Advocates Mobilize as Medicare Payment Reform and Children’s Health Insurance Funding Bill Emerges and Proceeds in Congress

Two major health care issues long being pushed by advocates as needing Congressional action are finally moving forward as Congress approaches the coming Easter-Passover recess period, and they are being combined into one major bill.  The particular matters concern a) reforming the method and formula by which Medicare pays for physician services, and b) continued funding for the State Child Health Insurance Program (CHIP.)


First up, the CHIP story…

This program was created in 1996 in the wake of the failure of the Clinton administration’s comprehensive health care initiative of 1993-4 (“The Health Security Act”.)  It was a bipartisan effort in Congress spearheaded by Senator Ted Kennedy (D-MA) and Sen. Orrin Hatch (R-UT), with support from then First Lady Hillary Rodham Clinton and House Speaker Newt Gingrich (R-GA.)  It provides funding to states to provide health insurance for uninsured children in low and moderate income families, either through Medicaid, a special program, or some combination thereof.  New York has a mixed/blended program, which was created under the Pataki administration in 1997, building off of a rudimentary children’s health coverage program that had been created by his predecessor Mario Cuomo.

The program came up for reauthorization in 2007 and a 2-year fight ensued to do so, during which then President George W. Bush vetoed it 3 times because he did not support the expansions being promoted by Democratic congressional leaders.  Shortly after President Obama took office in 2009, the Children’s Health Insurance Program Reauthorization Act (CHIPRA) was finally enacted, to continue the program for another decade, and it included several improvements to cover more children, cover more benefits, and streamline enrollment.  However, actual funding for the full 10 year period was not included.  When the Affordable Care Act was enacted a year later in 2010, it provided funding up through 2015, and required states to maintain the CHIP programs they had in place with no cutbacks, despite the impacts of the Great Recession on state budgets.

Overall, CHIP has been a smashing success, and a rare bipartisan-supported program.  It covers 8M children nationally, including almost 300,000 here in New York.  The uninsured rate for children has dropped dramatically, and is now very low in New York.  The coverage is tailored toward the needs of children and adolescents, and is available to all children:  at no-cost (via Medicaid) for low-income families; low-cost for working-poor and moderate income families, and full-cost (still quite affordable) for upper-income families.  In short, we have universal coverage available for all children in New York.

While CHIP per se is in place legally for still another 4 years, the funding authorized for it ends as of Sept. 30 of this year.  Since many states, like New York, are developing and adopting their annual budgets now, action by Congress is needed pretty immediately and cannot wait until the fall, as states need clarity and certainty on the matter in order to plan accordingly.  This situation has engendered a “must-do” dynamic in Congress.  The current bill in the House (H.R. 2) would provide funding for CHIP as is for another 2 years, essentially punting the whole matter to the next President and Congress who will take office in 2017.  Congress says it will pay for this extension by booking additional savings to Medicaid reductions under its new budget proposals that came out last week (…and all of that is the subject of another whole blog post here sometime soon.)

 medical team discussing results

Meanwhile, concerning Medicare payments to doctors,…

Back in 1997 as part of the Balanced Budget Act, Congress attributed budget savings to Medicare under a “Sustainable Growth Rate” (SGR) formula that envisioned gradual reimbursement rate reductions for physicians over time.  However, every time since then when one of these cuts were to happen, physicians would threaten to stop taking Medicare claiming they would not be receiving adequate payments, and Medicare patients would clamor for Congress to forego the decreases.  As a consequence, for nearly 2 decades now the “SGR problem” has continually resurfaced as a political crisis with piecemeal, temporary patch-ups, and the system as a whole was never implemented.  The problem could have been addressed long ago but for how to pay for the cost of foregoing the scheduled reductions, which by now have grown to be quite sizeable in the aggregate.  By now, all stakeholders agree that it must be discontinued and a new method to control physician costs in Medicare put in its place.

Again, enter the Affordable Care Act.

While the ACA is most well-known for its insurance coverage provisions, the law itself also contains many provisions that may be described collectively as “delivery system reforms” which, among other things, encompass payment reforms, either explicit or implicit.  Since the ACA’s enactment some 5 years ago, the Obama administration has proceeded with slowly implementing these provisions, including policies to move away from currently-nearly-universal piecemeal fee-for-service methods to new “alternative payment methods” (APMs) such as bundled payments, global budgets, payments for episodes of treatment, and payment for value and outcomes.  All of these ideas are designed to curtail well-documented financial waste and inefficiency in the U.S. health care system.  Just recently, the Centers for Medicare and Medicaid Services (CMS) announced a goal of shifting payment for 50% of Medicare services to these APMs by 2018.

By moving forward with incorporating these APMs into Medicare, Congress has found a way to offset the cost of discarding the SGR scheme.  However, it also is booking some savings/offsets in ways that will affect some Medicare beneficiaries directly in 2 ways: upper-income beneficiaries will pay a slightly higher premium for their Part B coverage, and all beneficiaries will have to incur the standard Part B deductible (currently about $148/year) regardless of whether or not they carry a private supplemental “Medigap” policy or are enrolled in a private “Medicare Advantage” plan.

