Administration Takes Aim at Birth Control Coverage Through New Federal Regulations

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.

C4A LogoGuest post by Claudia Calhoon, MPH, Director of Health Policy at the New York Immigration Coalition.

On Wednesday, December 13, the Assembly Committee on Health, the Assembly Puerto Rican/Hispanic Taskforce, and the Assembly Taskforce on New Americans convened a public hearing on Immigrant access to healthcare.  Coverage 4 All, a campaign of Health Care For All New York led by the New York Immigration Coalition and Make the Road New York was instrumental in advocating for the hearing. The campaign’s goal is to expand insurance eligibility to all New Yorkers to reduce disparities in coverage.   Barriers to coverage are just one of the many current threats to immigrant health access and quality.

Agencies that provided testimony included the New York State Department of Health, the New York City Mayor’s Office for Immigrants Affairs, New York City Department of Health and Mental Hygiene, and New York City Health + Hospitals.  In addition, fifteen individuals from a range of social service, advocacy, health care, and community settings spoke about the impact of the federal administration on immigrant mobility, health utilization, coverage eligibility, and enforcement of language access regulation. Amid a federal landscape hostile to immigrants, New York State programs and protections are increasingly important.

Critical areas of particular attention included making sure that new mothers know they can safely continue to enroll in Medicaid and get prenatal care regardless of their immigration status, and continue to use the Women’s Infants, and Children (WIC) Food and Nutrition services. Another area of common interest among advocates was the opportunity that the state has to expand the Child Health Plus insurance program to cover young adults up to age 29 at a cost of $81 million.  Dr. Alan Shapiro, co-founder of Terra Firma, which works with unaccompanied minors, noted that health needs don’t end when young people turn 19.  These individuals “still have comprehensive primary care needs. They need access to immunizations, urgent care, sexual and reproductive health services.” The Child Health Plus Expansion is part of Health Care for All New York’s policy agenda, and the key priority of the Coverage 4 All campaign.

Hearing testimony from multiple stakeholders also highlighted the critical nature of improving enforcement of language access regulations, addressing mental health needs of immigrant communities subject to heightened stress under enhanced federal immigration enforcement, and ensuring that safety net hospitals have the revenue they need to care for all New York State residents.

NYIC_Logo-RV_Mar13,2012Guest post by Max Hadler, Senior Health Policy Manager at the New York Immigration Coalition.

Immigrant New Yorkers are under relentless attack from the anti-immigrant forces that wield the levers of control in Washington, DC. In this environment, it falls on New York State to devise solutions to the crisis. Access to health care represents a key element of immigrant inclusion and protection that state and local governments must address. In acknowledgment of the ongoing health access disadvantages that immigrants face and the acute needs related to the current sociopolitical dynamic, the New York State Assembly has called a public hearing on immigrant health for 10am on December 13. Public testimony is strongly encouraged from anyone with a stake in immigrant health access. The hearing will be held at 250 Broadway, New York, NY. This is the official Hearing Notice.

The hearing has been called by Assembly Health Committee Chair Richard Gottfried and cosponsored by New Americans Task Force Chair Michaelle Solages and Puerto Rican/Hispanic Task Force Chair Marcos Crespo. Coverage 4 All, a campaign of Health Care For All New York led by the New York Immigration Coalition and Make the Road New York, has been instrumental in advocating for the hearing. The campaign’s goal is to expand insurance eligibility to all New Yorkers to reduce disparities in coverage (noncitizens are five times more likely than citizens to be uninsured), but coverage is just one of the many current threats to immigrant health access:

  • Persistent restrictions on health coverage based on immigration status, exacerbated by the Trump administration’s cancellation of many forms of immigration relief
  • Pervasive fear of using health care services because of the dramatic increase in immigration enforcement and threats against immigrant communities
  • Acute behavioral health care needs layered on a system that already cannot meet the demand for culturally and linguistically responsive behavioral health services
  • Major cuts to uncompensated care funding that threaten the financial sustainability of safety-net health care systems
  • Language access laws that lack sufficient monitoring and enforcement mechanisms

We strongly encourage testimony from anyone with a stake in immigrant health access – directly affected community members, concerned citizens, immigrant rights advocates, health care consumer advocates, health care providers, social services providers, legal services providers, local and state health officials, and faith communities, to name a few. This hearing is an unprecedented chance to voice concerns to the New York State Assembly, and to propose solutions the state can undertake to improve immigrant health access. Do not miss this opportunity!

