With the recent release of the Senate and Assembly One-House budgets, HCFANY is excited to see some of our policy agenda items included. However, HCFANY is also disappointed that key proposals to protect and improve health care coverage for many New Yorkers were left out.  Read below for HCFANY’s response to the One-House budgets: 

HCFANY supports the following proposals in either the Assembly or the Senate One-House Budget or both: 

• Increase primary care spending through the Primary Care Investment Act (A1915A/S1634).

• Strengthen maternal and reproductive health care access. 

• Cover more lactation support services under Medicaid, including allowing certified lactation consultants to enroll as Medicaid providers and covering breast pump supplies. 

Primary Care spending: In the United States, less than five cents of every dollar we spend on health care goes to primary care doctors and nurses, even though they handle a third of health care visits. In New York, nearly 70 percent of all emergency room visits are non-emergent and could be better treated in a primary care setting, over double the national rate. HCFANY strongly supports the inclusion of the provisions of the Primary Care Investment Act in the Senate’s One-House Budget, which requires insurance carriers to increase spending on primary care by one percent each year until they reach a target of 12.5 percent. Investment in primary care can reduce the prevalence of chronic diseases and overall health care spending. According to a recently released survey on health care affordability, 79 percent of New Yorkers support requiring insurance carriers to gradually increase spending on primary care. Many other states have also enacted similar policies requiring increased primary care spending (e.g., Colorado, Delaware, Oregon, and Rhode Island). New York should follow suit.  

Maternal, reproductive, and lactation care: In New York, Black mothers are five times more likely to have a pregnancy-related death than their White counterparts. HCFANY strongly supports initiatives that tackle racial inequities within New York’s health care system and is excited to see greater and continued support from New York’s Legislature for maternal and reproductive health care. Almost half of births in New York are covered under Medicaid, and with current federal threats that may cut funding for Medicaid—providing health care access to around 7 million New Yorkers. New York can use the budget to safeguard access to care for many New York mothers. 

HCFANY supports the following initiatives introduced in the Executive Budget but urges the Legislature and the Governor to adopt slight modifications in the final budget: 

• Strengthen the New York Department of Health’s (DOH) oversight of material health care transactions and require public disclosure and allow public participation during the health care transaction process. A material health care transaction includes mergers, acquisitions, or a form of partnership with the purpose of administering contracts with health plans, third-party administrators, pharmacy benefit managers, or health care providers. What is excluded from this definition is partnerships for clinical trials or transactions that result in a health care entity increasing its total gross in-state revenue by less than $25 million. 

HCFANY supports granting the DOH authority to determine a health care transaction’s potential market and cost impact and the post-closure impact on costs, quality, access, health equity, and competition. Additionally, the Executive budget proposes that transactions require written notice before the transaction closes to include whether either a party or parent company owns a health care entity that has closed, is in the process of closing, or has reduced its services provided. In the Senate’s One-House budget, HCFANY supports the addition of extending the notification time frame for closures from 60 to 90 days.  

HCFANY, separately, urges the Legislature to make amendments to the language to improve transparency and consumer engagement for this process by (1) requiring full public disclosure of the material transactions, (2) extending the time to file such a transaction, and (3) allowing the public to provide input on the proposed transactions to the DOH, similar to the provisions of the Local Input for Community Healthcare Act (LICH) (S1226/A6004) passed by both houses of the Legislature and vetoed by the Governor last year. The LICH bill would require the approval of closures of a hospital or maternity, emergency, or mental health services to consider findings from a Health Equity Impact Assessment, and closures must be reviewed in public sessions by the State’s Public Health and Health Planning Council.  

HCFANY is disappointed that the following initiatives are not included in the One-House Budgets:  

• Include the No Blank Checks Act (S6375), which would create a uniform patient financial liability form that includes a good faith estimate of what a patient owes financially for the care or service they will receive. 

• Include the Fair Pricing Act (S705/A2140), which would limit prices on routine medical services to 150% of the Medicare rate.  

• Redistribute some of the $1.4 billion from Managed Care Organization (MCO) tax revenue for direct patient support and a rainy-day fund. 

No Blank Checks: When patients walk into an appointment for a health care service, they are often required to sign a form agreeing to pay for any charges not covered by my insurance before they receive any care. This form legally binds them to pay for the service they get without knowing the outcome, how much will be covered by insurance, or whether their provider will bill correctly. It is essentially a blank check. The provisions of the No Blank Checks Act would create a uniform patient financial liability form that includes a good faith estimate of a patient’s financial obligation for their care. If patients are liable to pay for the service beforehand, health care services should inform them of how much it will cost. New Yorkers need greater price transparency, and many agree, as 92 percent of New Yorkers endorse requiring hospitals and doctors to provide up-front cost estimates to consumers.  