As for what advocates think of all this,… as with any piece of major legislation, it’s a bit of a mixed bag, reflecting political compromise across both sides of the aisle.

On the one hand, the whole “SGR problem” is finally resolved once and for all and goes away.  However, this progress comes at the cost of some additional out-of-pocket costs for Medicare beneficiaries, and continued erosion of Medicare’s “universality”, a process that began under the Medicare Modernization Act of 2003 which introduced various “means-testing” measures into the program.

On the other hand, CHIP funding is renewed “cleanly” without any cutbacks whatsoever (despite what appeared in recent CHIP reform proposals from Congressional leaders, and again that’s a subject for another future post here), and including some scheduled increases in funding to states that will go into effect this fall.  While the House is proposing to extend CHIP funding for only 2 years and not the 4 years needed to align with the program’s existing legal authorization, Democrats in the Senate are signaling that they will push for a 4-year extension.

A couple of other unrecognized aspects of this bill… one good, one problematic.  The bill does continue special ACA funding for 2 years for Federally-Qualified Health Centers (FQHCs), the Teaching Centers Program, and the National Health Service Corps, which provides placement of newly-graduated health care professionals in medically-underserved communities, such as urban centers and rural counties where physicians are scarce.  However, it bans FQHCs from using the additional money to pay for abortion services, a provision that has aroused opposition from reproductive rights advocates.  Such restrictions have been in place for FQHCs for quite some time now via appropriations bills, but not via statute.

US Capitol

Finally, the politics of it all…

The House bill is expected to pass the bill by the end of this week, but it will likely require more-moderate Republicans joining forces with Democrats to do so, since far-right Republicans are balking at the unpaid-for cost and a straight-forward continuance of CHIP as is.  In fact, this “grand compromise” on Medicare SGR and CHIP is the result of behind-the-scenes negotiations between House Speaker John Boehner (R-OH) and Minority Leader Nancy Pelosi (D-CA), a move that has surprised everyone and upset Boehner’s more-right-wing colleagues.  The Senate will take up the matter when they return from recess in mid-April.

On the whole, advocates are generally supporting the bill, urging the House to proceed and then turning to the Senate to make improvements.  While the bill has problems and shortcomings, many believe that it’s the best deal possible given the circumstances and players involved, and that by removing these matters from the upcoming budget debates of this spring, summer, and fall, they are protecting them against far worse prospects.

(For a full summary and analysis of the bill, here’s a 4-page brief from the Center on Budget and Policy Priorities.)

New York Health Care Advocates Mobilize for Final State Budget Push and Funding Priorities

As the New York State Legislature’s annual budget session draws to a close by the end of this month, advocates are corralling their forces to influence the negotiations between Governor Cuomo, the State Senate, and the State Assembly, and weighing in with their top policy and funding priorities.

 NYS Capitol

The process began in late January with the Governor’s release of his proposed budget.   The Legislature began its work in early February with a series of joint hearings throughout the month on various parts of the budget, hearing from and questioning the various commissioners and stakeholders, including advocates.  The hearing on health provisions was held on February 2nd.  In late February, the Governor released his 30-day amendments.  In early March, working off the Governor’s proposals, each legislative chamber crafted their own “one-house” bills, which were each enacted by March 12.  Conference committees were then appointed to publicly debate the differences with each other and the Governor, and 3-way negotiations began in private between the Governor, Senate, and Assembly leadership.  A final agreement is expected by late March, with bills voted on by April 1st.


HEALTH CARE FOR ALL NEW YORK (HCFANY), a consumer health advocacy coalition focusing on all things related to Affordable Care Act (ACA) implementation, has identified the following issues of importance:

Funding for the “NY State of Health” health benefits exchange marketplace:  As of the end of February, over 2.1 million New Yorkers have enrolled into insurance coverage through this new program since it opened in October 2013, either through Medicaid, Child Health Plus, or the new private “qualified health plans” (QHPs), far exceeding all predictions.  88% of them were previously uninsured, and 80% of those enrolling in private coverage were eligible for financial assistance either in the form of premium subsidies or cost-sharing reductions.   In short, it’s proven a smashing success!

While the federal government has provided administrative funding for the first 2 years of its operations, this marketplace must be self-sustaining starting in 2016.  Governor Cuomo has proposed a modest, broad-based assessment on all insurers in all markets to raise the needed funds, since it serves as the safety net for all uninsured New Yorkers and benefits the state’s entire health insurance system.  The Assembly has agreed with the Governor, and added an important consumer protection that the assessment cannot be passed along to policyholders in their premiums, but rather, must come out of insurers’ windfall profits given all the new customers they now have.  Surprisingly, the Senate did not include any funding mechanism for the marketplace in their one-house bill, saying they disagreed with the Governor’s approach but offering no alternative.

