Testimony: Pass the New York Health Act

Before the Joint New York State Senate and Assembly

Public Hearing on the New York Health Act (A.5248/S.3577)

I am Juan C. Pinzon, Director of Health Services at the Community Service Society of New York (CSS). For 175 years, CSS has been an unwavering voice for low- and moderate-income New Yorkers. Our health programs help New Yorkers enroll into health insurance coverage, find healthcare if they are ineligible or cannot afford coverage, and help them use their coverage or otherwise access the healthcare system. We do this through a live-answer helpline and through our partnerships with over 50 community-based organizations throughout New York State. Annually, CSS and its partners serve over 100,000 New Yorkers, saving them millions of dollars in health care costs.

CSS thanks the Health Committee Chairs—Senator Rivera and Assemblymember Gottfried—and the Health Committee Members for their leadership on behalf of New York’s health consumers in their tireless efforts to improve coverage and contain costs for New York residents and for holding this hearing today on this landmark bill.

CSS Supports the Passage of the New York Health Act

CSS enthusiastically supports the New York Health Act. New York government leaders have a long list of health care achievements:

• Our innovative universal children’s health insurance program was a model for adopting the federal CHIP program and now covers over 400,000 children;
• Our coverage programs for low-income people, first Family Health Plus, and now the Essential Plan (Basic Health Plan) cover nearly 800,000 adults;
• Our New York State of Health Marketplace has the most elegant real-time eligibility rules engine in the country and is responsible for enrolling 4.7 million New Yorkers in coverage;
• Our consumer insurance protections are likewise strong: a robust Managed Care Bill of Rights; strong insurance rate review; first-in-the-nation surprise billing law; and resilient consumer assistance programs.

Yet, despite all these extraordinary achievements, New York’s consumers face two inexorable problems that the NYHA would elegantly resolve. 

First, it would cover the remaining 1 million or more New Yorkers who remain uninsured. No more complicated eligibility rules.  No more begging for “charity care” for immigrants or other people without insurance. 

Second, it would eliminate the profound affordability problems that plague nearly everyone else. CSS recently worked with Altarum’s Healthcare Value Hub to do a survey on health care affordability in New York. And the results—even after New York’s remarkable implementation of the Affordable Care Act—are sobering. Half (52%) of the New Yorkers surveyed (nearly all of whom were insured) said they had faced a health care affordability problem, such as cutting pills, not filling prescriptions, skipping care, or not doing what their doctor told them to do because of costs. And 35% said they were struggling to pay medical bills: using up their savings; skipping meals or paying rent; and reported being in collections or having credit card debt.

Take, for example, the story of Dick, a retiree in Tompkins County who contacted the Community Health Advocates program last year. Dick couldn’t afford the eye injections he needed every six to eight weeks to treat his macular disease. The injections are very expensive—$2,650 per treatment. Dick had both Medicare and retiree coverage, so he thought the injections would be fully covered, but they were not. He was left with a balance of nearly $400 for each treatment. CSS worked with Dick to explore all of the available coverage options, but the only solution his advocate could find was to apply for a foundation grant that covers up to $4,000 of expenses for macular disease assistance a year.

These health care affordability problems are getting worse. In 2008, New Yorkers were spending 5.5% of their median household income on health care. In 2016, that percentage increased to 7.7%. Finally, New Yorkers blame the health care industry for these out-of-control costs: 69% said that insurance companies charge too much; 69% said hospitals charge too much; and 68% said that drug companies charge too much.

The NYHA addresses both the problem of the uninsured and out-of-control industry costs.  It is extremely popular and is supported by 656 organizations (including CSS).  The NYHA would cover all New Yorkers—so no one would be left uninsured because of their immigration or economic status.  Unlike our confusing patchwork insurance system, it would be administered by a single publicly accountable health plan that would negotiate fair prices with providers and drug companies. It covers vision, dental, medical devices and long-term care. The NYHA would cost $309 billion and would be financed through a progressive and fair tax system, where the wealthiest pay more than those least able to pay. It would also curb our state’s extraordinary health care inflation rate: a Rand Study estimates that it would save more than $11 billion in health spending by 2022.

 Finally, from the consumers’ perspective, the NYHA makes getting health care easy:  you get a card, you go to the doctor, hospital or pharmacy, the NYHA plan pays for the care, and you are done. No “skinny” networks or ultra-restrictive drug formularies. No co-pays. No co-insurance.  No bombardment of bewildering, duplicative, and often erroneous, medical bills.  No collection agents.  No ruined credit scores.  No ruined lives.  Now, that’s “patient-centered” care.

For these reasons, and more, CSS endorses the adoption of the NYHA.

