It’s been a busy week where the New York State budget is concerned, as the Assembly and Senate worked hard to release their respective budget proposals. We’ve been monitoring this process closely to see if HCFANY’s budget priorities – Basic Health Program, out-of-network billing protections, and funding for consumer assistance – made the safe transition from the Governor’s budget to the house proposals. Both proposals have now been released, and you can get HCFANY’s take on the house budget proposals below and in our recent press releases on the Assembly and the Senate proposals.

The Assembly’s Proposal

Released on Wednesday morning, the Assembly’s budget proposal includes all three of HCFANY’s budget priorities. The Assembly accepted all aspects of the Governor’s proposal to create a Basic Health Program (BHP). The BHP has the potential to benefit New Yorkers and the State’s coffers: it would make health care more affordable for thousands of lower-income working New Yorkers, while also bringing in federal funding to save the State in the hundreds of millions of dollars.

The budget proposal also includes several consumer protections related to out-of-network health care services, even improving on the Governor’s original proposal by requiring that all plans offer an option for out-of-network coverage. Like the Governor’s proposal, the Assembly’s proposal would protect consumers who receive “surprise” medical bills for out-of-network services they didn’t even know they were receiving (e.g. during an emergency room visit). Consumers would be taken out of the billing negotiations for these services, leaving it up to the provider and the plan, with the help of an independent entity, to decide an appropriate fee and payment. Consumers would just need to pay their regular co-pay and any other cost-sharing associated with visits to in-network providers. The budget proposal also requires all plans to adhere to network adequacy requirements, which currently only apply to HMOs in New York State.

Finally, the Assembly included what amounts to $2.5 million in federal funding to help consumers use their health insurance, by funding the state’s designated consumer assistance program, Community Health Advocates.

The Senate’s Proposal

The Senate’s budget proposal was a little slower to come, reportedly due to disagreement on certain issues. A resolution was finally released yesterday evening and results, at least in terms of affordable, quality health care, are more mixed.

Out-of-network protections were included, showing that all three entities are moving towards addressing out-of-network billing problems and network adequacy limitations in this legislative session. The Senate’s proposal largely mirrors the Governor’s and Assembly’s proposals, with a few technical differences. Importantly, there is no clear requirement that plans offer an out-of-network option, though the Senate did express their concern about availability of this coverage for consumers and may address the issue as negotiations move forward.

The Basic Health Program is also mentioned, though the Senate has not yet made a final decision as to its inclusion. Instead, the Senate proposes to wait until a complete analysis of the financial impact of the program is available, which is set to be released any day now. Community Services Society and the Urban Institute have both analyzed the financial impact of BHP in the past, finding that it could save the State hundreds of millions of dollars due to the federal funding available. It’s encouraging that the Senate chose to mention the program and has committed to a deeper analysis once the financial results are available.

There were also a couple of unwelcome surprises in the Senate’s proposal. Namely, the Senate proposes to defund the NY State of Health and neglects to authorize the federal funding for consumer assistance. Both actions are puzzling, as these programs have significant benefits, low or no cost to the State and they involve significant federal funds flowing into New York State. Six hundred thousand New Yorkers have already found affordable health insurance on the NY State of Health, and many more are likely to do so before the open enrollment period ends on March 31. And, thousands of New Yorkers each year benefit from the State’s designated consumer assistance program, Community Health Advocates, which helps people use their insurance and deal with problems, such as billing issues.

Both houses will now launch into final negotiations, with the final process scheduled to wrap up by the end of the month.

Is this all sounding like a foreign language? In case you’re unfamiliar with New York’s budget process, which is surely not intuitive, here’s how it works (in brief):

First, the Governor releases his proposal, called the Executive Budget. This year, the Executive budget was released on January 21, and you can read our analysis of some of the health care pieces on our blog. The Assembly and Senate spend a few weeks considering the Governor’s proposals before releasing their own budget proposals, called the “one-house” bills. After the release of the “one-house” bills, the houses break into “conference committees” to deal with final negotiations around various aspects of the budget, before the final “enacted budget” is passed. This is the law that governs how the State spends its money and runs its programs. The whole process is scheduled to be complete in two short weeks, by the end of March.