Funding for the “Community Health Advocates” (CHA) program:  CHA is New York’s official consumer assistance program for health insurance, created under the ACA.  It is comprised of a network of non-profits across the state who help people with all kinds of “post-enrollment” issues related to using health insurance, or accessing needed services if they are uninsured.  CHA too has proven a smashing success, serving hundreds of thousands of people and saving them millions of dollars in total since it began in 2010.  With now 2.1 million more New Yorkers gaining coverage, demand for CHA’s services has increased dramatically.

The federal government provided start-up funds for these state consumer assistance programs like CHA, but it ends as of this June.  Governor Cuomo proposed to provide $2.5M to keep the program in operation.  The Assembly raised that amount to $3M, but the Senate one-house bill did not include any funding.  At its previous height of maximum federal funding, CHA operated at $5M/year, providing on-the-ground services in every county statewide, with an additional focus on serving small businesses as well as individual consumers.  As federal funding diminished in the last couple of years, CHA had to scale back that effort.  HCFANY is calling for the Governor and Legislature to restore CHA to the full $5M/year level so that it can return to its formerly-robust level of operations.

Funding for operating a new “Basic Health Program” (BHP):  Under the ACA, states have the option to set up a BHP to provide very low-cost insurance coverage to the working poor who have too much income to qualify for Medicaid yet have difficulty affording the costs of purchasing and using private insurance.  In last year’s budget agreement, a BHP was authorized, making New York only the second state to do so, and the Cuomo administration has proceeded with plans to set one up, with the goal of opening it for enrollment in January 2016.  BHP coverage will be paid for by federal funds, but the administrative costs to operate it won’t.  Governor Cuomo proposed to reallocate existing funding within the Department of Health’s budget to do so, and the Assembly agreed, but the Senate’s one-house bill repealed the whole program.  Senate leaders are apparently worried that come 2017, with a new president and new Congress, the ACA and/or parts of it (such as funding for BHPs) could be repealed, leaving the state responsible for the entire cost of it.

Indigent care funding for hospitals:  The ACA requires that federal “Disproportionate Share Hospital” (DSH) funding be directed to states with high levels of uninsurance who target these funds to hospitals that serve high numbers of Medicaid and uninsured patients.  In 2012, New York revised its Indigent Care Pool (ICP) allocations to meet ACA requirements, but allowed hospitals a three-year transition period to conform.  Now, Governor Cuomo proposed to provide an additional three-year transition period, and the Senate and Assembly agreed.  It is unclear if the federal government will accept this further delay.  HCFANY disagrees with this approach and urges that the ACA’s new system go into effect now so that hospitals that actually provide lots of indigent care receive the DSH funds they deserve, while others that don’t won’t get this funding any longer.

HCFANY also supports the Assembly’s proposal to reconvene the Medicaid Redesign Team Technical Assistance Committee to make recommendations to adjust ICP payments if New York’s DSH funding is reduced because of non-compliance.  In addition, HCFANY supports a proposal from the Governor and Assembly to make the state’s “financial assistance compliance pool” permanent, and opposes the Senate proposal to eliminate it after 2016.  This pool rewards hospitals that comply with the state’s hospital financial assistance law by providing low-income, uninsured patients with access to and help with enrolling in their financial assistance programs.

Private equity demonstration projects:  Governor Cuomo proposes allowing a demonstration project that would allow private equity firms to invest in the restructuring of up to 5 financially-precarious hospitals across the state that operate in medically-underserved areas.  The Senate raises the number of allowable hospitals to ten, while the Assembly opposes the whole idea outright.  HCFANY agrees with the Assembly, and believes that an influx of private equity would inappropriately shift the incentives of these hospitals away from providing access to quality care, particularly low-income and uninsured patients, in favor of creating profits for investors, thereby draining overall financial resources that are desperately needed by these facilities.

 MMNY logo

MEDICAID MATTERS NEW YORK (MMNY), a lead consumer health advocacy coalition focusing on all things related to Medicaid and public insurance programs, has identified the following issues of importance:

New co-pays for some Medicaid patients:  Governor Cuomo has proposed modest co-payments for Medicaid patients enrolled in managed care plans who have incomes above the poverty level (currently, about $16,000/year.)  The Assembly has rejected this idea, and the Senate’s bill is unclear.

Preserve important consumer protections of “spousal and parental refusal” and “prescriber prevails”:  Governor Cuomo has proposed to eliminate the rights of spouses and parents to hold back a given amount of family income and assets from being taken into consideration when being determined eligible for long-term care services under Medicaid, in lieu of having to divorce a spouse or give up custody of a child to the state.  The Senate and Assembly have both rejected this idea, as they have for many years now when proposed by various Governors.

Governor Cuomo has also proposed to eliminate the right of patients enrolled in traditional fee-for-service Medicaid to access medicines not listed on the state’s Medicaid preferred drug list when they are prescribed by the patient’s doctor as the only suitable course of treatment in a particular situation.  The Senate and Assembly have both rejected the Governor’s idea, as they have for many years now when proposed by various Governors.

