Health Care Reform in New York

Health care reform in New York has been an evolving process over more than 2 decades, with a variety of legislative advances. The Metro New York Health Care for All Campaign is proud to have been active in various campaigns that resulted in much of this progress:

Late 1980s:

• Expansions of Medicaid eligibility to cover more low-income people
• Limits on “balance billing” that providers can charge people on Medicare

1990s:

• Creation of “EPIC” (Elderly Prescription Insurance Coverage) program, to help low-income seniors with medicine costs
• Creation of “CHP” (Child Health Plus) program, to provide insurance coverage to low-income children
• Enactment of Open Enrollment and Community Rating law, forbidding insurers from denying coverage or charging more based on age, gender, occupation, and health history
• Standardization of individual/non-group insurance market and requiring all HMOs and non-profit insurers to offer individual coverage
• Enactment of the Managed Care Consumers’ Bill of Rights
• Due process protections for people on Medicaid who are required to enroll in managed care plans, and standards for such plans
• Expansion of Child Health Plus program to cover more uninsured children
• Creation of an external appeal process for consumers who have medical disputes with their health plans

2000s:

• Creation of Family Health Plus program for uninsured working poor parents and adults
• Expansion of EPIC program to cover moderate income seniors
• Expansion of Medicaid to cover lawfully-present immigrants
• Requiring all hospitals to offer financial assistance programs to low and moderate income uninsured and underinsured
• Expansion of Child Health Plus as a coverage option for all children in New York
• Gov. Spitzer establishes the “Partnership for Coverage” process to develop proposals and options for New York to move toward universal coverage; Gov. Paterson continues that process with a report that is released in July 2008
• Expansion of Family Health Plus to employers and unions
• Streamlining and simplification of Medicaid application and recertification process
• Expansion of COBRA coverage to 36 months
• Requiring insurers to cover young adult dependents up through age 29
• Expansion of Managed Care Consumers Bill of Rights to provide additional protections and cover managed care “look-alikes”
• Established transparency and reporting requirements for hospitals that receive charity care funding

2010:

• Require all insurer’s rate increases for products in the individual, small group, and Medicare supplemental markets to be approved or modified by the State Dept. of Insurance
• Raise insurer’s “medical-loss ratio” requirements to 82%, for products in the individual, small group markets, and 75% for Medicare supplemental market
• Creation of the “New York Bridge” plan that provides affordable comprehensive coverage for uninsured people with serious pre-existing health conditions

2011 and beyond: 

The main task ahead: enactment of various state requirements and options for states under the new national health care reform law (Patient Protection and Affordable Care Act), including:

• A variety of new private health insurance rules not already in New York law
• Preserving current consumer protections in New York private insurance law that go beyond the new national law, such as pure community rating and comprehensive benefit mandates
• Establishing a state-based “health insurance exchange” for individuals, families, and small businesses
• Enhancing financials subsidies available to moderate income individuals and families to help them purchase coverage
• Expand Medicaid to cover more low-moderate income adults
• Creation of a new “basic health plan” to offer affordable coverage to low-moderate income individuals and families
• Establishing ways to go beyond the national law to assure coverage of comprehensive reproductive health care services
• Establishing ways to go beyond the national law to assure affordable coverage options and services for immigrants and their families
• Create new consumer assistance and ombuds programs for individuals and families
• Expansions of new community health centers across the state
• A variety of new programs and initiatives to help address disparities in health and health care access and quality, by race, ethnicity, gender, age, and disability
• Monitor and comment on a whole variety of delivery system reforms intended to expand access to services, improve quality of care, enhance efficiency, and control cost growth
• Monitor and comment on a whole variety of regulations proposed at both state and federal level

Advocates’ goal: to take advantage and max out all possible provisions of the ACA in a way that lays a foundation to move toward full universal coverage, perhaps as early as 2014, but certainly by 2017 when states are allowed to apply for waivers to move toward more fully comprehensive programs, including state-based single-payer-style systems.