This year, New York’s legislature showed that it was willing to take on powerful industry stakeholders to protect consumers. However, in some areas it left a lot undone.
First, because of A2969/S2849, insurance companies can no longer change drug formularies in the middle of the year. Plans are prohibited from removing a drug from your formulary, moving the drug to a different tier, or adding utilization restrictions. Those changes can occur on renewal, but can no longer occur during the plan year while once consumers are locked into a plan. Changes can also happen if a generic equivalent becomes available or if the FDA identifies safety problems. You can read more on why this bill is necessary here (note that there were some changes to the final bill, including losing some of the notification requirements we liked). Maybe next year we’ll get stable provider networks!
Another great new law also address prescription drug costs. A2836/S6531 requires pharmacy benefit managers (PBMs) to become licensed to operate in New York. The law also protects pharmacists’ ability to provide the best care to customers by prohibiting contracts that require pharmacists to withhold information about alternative medications. While HCFANY would like to see more information become publicly available about PBMs and their business practices, this is a great start. You can find more background information on this issue here.
Finally, the legislature took action to protect consumers from high insurance premiums by passing A264/S3171. Consumers in New York are protected from out-of-network emergency room charges because of our surprise bill law. For most of those charges, health plans and providers use a third party to settle on an appropriate payment. However a loophole meant that some charges were not subject to this process (called independent dispute resolution). Some hospitals probably liked that loophole because it made it harder for plans to negotiate lower prices, but we wanted it closed because high hospital prices lead to high insurance premiums. More info is available here.
As happy as we are about those bills, we hoped for more in other areas. Particularly in immigrant coverage: this could have been the year that New York finally expanded health coverage to everyone regardless of immigration status. A5974/S3900 would cover low-income New Yorkers through the Essential Plan, regardless of immigration status. It passed favorably through the Assembly Health Committee but went nowhere in the Senate. It’s exciting that the bill got 28 sponsors, but it should have passed! Likewise, the legislature could have passed A3316/S1809 to ensure that immigrants losing Temporary Protected Status would at least know they could have health coverage in New York.
California made progress on covering undocumented immigrants this year; New York could have done the same. HCFANY will keep pushing for both bills next year.
Another major disappointment was the legislature’s failure to pass A6677/S5546, which would have rationalized how New York compensates hospitals for care provided to low-income New Yorkers. The result is another year in which hospitals get money from the indigent care pool regardless of how they treat needy New Yorkers. Those dollars are precious and should be targeted to the hospitals that provide most of that care.
There were also mixed results in our efforts to make hospitals more accountable to the public. We’ll talk more about that in our next post!