Funding for “transitional immediate need Medicaid” services:  Currently, New York offers Medicaid coverage for critically needed personal care and urgent medical care while a Medicaid determination is pending (which can take up to 45 days) because doing so can avoid unnecessary hospitalization and/or institutionalization of patients.  Governor Cuomo has proposed to end such coverage.  The Senate did not address the matter in its one-house bill, while Assembly proposes to continue access through allowing a “presumptive eligibility” determination.

Funding for the Independent Consumer Advocacy Network (ICAN):  As New York proceeds to transform its entire Medicaid program into a “care coordination” approach across the board, it created ICAN within last year’s budget.  ICAN’s mission is to assist people on Medicaid needing long-term care and other special services with the transition from the old fee-for-service system.  This year, the Governor proposed a $5M allocation for the program, which the Assembly supported but the Senate did not address in its one-house bill.

Adopting a “Community First Choice” (CFC) option:  CFC is a federal Medicaid funding initiative that allows states to more widely provide long-term care to people in their homes and communities rather than solely in institutions, and states that enact a CFC program receive an additional federal Medicaid funding.  Governor Cuomo’s budget includes an exemption from the Nurse Practice Act for new “Advanced Home Health Aides”, thereby increasing the availability of personnel necessary to fully implement a CFC program, and enhancing federal approval of the state’s CFC proposal submitted in December 2013.  The Governor’s budget also includes authorization to reinvest savings resulting from a CFC approach (estimated to be approximately $300 million annually) into initiatives that will further the state’s Olmstead Plan” to de-institutionalize as much long-term care as possible.  The Assembly supports the Governor’s CFC proposals, while the Senate rejects them.

Capital funding for community-based entities:  Governor Cuomo has proposed $1.4B in new capital funding for hospitals, yet none for community-based entities.  As the state proceeds with its “Delivery System Reform Incentive Payment” (DSRIP) program under Medicaid and its broader “State Health Improvement Program” (SHIP), both of which emphasize and prioritize non-institutional, community-based care programs working in collaboration with hospitals, MMNY believes it is important that they too have access to capital funds.  The Assembly directs $10M for community health centers, while the Senate adds $500M more and directs that capital allocations be available to all providers, to be determined in consultation with the Legislature.

Looking Back at 2014

As we close out 2014, we look back with pride to all of work of this past year and the role we played in fostering community-labor collaboration in the struggle for health care justice in New York, and comprehensive, quality, affordable health care for all New Yorkers.

clapping hands

First, we want to thank all those who supported us financially in 2014 – your donations made it ALL possible!

The following groups and individuals joined our “2014 Health Care for All Team” as part of our Annual Dues Campaign in the spring:

go team

Alliance for a Greater New York
Associated Musicians of Greater New York, Local 802, AFM
Children’s Defense Fund of New York
Citizen Action of New York
Committee of Interns and Residents, SEIU Healthcare
Communications Workers of America, Local 1180
Commission on the Public’s Health System in New York City
Community Health Care Association of New York State
Community Service Society of New York
DC 37 Retirees Association
District Council 37, AFSCME
Doctors’ Council, SEIU
Federation of Protestant Welfare Agencies
Gay Men’s Health Crisis
Goddard-Riverside Community Center
Greater NYC for Change
Healthcare Education Project (1199SEIU-GNYHA)
International Association of Stage and Theatrical Employees, Local 1
International Association of Stage and Theatrical Employees, Local 600
Long Island Coalition for a National Health Program
Make the Road New York
Medicare Rights Center
Municipal Hospital Employees, Local 420, DC 37 AFSCME
National Association of Social Workers, NYC Chapter
New York Immigration Coalition
New York State AFL-CIO
New York State Nurses Association
New York Statewide Senior Action Council
Open Door Family Medical Centers
Organization of Staff Analysts
Physicians for a National Health Program, New York Metro Chapter
Planned Parenthood of New York City
Professional Staff Congress, CUNY
Public Health Solutions
1199 SEIU United Healthcare Workers East
United Auto Workers, Region 9A
United Federation of Teachers

Robert Ambaras
Harold Allen
Ellis Arnstein, MD
Richard Bergman
Carmelita Blake, PhD
Francine Brewer
Anne and Sid Emerman
Shaurain Farber
Pat Fry
Nadia Jakoubek
Robert Lerner, MD
Jose Matta
Cheryl Merzel, MD
Terry Mizrahi
Ethel Paley
Ralph Palladino
Martin Petroff, JD
Alex Pruchnicki, MD
Adele Rogers
Clara Reiss
Mark Scherzer
Robert Spencer
Lois Steinberg
Myron and Janet Sussin
Marc Tallent, MD

We also want to thank all those groups and individuals who supported our 2014 Annual Gala Benefit on November 17:

20th Anniversary Champagne Toast

ACS Cancer Action Network
Alliance for a Greater NY
Assemblymember Richard Gottfried
Berlin Rosen
Business and Labor Coalition of New York
Center for Independence of the Disabled in New York
Children’s Defense Fund
Citizen Action of New York
Commission on the Public’s Health System
Committee of Interns and Residents, SEIU Healthcare
Communications Workers of America, Local 1180
Community Health Care Association of New York
Community Healthcare Network
Community Service Society
District Council 37 Retirees Association
Doctors’ Council, SEIU Healthcare
Federation of Protestant Welfare Agencies
Gay Men’s Health Crisis
Greater NY Hospital Association
Greater NY Laborer-Employers Cooperative & Education Trust
GuildNet/Lighthouse Guild
Healthcare Education Project (GNYHA-1199SEIU)
Hudson Health Plan, Hudson Center for Health Equity
Institute for Puerto Rican and Hispanic Elderly
Left Labor Project
Local 802, American Federation of Musicians
Make the Road New York
Municipal Hospital Workers, Local 420, DC 37
National Association of Social Workers, NYC Chapter
New York City Americans for Democratic Action
New York City Central Labor Council
New York Committee for Occupational Safety and Health
New York Immigration Coalition
New York Professional Nurses Union
New York State AFL-CIO
New York State Nurses Association
New York Therapeutic Riding Center
New Yorkers for Fiscal Fairness
Open Door Family Medical Center
Organization of Staff Analysts
Physicians for a National Health Program, NY Metro Chapter
Planned Parenthood of New York City
Primary Care Development Corporation
Professional Staff Congress, CUNY
Raising Women’s Voices – New York
Sarah Lawrence College, Health Advocacy Program
SEIU Healthcare
Senator Liz Krueger
Systonic Systems
TWU Local 100
United Auto Workers, Region 9A
United Federation of Teachers
1199 SEIU United Healthcare Workers East
United University Professionals

Robert Ambaras
Carmelita Blake
Anne Bove
Rachel Burd
Jim Collins
Moira Dolan
Barbara Edmonds
Alice and Jon Fisher
Shiela Geist
Marcia Hunte
Feygele Jacobs
William Jordan, MD
Pauline Kuyler, MD
Stanley Lave
Lou Levitt
Robert Lichterman
Jose Matta
Merle McEldowney
Terry Mizrahi
Susan Moscou and Dan O’Connell, MD
Steve Oliver
Ralph Palladino
Kate Pfordresher
Marcia Poston
Alec Pruchnicki, MD
Heather Roberson
Constancia Romilly
Margery Schab
Mark Scherzer
Margaret Segall
Sarah Sheffield
Jerry Shroder
Joel Shufro
Sid and Sandy Socolar
Diane Stein
Peter Steinglass, MD
Merry Tucker

We also want to thank the following funders for supporting our work in 2014:

  • ACA Implementation Fund (received via the Community Service Society)
  • New York State Health Foundation (received via the American Cancer Society)
  • Robert Wood Johnson Foundation (received via the Community Service Society)

Here’s just a sampling of how we put everyone’s financial support to work this past year:

working together sign

January:  Metro joins with Health Care for All New York leaders to visit the Capitol Hill offices of New York Congressmembers to inform them about the benefits of the Affordable Care Act (ACA) for New Yorkers, and the need for continued funding for the state’s ACA-authorized consumer assistance program which helps people solve their health insurance problems.

February:  Metro speaks at Labor Press’ “Union Health Care Summit” which assesses the impacts of the Affordable Care Act on trade unions and needed improvements.

March:  Metro and our allies in Health Care for All New York partner with the Dept. of Financial Services to successfully urge the Legislature to enact a landmark law to expand consumer rights and protections when they incur “surprise medical bills”.

April:  Metro and our partners in the Get Covered New York project wind up a 6-month effort that located and referred approximately 4,000 uninsured New York City residents to enrollers for the new Affordable Care Act plans.

May:  Metro and our partners in the People’s Budget Coalition for Public Health launch the “Access Health NYC” campaign to urge city officials to fund grassroots community outreach and education about how the uninsured can enroll in coverage, use that coverage, and access needed services.

June:  Metro and our partners in New Yorkers for Accessible Health Coverage undertake a legislative advocacy campaign to take on insurers and restore consumer choice in pharmacy access.

Aug.:  Metro and our partners in No Bad Grand Bargain and the New York State Alliance for Retired Americans hold a Social Security birthday party outside the New York City Regional Office of the Social Security Administration (SSA), in conjunction with Local 3369 of the American Federation of Government Employees, calling attention to harmful cutbacks in staff and in-person services, and closures of 7 local SSA offices across NYC since 2011.

Sept.:  Metro and Health Care for All New York partner with the Healthcare Education Project to convene seven well-attended Regional Outreach and Enrollment Summits across the state, including in Queens, Manhattan, the Hudson Valley, and on Long Island.

Oct.:  Metro facilitates planning session on “Community Benefits” at the annual meeting of the National Physicians Alliance, held in Yonkers.

Nov.:  Metro producing radio and cable TV programming on Medicare Open Enrollment for 2015 featuring experts from the Medicare Rights Center, to help people understand their options and choices, including a lively listener call-in on WBAI-FM.