NOTE: You must receive an invitation to testify. If you would like an invitation, please e-mail Claudia Calhoon of the New York Immigration Coalition at ccalhoon@nyic.org. If you are unable to attend the hearing in person, you are strongly encouraged to submit written testimony (the email for written submissions is included in the official Hearing Notice).

megaphoneGuest post by Ann Danforth, Progressive States Advocacy and Policy Manager at Raising Women’s Voices-NY.

In their latest attack on women’s health, the Trump Administration released two new rules that weaken the Affordable Care Act (ACA)’s birth control benefit. The interim final rules (see here and here), which went into effect immediately, allow employers to deny their employees birth control coverage because of an employer’s moral objection to birth control. In addition, the rules expand the scope of employers who can cite religious objections for denying their employees birth control coverage. Luckily, here in New York, many (but not all) women will be protected by new state regulations that require insurers to cover birth control with no cost sharing.

The ACA guarantees coverage for a set of women’s preventive health care services, which through federal regulations issued by the Obama administration, include birth control. As a result, employers are required to cover all methods of FDA-approved birth control for employees with no cost sharing. Under the Obama administration, houses of worship were exempt from the requirement to cover birth control for their employees. An accommodation ensured that women who work for a narrowly-defined group of employers that object to providing coverage on religious grounds still had access to seamless birth control coverage.

The Trump Administration’s recent actions expand the exemption to include all employers, universities, and insurance companies, and make the accommodation optional. Now, instead of an accommodation that protects employers’ religious views and women’s access to vital health care, these new rules simply allow almost any employer to refuse to provide birth control coverage to their employees for either moral or religious objections to contraception.

While not all employers will choose to deny contraceptive coverage to their employees, these rules create sweeping new exemptions that put women’s coverage at risk, and roll back important gains in women’s health. Thanks to the ACA, 62.4 million women have insurance coverage for their birth control with no out-of-pocket costs. The percentage of women with employer sponsored insurance who were paying out-of-pocket expenses for birth control pills fell from 1 out of every 4 women before passage of the ACA to just 1 out of every 28 women in 2014. And in 2013 alone, women saved $1.4 billion in co-pays and deductibles on birth control pills.

Here in New York, an estimated 3,855,517 women between the ages of 18 and 64 have preventive services coverage, including birth control, with zero cost sharing thanks to the ACA. Fortunately, many New York women will still have guaranteed access to contraception with no cost sharing because of recently finalized New York State regulations. These regulations require coverage without co-pays for one type of contraception in each of the 18 FDA-approved categories (the federal ACA standard), and allow for the dispensing of 12 months of contraception after an initial three-month allotment (June 28, 2017 Register: Page 13, Notice of Adoption). Unfortunately, however, our state requirements do not reach “self-funded” insurance plans, which are regulated by the federal government, and not subject to the New York regulations. Because as many as 40 percent of New Yorkers have these self-funded plans, there are a number of New York women who will not be protected. The Trump Administration’s new rules have put us in a place where a woman’s zip code, employer, or income determine her ability to access the contraception she needs.

While our colleagues at the ACLU and the Center for Reproductive Rights have already filed lawsuits challenging the new rules, we must call on employers to stand up for their employees and publicly declare they will continue to provide contraceptive coverage. In addition, all of us who are employees can demand that our employers affirm they will continue providing contraceptive coverage. We will also continue to support legislation here in New York – the proposed Comprehensive Contraception Coverage Act – that would place even stronger contraceptive coverage requirements into state law.