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.  

Women are still struggling with surprise bills and making decisions about health care in the absence of meaningful price information, according to a focus group held by HCFANY. Several focus group participants described surprise bills as a big problem:

• Three described bills that should have been prevented by New York’s Surprise Bill Law.
• Some received out-of-network bills after being erroneously informed told by a provider or their insurance company that their provider was in-network.
• Some also described surprise bills for telemedicine visits which the patient did not know were billable visits.

Participants also described problems gathering information about prices before receiving health care services. The focus group was part of a series investigating the effect of medical debt on different types of people across New York.

Women are more likely to have health insurance than men, but are also more likely to have medical debt. Nationally, 8.2% of women are uninsured compared to 10.2% of men, but 26.8% have past-due medical bills while only 20.8% of men do.[1] The type of coverage women have is similar to the coverage the general population has, other than slightly higher enrollment in Medicaid (see Table 1).  However, women may be more exposed to affordability challenges than men because of lower earnings and higher health care costs.  

Even in New York, where the gender pay gap is the lowest in the country, women only earn 89 cents for every dollar earned by men.[2] Lower pay may mean women enroll in coverage that has lower upfront costs, but less financial protection because of higher cost-sharing. The employer-sponsored plans women have access to may also come with higher costs than average because women are more likely to work in lower-wage jobs that may offer less robust health insurance.[3] The financial challenges women experience are compounded because women are more likely to seek health care for themselves or to interact with the health care system as a caretaker for others than men. This is true even when excluding pregnancy-related health care because women are more likely to seek treatment for chronic illnesses than men.[4]

Table 1. Health Insurance for Adults Aged 19-64 in New York State, 2019
Type of Insurance	Women[5]	All New York[6]
Employer-Sponsored	61%	61%
Direct Purchase	7%	7%
Medicaid	24%	22%
Other	2%	2%
Uninsured	6%	8%

New York should do more to protect patients from unfair medical bills. The state should fully fund the Community Health Advocates program to support patients fighting surprise bills. It should ensure that surprise bills resulting from misinformation about a provider’s network status are covered by the Surprise Bill law. Legislation that would have done this failed to pass the State legislature last year. The State should also require providers to inform patients when a phone call will be billed as a telemedicine visit.

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[1] United States Census, Selected Characteristics of the Uninsured in the United States (Table S2702), 2019: ACS 1-Year Estimates Subject Tables, https://data.census.gov/cedsci/table?q=United%20States&g=0400000US36&tid=ACSST1Y2019.S2702&hidePreview=true and Michael Karpman and Kyle J. Caswell, “Past-Due Medical Debt among Nonelderly Adults, 2012-15,” The Urban Institute, March 2017, http://www.urban.org/sites/default/files/publication/88586/past_due_medical_debt.pdf.

[2] New York State Department of Labor, “Closing the Gender Wage Gap in New York State: Pay Equity and Achievement,” April 2018, https://www.kff.org/womens-health-policy/fact-sheet/womens-health-insurance-coverage/. https://www.governor.ny.gov/sites/default/files/atoms/files/Pay_Equity_Advancement_WageGap_.pdf.

[3] Michael Karpman and Kyle J. Caswell, “Past-Due Medical Debt among Nonelderly Adults, 2012-15,” The Urban Institute, March 2017, http://www.urban.org/sites/default/files/publication/88586/past_due_medical_debt.pdf

[4] Lois K. Lee, “Women’s Coverage, Utilization, Affordability, And Health After The ACA: A Review of the Literature,” Health Affairs, Vol. 39, No. 3: March 2020, https://doi.org/10.1377/hlthaff.2019.01361.

[5] Kaiser Family Foundation, “Women’s Health Insurance Coverage,” January 12, 2021, https://www.kff.org/womens-health-policy/fact-sheet/womens-health-insurance-coverage/.

[6] Kaiser Family Foundation, “Health Insurance of Adults 19-64 (2019), available at https://www.kff.org/other/state-indicator/adults-19-64/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D.

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On Friday, June 22, more than 70 HCFANY members from across the state gathered in Albany for our annual spring to learn about the Coalition’s ongoing and upcoming work to strengthen and expand health coverage all for New Yorkers and promote health equity. As you all know, it has been a very challenging year for health care, and we are very grateful to all who attended and engaged with us!

The agenda included an Advocates’ Panel during which we heard updates on HCFANY work on New York’s indigent care pool and safety net hospitals and the Coverage 4 All Campaign for immigrant coverage. We also discussed strategies for improving market stabilization and affordability in the individual market. Slides from the presentation are available here.

We were also honored to present our annual “Consumer Health Champion” Award to the grassroots groups, the “New York Grassroots Defenders of Health Care” who have been so instrumental in the fight to defend the ACA and Medicaid here in New York. Awardees included: ACR Health, “Faso Friday,” Long Island Save Our Health Care Alliance, NY-11 for Health Care, Rochester ADAPT, and Saratoga Progressive Action.

The meeting concluded with discussion and planning groups on federal advocacy, protecting New York State’s individual market, and preserving and expanding immigrant coverage.

Guest post by Jessica Pierson, graduate student intern with Raising Women’s Voices-NY.

National Women’s Health Week kicked off on Mother’s Day and will continue through Saturday, May 19^th. Raising Women’s Voices-NY is celebrating by hosting activities and providing resources to promote women’s health throughout the week.

On Tuesday, May 15^th, Raising Women’s Voices is hosting a Twitter Chat from 2 to 3 p.m. to discuss women’s health using the hashtag, #HerHealth. Organizations from around the country will be sharing information on a range of women’s health topics, such as what to expect at a well-woman visit, black maternal health disparities, how to take advantage of cost-free preventive services, reproductive health care for trans folks and how to navigate the health care system.

National Women’s Health Week is a great time to remind women to schedule their annual well-woman visit, which is free with their health insurance. RWV has created a flyer outlining key women’s preventive services for health organizations to use in promoting National Women’s Health Week. Navigating the health system can be difficult and confusing. RWV’s flyer can help simplify women’s experiences with the health system by explaining that services such as birth control, STI/HIV testing, blood pressure tests, flu shots and help quitting smoking are all included in a free well-women’s visit! The flyer also explains how to schedule an appointment, what to expect at the appointment and how to get the most out of the visit. RWV suggests distributing these customizable flyers at bus stops, laundromats or other local spots in order to reach women in every corner of your community.

Looking to promote women’s health in your area? RWV suggests amplifying National Women’s Health week by hosting an open house or community care night, holding a panel discussion or press events.

The Affordable Care Act improved access to women’s health services, but still millions of women are uninsured. Although Open Enrollment for health insurance through NY State of Health doesn’t start again until November, women may qualify for a Special Enrollment Period of 60 days if they experience a qualifying life event. Examples include losing your job-based health insurance, getting married, having a baby, adopting a child or, in New York only, becoming pregnant. Medicaid, Essential Plan, and Child Health Plus enrollment continue year-round. If you think you might qualify for enrollment, contact the Community Health Advocates hotline at 888-614-5400.

It is imperative that we celebrate National Women’s Health Week by helping women get insured and utilize their insurance wisely to optimize their health and well-being, and catch health problems early. RWV hopes you will join us for our Twitter Chat on May 15 and help us promote women’s health all week long!