Dec.:  Metro and our allies launch the Campaign for New York Health, to promote state legislation for a truly universal health care program in our state, and turn out hundreds at five public hearings across the state, including New York City.


…and we look forward to continuing our work with everyone in 2015.  Thanks again!

Campaign for New York Health Prepares for Assembly Hearing in NYC on Universal Health Care

On Tuesday December 16, the New York State Assembly Health Committee is holding a hearing in New York on the “New York Health Act” (A.5389-A/S.2078-A) to create a fully-public, truly-universal health care program in New York.  The Act is sponsored in the Assembly by Health Committee chair Richard Gottfried, who represents the west side of Manhattan, and in the State Senate by Sen. Bill Perkins, who represents Harlem.  The hearing will start at 10 a.m. and be held at New York University’s Global Center for Spiritual and Academic Life, 238 Thompson St., 5th fl. Grand Hall, in Greenwich Village.  People can sign-up to testify at this hearing or submit written testimony here.  Oral testimony will be limited to 5 minutes, and people with longer statements are urged to summarize their main points.


The NYC hearing is part of a series of hearings being held by the Assembly Health Committee across the state.  Hearings have already been held in Syracuse on Dec. 4, in Rochester on Dec. 8, and in Buffalo on Dec. 10.  Future hearings after the one in New York City will be held on Long Island (Mineola) on Dec. 17, and in Albany on Jan. 13.

The Campaign for New York Health (CNYH), a multi-constituency coalition promoting the legislation, is advancing participation in these hearings, and holds press conferences in each city prior to the start of the hearing that feature the bill sponsors and other supportive public officials, doctors and nurses, labor leaders, patients with personal stories, health care activists, and local faith and community leaders, among others.  These press events have been garnering much local coverage in local and statewide media.  The press conference prior to the New York City hearing will take place at 9:30 a.m. at the hearing location.

CNYH is also holding “meet-and-greet” events in each community so that local activists and interested citizens can hear directly from the bill sponsors and CNYH representatives, engage in discussion, and have their questions about the bill answered.  The New York City meet-and-greet event will be held on the evening prior to the hearing, Mon. Dec. 15, from 6-8 p.m. at 220 Fifth Avenue, 5th fl., in Manhattan.  The public is welcome to attend.  RSVPs are requested in order to make adequate preparations for space and light refreshments, and can be made here.

CNYH’s website is where interested groups and individuals can sign up to get involved.

Metro Returns to Our Labor Roots

After a four-and-a-half-year hiatus, the Metro New York Health Care for All Campaign rejoined the family of District Council 1707 of AFSCME.  In late September, the community-labor health advocacy coalition moved into the union’s headquarters in the Hell’s Kitchen neighborhood of Manhattan.  Previously, Metro was based at the union’s former location in the Soho section of Manhattan from 2002-10.  It was from there that we lead the New York City Organizing Committee of Health Care for America Now, the large omnibus, multi-constituency campaign that pushed historic health care reform legislation through Congress during 2008-10, now known as the Affordable Care Act (ACA.)

 DC 1707

The union recently elected new leadership, comprised of Victoria Mitchell as Executive Director, and Lorraine Guest as President.  DC 1707 is comprised of six locals representing workers at non-profit agencies who provide human services via contracts with the City of New York:  day care centers, home care programs, social services, teaching and educational organizations, membership and fundraising groups, and Head Start programs, along with a retirees chapter.  We thank Ms. Mitchell and Ms. Guest for warmly welcoming us back.

Previously, Metro was based at the New York City office of Citizen Action of New York.  During our tenure there, we worked closely with Citizen Action and other groups involved in leading Health Care for All New York, a major state consumer health advocacy coalition, as the state implemented ACA.  To date, over 1.6 million New Yorkers have enrolled in new health insurance coverage plans created under the ACA, through the New York State of Health marketplace.  The vast majority of them were previously uninsured.  We greatly appreciate Citizen Action’s hospitality, and the generosity of their Executive Director Karen Scharff.  We look forward to continue working with them on new initiatives to expand coverage to those who have not yet benefited from the ACA, and to improve quality care and value in health care services.

Our new contact information is:

420 West 45th Street
New York, NY  10036

Phone:  646-527-6612
FAX:  212-925-0806 (include cover sheet)

Email:  metrohealth (at) igc (dot) org

2014 Health Care Justice Leadership Gala Announced

Each fall, the Metro New York Health Care for All Campaign sponsors the Annual Health Care Justice Leadership Gala.  The event salutes leadership in the fields of public service, trade unionism, and community advocacy, and features a special keynote speaker who frames the current moment in the struggle for health care justice in New York and America.