CSS Urges the Legislature to Act Now to Adopt Interim Measures to Address the Uninsurance and Affordability Crises

Assuming the NYHA was passed and signed by Governor Cuomo this session, CSS is mindful that it may take a few years to establish.  While we wait for the NYHA’s adoption and implementation, CSS respectfully urges the Legislature to adopt interim measures to help address the two problems the act solves:  the remaining uninsured and the state’s affordability crisis.  These measures are described below in the remainder of our testimony.

Measures to Address the Remaining Uninsured

The vast majority of the remaining uninsured fall into three groups of people:  (1) low-income adult immigrants who are ineligible for coverage (320,000 people); (2) moderate-income individuals who find coverage unaffordable despite the available subsidies (320,000 people); and (3) very low-income people who are eligible for Medicaid and/or Child Health Plus, but remain unenrolled (390,000 people). 

To address these three groups of uninsured, CSS urges the enactment of the following measures:

1. Adopt S.3900/A.5974, sponsored by Assemblymember Gottfried and Senator Rivera, which creates a state-funded Essential Plan for immigrants who are ineligible for coverage.  This program would be offered to the 246,000 unauthorized immigrants below 200% of the federal poverty level and would costs $532 million in the first year. 

2. Make coverage more affordable for people. There are two methods to achieve this goal. The first would be to offer a state-funded Essential Plan to approximately 120,000 people between 200% and 250% of the federal poverty level.  This would cost around $132 million in the first year.  The second option would be to establish—as California  has—additional state subsidies for people between 200% and 400% of the federal poverty level.  This option would make coverage more affordable for approximately 155,000 New Yorkers and cost anywhere between $250 million and $530 million, depending on the generosity of the subsidies.

3. Support more community-based enrollment assistance to reach the hard-to-reach eligible but uninsured. New York’s current Navigator program is funded at $27.2 million. But these community-based Navigators haven’t had a pay raise, or cost-of-living increase, in over six years.  The Legislature should consider supplementing these funds, with an extra emphasis on communities that have a disproportionate percentage of the remaining uninsured.

CSS believes that the adoption of these three measures could go a long way to addressing the issue of the remaining uninsured. 

Measures to Address the Affordability Crisis

            Similarly, there are important measures that can help people address the affordability and medical debt crisis. CSS lauds Assemblymember Gottfried and Senator Rivera, Senator Breslin, and Senator Krueger for introducing A.8639/S.6757, the Patient Medical Debt Protection Act, which addresses the medical debt crisis by implementing the following measures.  These measures require all the stakeholders to come together and adopt a patient-centered approach to health care costs and medical billing that address patients’ needs.

1. Make patient billing simple.  Consumers are bombarded by bewildering bills from myriad providers operating out of a hospital. One hospital visit should result in one NYS-created uniform, standardized, itemized hospital bill that explains each charge and is sent within seven days of discharge. (New York’s current Patient Bill of Rights requires that hospitals provide patients with an itemized bill and explanation of charges on request, but this is rarely offered.)

2. Medical debt should have a two-year statute of limitations and the statutory interest rate should be cut from 9% to 3%. While medical providers only have two years under state law to submit insurance claims, they can sue patients for up to six years after the service was provided. That’s not fair.  Fifteen other states have a shorter statute of limitations than New York. For example, Arkansas imposes a statute of limitations of only two years for medical debt.

3. New York’s 2015 surprise bill law was a landmark consumer protection, but it is missing a key piece: surprise bills caused by provider or plan misinformation. A survey of more than 200 Community Health Advocates’ surprise bill cases found that 35% resulted from misinformation provided by either the plan or the provider. New York’s law leaves consumers on the hook for those bills. Plans are already required to update their provider directories within 15 days of a change but rarely do. Consumers should be held harmless if given false information about their provider network.

4. Consumers should not be responsible for so-called “facility fees” that are not actual medical services. Connecticut has already banned many facility fees for outpatient services provided off-campus and required robust disclosures to patients about the use of facility fees.[1]

5. New York’s hospital financial assistance law should:

   1. Apply to all providers working in a hospital even if not employed by the hospital as well as charges for ambulance and other pre-emergency services.

   2. Require one standard application to be used at each hospital.

   3. Require one standard appeal process.

6. Providers should stop using standard patient financial liability forms that ask patients to waive state protections against liability for medical bills, without even knowing what those may be. Any agreements that patients sign waiving those rights should be unenforceable.

7. Licensed providers in New York should be required to provide complete information—regardless of payor or “proprietary pricing contracts” —to the All Payer Database as a condition of operating and in a way that makes the information accessible to consumers.

CSS believes that only the adoption of the NYHA can assure that the all New Yorkers have affordable, quality health insurance.  But while we wait for the implementation of the NYHA, our state needs to aggressively address the two remaining burdens facing New Yorkers:  providing coverage to more; and easing the affordability burdens for all. That’s what real patient-centered care looks like.

Thank you for providing us the opportunity to testify before you today.

Issues Covered

Access to Health Care