Fair Pricing: According to 32BJ Health Fund claims data, the exact same service can cost $1,000 more at a hospital-owned outpatient department compared to a doctor’s office. Spending on hospital care is the biggest contributor to rising health care spending in New York, rising twice as fast as income and four times as fast as inflation. Rising prices directly affect New Yorkers as around two-thirds of them have experienced a health care affordability burden this year, with even more worried about affording care in the future. The Fair Pricing Act, which caps prices for routine services at a reasonable 150% of Medicare rates, would save the State an estimated $1.1 billion, $213 million of which would be saved annually by New Yorkers in reduced out-of-pocket costs. It is also supported by 86% of New Yorkers.  

MCO tax: The MCO tax allows the State to draw down federal funds by taxing Medicaid and the Essential Plan MCOs to receive a federal match. The State then reimburses MCOs to make them whole and pockets the additional revenue. The Executive budget is allocating a significant portion of this revenue to hospitals. However, HCFANY urges the Governor and the Legislature to come together to reallocate some of these funds to support patients directly in the final budget. With federal threats to cut funding to Medicaid and Affordable Care Act health programs, the State can use this tax revenue to protect New Yorkers’ access to health care coverage by allocating some of this revenue to principal reserves or rainy-day funds. Medicaid provides health and financial security for seniors, children, and working-class families, and it is a critical source of funding for hospitals, clinics, community health centers, and long-term care facilities. The State should use the MCO tax revenue as an opportunity to prepare for potential cuts to federal health programs, including Medicaid. 

• Worried about federal threats to health coverage? Call key New York Members of Congress today and ask them to stop federal threats to health care in order to pay for tax breaks for millionaires. They need to hear from New Yorkers on why they need to vote to protect our access to health care: click here.  

• Learn how federal threats affect New York State and each of its congressional districts: click here.  

Stay tuned for our comments on the final State budget releases.  

HCFANY is thankful to have the opportunity to testify at the 2025 Joint Legislative Budget Hearing on Health. Our fully detailed written comments are here. The Executive Budget includes many proposals to help protect and enhance New Yorker’s access to affordable health coverage. However, the current federal landscape on health care access is uncertain, as proposed cuts to federal health programs could cost the State $10 billion to maintain health coverage for New Yorkers (Learn how these federal threats affect New Yorkers statewide and by Congressional District here).  

The Managed Care Organization (MCO) tax revenue provides an opportunity for the State to ensure New Yorkers have access to and can afford health care. HCFANY urges the Legislature to consider alternatives to the distribution of $1.4 billion of this tax revenue, which currently does not include direct support for patients.  

HCFANY recommends:  

1. Expanding subsidies for Child Health Plus to eliminate premium cliffs and align coverage start dates to the first day of the month of application.  

This would help ensure that middle-income families can afford their children’s health insurance. Once families surpass the 400% Federal Poverty Level (FPL) income threshold, their children’s annual insurance premiums increase by around $3,000 per child. Additionally, the State should follow similar rules as Medicaid and the Essential Plan for CHP coverage start dates. 

2. Addressing New York’s expensive health care system.  

New York is ranked second in the nation for the most health care spending per person, and HCFANY proposes three solutions to remedy this: 

1. Implement an independent New York Office of Health Care Affordability, like the model created in California.  

2. Include provisions of the Fair Pricing Act (S705|A2140) to ensure consumers and payers are charged a fair reimbursement rate for routine medical services, regardless of where the patient gets care.  

3. Improve patient outcomes and reduce inequities by including the provision of the Primary Care Investment Act (S1634|A1915A).  

3. Creating a principal reserve or a rainy-day fund to ensure New Yorker’s access to care is protected from the threats of federal cuts.  

This funding could help keep lawfully present immigrants enrolled in Medicaid covered if the federal government cuts access to health insurance for this population.  

4. Increasing funding for consumer assistance programs like Navigators and the Community Health Advocates (CHA) program.  

These are only a few initiatives that HCFANY is urging the Legislature to consider, please see our full written testimony here. 