This year, the following groups and individuals will be recognized:

Assemblymember Annette Robinson, who has represented the Bedford-Stuyvesant area of Brooklyn since 2002.  She chairs the Banking Committee, and serves on the Aging, Children and Families, Housing, Small Business, Oversight, Analysis and Investigation, and Real Property Taxation Committees.  Previously, she served in the New York City Council.  In recent years, she has provided key leadership in bringing public officials in Brooklyn together to preserve Interfaith Medical Center, one of our city’s foremost community safety net hospitals, and to develop a creative solution for the Center’s future.


The Healthcare Education Project, a joint program of 1199 SEIU United Healthcare Workers East and the Greater New York Hospital Association.  Its mission is to protect and expand  access to quality, affordable healthcare for all New Yorkers through community education, advocacy, and coalition building.  Launched in the late 1990s, the Project works in partnership with individuals, healthcare providers, and civic and religious leaders in local neighborhoods across New York.  In recent years, they spearheaded Regional Enrollment Summits across New York State, in collaboration with Health Care for All New York, and undertook door-to-door canvasses in low-income communities to identify uninsured New Yorkers and direct them to in-person enrollers.

The Coalition to Transform Interfaith, a community-labor-faith collaboration to protect and expand health care in Bedford-Stuyvesant, one of our city’s low-income communities with many uninsured.  To date, they have successfully kept Interfaith Medical Center in operation, and are now spearheading an innovative effort to re-establish the Center’s viability into the future.  They are striving to reorganize Interfaith as a “co-operative” jointly operated by the staff, patients, and community leaders.

This year’s Gala will be held on Monday evening, November 17 at District Council 1707 of AFSCME, 420 West 45th Street (bet. 9th & 10th Aves.) in Manhattan.  An informal reception will begin at 6 p.m., followed by the presentation of the awards.  The keynote speaker will be James Knickman, President and CEO of the New York State Health Foundation.

 The Gala is a fundraiser for the Metro New York Health Care for All Campaign.  The suggested contribution for individuals is $75, although all are welcome whatever they can donate.

Organizations and unions can support the Gala by joining the Host Committee, placing an announcement in the Commemorative Journal, or reserving groups of tickets.  Contact us directly for more information on these options.  The deadline for commitments for the Host Committee and placing journal announcements is Friday, November 7.


Health Professionals, Unions, and Advocates to Join Forces for Historic Climate Change March in New York City

On Sunday, Sept. 21, the streets of Manhattan will be filled with tens of thousands of people participating in the People’s Climate March, and health care justice advocates will be there too!  The march is being held in advance of a special United Nations session on Climate Change that will immediately precede the organization’s annual meeting of its General Assembly.  Organizers are hoping that the march will be on the magnitude of the 2003 march against war in Iraq and the anti-nuclear march of 1981, each of which drew very large crowds (in the hundreds of thousands.)

planet earth and hands photo

The march will be organized in six sections, each with its own “theme”.  The health contingent will be at the head of the second section, whose theme is “We Can Build the Future.”  We’ll be directly following the trade union contingent, and right behind the major health care unions such as 1199 SEIU United Healthcare Workers East, the New York State Nurses Association, and others.  The section will form up along Central Park West above Columbus Circle from W. 66 to 72nd Streets.  Participants will be able to enter from W. 72nd St., and are urged to arrive between 10-11 a.m., as the march will step off starting around 11:30.  Large crowds are expected, so people are urged to arrive early.  When you enter the section, walk toward the front to find the health groups.

Prior to the march, a special press conference focusing on climate change and health will be held at 9:30 a.m. outside Roosevelt Hospital, located at 59th St. and 10th Avenue in Manhattan.  Those scheduled to speak include Oliver Fein, MD (Professor, Weill Medical College, Cornell Univ.), Erica Frank, MD, Professor, University of British Columbia), Robert Gould, MD (President, Physicians for Social Responsibility), Corey Johnson (Chair, NYC Council Health Committee), Judy Sheridan-Gonzalez, RN (President, NYS Nurses Assoc.), Susan Spieler, PhD (Director of Continuing Education, Training Institute for Mental Health), and Catherine Thomasson, MD (Exec. Dir., Physicians for Social Responsibility).

Some of the groups involved in organizing the health contingent include (in alpha order) ACT UP/New York, Alliance of Nurses for a Healthy Environment, Climate 911, Healthcare Now NYC, International Transformational Resilience Coalition, NYS Nurses Association, Metro NY Health Care for All Campaign, Physicians for a National Health Program, Physicians for Social Responsibility, Psychologists for Social Responsibility, and the U.S. Climate and Health Alliance, among others.

Full information on the Public Health contingent can be found here.

General information on the march overall can be found here.

“Regional Enrollment Summits” Announced Across New York for this Fall

During the first open enrollment period for new health insurance plans available under the Affordable Care Act nearly 1 million New Yorkers signed up for coverage, and over 80% of them were previously uninsured.  That’s great news, and a good advance on lowering New York’s number of uninsured (previously, 2.5 million in 2013.)  For a full report on New York’s success, click here.

color crowd crop

The next open enrollment period begins on this coming November 15th and runs until February 15th.  It will be our next opportunity to sign-up those who are still-uninsured for coverage.  To help everyone get ready for it, advocates and our allies have joined forces to plan a series of “Regional Enrollment Summits” across the state, to bring all stakeholders together to assess what happened previously, and plan for the coming fall and winter.

