with insurance premiums through the Affordable Care Act and so won’t be affected – but those that don’t get assistance cannot manage another increase. Your voice matters in New York – while the Department’s decisions must be based on the information provided by the insurers, your stories about managing (or not managing) premium increases over the past few years add valuable information to public discussions about health care in New York. New York will only develop good solutions to our affordability crisis by listening to all voices – we need to hear from you!

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[1] Cynthia Cox, Rachel Fehr, and Larry Levitt, “Individual Insurance Market Performance in 2018,” Kaiser Family Foundation, May 7, 2019, https://www.kff.org/private-insurance/issue-brief/individual-insurance-market-performance-in-2018

A new survey found that most New Yorkers still struggle to afford healthcare and are worried about affording care in the future. This probably isn’t news to many of us – but the findings make the state budget’s lack of action on health care even more glaring.

New York has traditionally been a healthcare leader, and we have one of the lowest uninsured rates in the country. But insurance isn’t enough. Many of the survey questions were asked of insured New Yorkers. They are having trouble managing the costs of their premiums, co-pays and deductibles.

The survey shows the toll this takes – almost half of New Yorkers (45 percent) have avoided care or taken drastic actions like cutting pills in half or not filling prescriptions. Over a third of New Yorkers (35 percent) reported serious financial repercussions including using up all or most of their savings, being put in collections, or being unable to pay for food, heat, or housing on top of medical bills.

New Yorkers blame health plans, the pharmaceutical industry, and providers like hospitals almost equally. They are ready for the government to step up and do something. But the only proposal in the governor’s budget that could address costs is one that would license pharmacy benefit managers. That’s a great start in reining in prescription drug costs, but it’s a step many other states have already taken. The state could do a lot more to help New Yorkers manage this problem, including a state premium assistance program, a drug utilization board that could set prescription drug rates, or creating a public option for the lowest-income people in the individual market (see our budget testimony here for more information).

The New York Health Act would create a single-payer public program that provides health coverage for all New Yorkers.  Last week, RAND released a report finding that the bill is financially feasible. This is a big deal because single payer efforts in other states have floundered due to cost concerns. The savings weren’t huge – the researchers estimated total health spending would only decrease by 2-3 percent. But the program would provide universal health coverage in New York, which many have believed would cost much more than our current system.

A single-payer system would mean providers, like hospitals, doctors, and pharmacies, get paid directly by one state program. Patients would not pay anything when they receive care. Instead they would have to pay a new tax based on income. Employers and employees would split it, as they do now with premiums. The RAND researchers found that most New Yorkers would save money by paying the tax because they would no longer pay for premiums, deductibles, or co-payments.

Single-payer is one of two models of achieving universal health coverage. The New York Health Act is most similar to the models used in the United Kingdom and Canada. In those countries, most care is paid for through one government program. Private insurance still exists to supplement the national program, but it is a small part of their health care systems. Like Canada’s system, care under the New York Health Act would still be delivered by the private sector (in the United Kingdom care is largely delivered at public clinics and hospitals).

The Affordable Care Act (ACA) was based on the other model for achieving universal coverage, one that includes a bigger role for private insurance. In those countries, people get subsidies to buy coverage, benefits are standardized, and there are penalties for people who do not purchase insurance. Private insurers collect premiums and pay providers. Insurers are not allowed to deny coverage to people with pre-existing conditions. The ACA helped New York cut the number of people without insurance in half, to only 5 percent of the population. That’s a great achievement, but closing that gap is important.

A benefit of a single-payer program is that it would be much simpler for consumers and providers. Its simplicity is one reason the RAND researchers found it would reduce spending overall. Private insurers offer dozens of plans with slightly different benefits and with different fee schedules, which makes billing very complex. Providers also have to develop administrative systems for dealing with many sources of payment. Those costs would go away. The state would still be responsible for some administrative costs but our existing public programs have relatively low administrative costs compared to private insurers.

The RAND researchers also found that the system would save money because the program would have more purchasing power than any private insurer or even large programs like Medicaid. That should mean better prices for things like medication, for the same reason that places like Costco that sell bulk goods can charge less.

Details are incredibly important in health care, as any consumer who’s dealt with a claim denial or billing error can explain. That means there is still a lot of work to do before New York can realistically develop this single payer program. However, the new report means there is new energy for figuring out those details. To learn more about the bill, check out the Campaign for New York Health’s website.