Health Care for All New York is delighted that the new budget deal includes key HCFANY legislative agenda items, including: the reform of our State’s broken Hospital Financial Assistance Law (HFAL); the elimination of cost-sharing for insulin; a program to provide enhanced subsidies to help offset the costs or premiums of cost-sharing in the Marketplace; and continuous coverage for children up to age six in our State’s public health insurance programs. But HCFANY is hugely disappointed to see that Coverage4All was not included in the final deal. And in a break with the Assembly’s historic support for Community Health Advocates, it maintained over a 50 percent cut to its allocation ($1 million in 2023 decreased to $469,000 in 2025). 

The Budget deal reforming our state’s broken HFAL will provide enormous relief to New Yorkers. Over the past 7 years, New York’s “charitable” hospitals have sued over 80,000 patients contributing to the grim statistic that 760,000 people have medical debt. The ubiquity of these lawsuits will now be significantly curtailed. The new law outright bans lawsuits against patients with incomes below 400% of the federal poverty level (FPL), which is about $60,000 for an individual. It also requires hospitals to provide free care to patients with incomes up to 200% of FPL ($30,000 for an individual), and heavily discounted care – between 10-20% of the Medicaid rate – for patients up to 400% of FPL. Further, hospital payment plans cannot charge more than 5% of a patient’s gross family income in a year. And it eliminates burdensome “asset” test rules that became a cover for bureaucratic applications where patients have to prove the negative: that they are not secretly stashing their wealth in an effort to get help paying for healthcare. Finally, hospitals will be barred from including “immigration” eligibility tests for financial assistance.

Another positive aspect of the budget for healthcare consumers is the inclusion of a law that eliminates cost-sharing for insulin for enrollees in state-regulated health insurance plans. More than 1.5 million New Yorkers have diabetes, of which about 500,000 people rely on insulin. This provision will help many diabetics, but especially people of color, seniors, and people who live in low-income households, who disproportionately suffer from diabetes complications, including kidney failure, blindness, and loss of limbs.

Two key coverage provisions were also included in the final budget. First, New York will join the states of Oregon and Washington to guarantee continuous public insurance (Medicaid and Child Health Plus) coverage of children up to the age of six. This provision will help families avoid costly gaps in health coverage.  Second, the budget includes authorization to improve cost-sharing or premium assistance programs for people enrolling through the Marketplace. Few details are out, but HCFANY will post about these measures as they are finalized.  

While the Budget news is mostly good, HCFANY is hugely disappointed that the Assembly Leadership has broken with its storied tradition of standing up for healthcare consumers in two important areas. First, the Budget deal failed to include Coverage4All, a foregone conclusion by the Assembly’s omission in its one-house budget bill. Second, the Assembly continued to maintain over a 50% cut in its share of funding for the Community Health Advocates program which serves over 35,000 consumers a year, saving them $36 million in health care costs. 

Our work is not done!  For the remainder of the session, which ends on June 6, HCFANY will focus on trying to secure the passage of the stand-alone Coverage4All bill (S2237B|A3020), which would authorize the Governor to amend the 1332 Waiver to secure funding for covering up to 150,000 immigrant New Yorkers, as well as the “Stop SUNY Suing” Act (A8170|S7778), which would prevent the five state-operated hospitals from suing their patients with medical debt. 

One Pager: New York’s Reformed HFAL

The One-House Budgets are released! The Senate One-House Budget includes a significant portion of the HCFANY policy agenda, building on the Governor’s proposals in the Executive Budget. We’re still studying what is included in each bill, here’s what we know so far:

Good news: the Senate and Assembly One-House Budgets both:

• Ban cost-sharing for insulin for enrollees in State-regulated health insurance plans
• Improve affordability of Marketplace plans via premium assistance/ cost-sharing subsidies
• Adopt Kids Coverage to ensure children up to age 6 remain continuously covered in Medicaid or Child Health Plus
• Include Coverage4All, using federal funding to cover income-eligible immigrants in the Essential Plan

Even better, the Senate One-House Budget improves on the Governor’s budget by incorporating all of the HFAL improvements in the Ounce of Protection Act, including:

• Expanding Hospital Financial Assistance eligibility to individuals making up to 600 percent FPL
• Banning Hospitals from suing patients making under 600 percent FPL for medical debt
• Incorporating time-limited debt repayment plans so patients who make an agreed upon number of payments don’t have to spend their lives in debt

Bad news: the Assembly Budget completely cuts the Governor’s proposed medical debt reforms.

Take Action: Use the Phone2Action tool to call your legislators.

• Thank your Senators and ask them to fight to keep the Senate One-House Budget consumer health and medical debt reforms in the final budget.
• Ask your Assembly members to tell Assembly leadership to fight medical debt and fix our broken Hospital Financial Assistance Law.