These events will bring together community leaders and stakeholders to review the first year of outreach and enrollment for health insurance coverage available through New York State of Health, our state’s new health insurance marketplace. Health advocacy groups, navigators, community groups, health care facilities, unions, health plans, and small business representatives are all encouraged to attend.

In our area, two summits will be held in New York City and one on Long Island.  (There may also be one added in the Lower Hudson Valley – watch for further details.)  If your organization or union is focusing on outreach to uninsured New Yorkers and/or helping them to enroll in coverage, we invite you to attend one of them.

Here’s the details about the NYC are summits:

  • Mon. Sept. 22, 10 a.m. to 1 p.m. – Long Island Summit; at 1199SEIU, 100 Duffy Avenue, Suite 3W, in Hicksville (adjacent to the LIRR train station); registration (by Sept. 18)
  • Tues. Sept. 30, 10:30 a.m. to 2 p.m. – Brooklyn-Queens-Staten Island Summit; at York College, Faculty Dining Room, 94-20 Guy R. Brewer Boulevard (south of Archer Ave.), in Jamaica; registration (by Sept. 28)

The agenda for the summits will include:

  • Presentation by “New York State  of Health”, our state’s online health insurance marketplace
  • Panel discussion by groups doing public outreach and enrollment activities
  • Discussion groups to plan share best practices and lessons learned, and plan for the future.

Additional summits across our state include:

  • Fri. Sept. 12, 10:30 a.m. to 2 p.m. – Capital District Summit; at 1199SEIU, 155 Washington Ave., in Albany; registration
  • Tues. Sep. 30, 1 to 4:30 p.m. – Central New York Summit; at Southern Tier Independence Center, 135 E. Frederick St, in Binghamton; register
  • Thurs. Oct. 2, 9 a.m. to 12 noon – Western New York Summit; at 1199SEIU, 2421 Main Street, in Buffalo; register

Sponsoring groups for the summits include Citizen Action of New York, Community Health Care Association of New York State, Community Service Society of New York, Healthcare Education Project of 1199SEIU/GNYHA, Health Care for All New York, and Raising Women’s Voices-New York.  Additional co-sponsors for each local summit will be solicited.

New Yorkers to Celebrate that “Social Security Works!”

This summer has marks the 49th anniversary of the enactment of Medicare and Medicaid, and the 79th anniversary of Social Security.  All of these programs are all of a piece, and together comprise the bedrock of our nation’s ever-evolving and expanding historic social contract, which most recently added the Affordable Care Act to its scope.  In terms of advocacy, when we support any one of these programs, we support them all, as they are intricately linked to each other, particularly in the minds of the public and voters.

Soc Sec card

With that in mind, health care advocates are joining with senior citizens, disability rights advocates, and union retirees to celebrate the 79th anniversary signing of the Social Security Act by President Franklin D. Roosevelt.  This coming Thursday, August 14, we’ll all be gathering that morning at 11 a.m. outside the NYC District office of the Social Security Administration (SSA), located in Jamaica, Queens, the busiest Social Security office in the country, located at 155-10 Jamaica Avenue (at Parsons Ave.)  (See our action alert invite here, with all the details.)

We’ll be talking about what Social Security means for New York.  About 3.5 million New Yorkers and their families receive benefits from Social Security, including 1.1 million in New York City.  Statewide, beneficiaries include 2.3 million retirees, 520,000 people with disabilities, 421,000 surviving spouses, and 258,000 children.  The program also pumps over $50 billion annually into New York’s economy, and together with Medicare, keeps 1.2 million New Yorkers out of poverty.  (You can read the latest report from Social Security Works about all the ways New Yorkers benefit from it.)

We’ll also be refuting some of the BIG LIES that opponents of government social programs like to tell.  Social Security is NOT going broke!  In fact, it is fully solvent for another 20 years.  Also, Social Security has not contributed one penny to the federal budget deficit.  It has its own Trust Fund that is funded by a dedicated tax from contributions taken out of every workers’ paycheck.

We’ll be calling on Congress to rectify the crisis of recent local Social Security office closures and in-person service cutbacks resulting from budget cuts.  Since 2011, seven local Social Security Administration offices across New York City have been closed because of budget cutbacks, including in Astoria, Chinatown, East New York, Glendale, Midtown Manhattan, South Bronx, and Williamsburg.  Meanwhile, the number of people on Social Security will double in the next 20 years.  In addition, the Social Security Administration is shifting some services solely to online modalities, creating barriers to necessary services for New Yorkers who are not internet literate or do not have regular internet access.  New York’s Senator Charles Schumer has recently introduced a bill to address this problem (S.2742), and a similar bill (H.R.3997) has been introduced in the House by Rep. Brian Higgins of Buffalo.

There are also bills in Congress to improve and expand Social Security:

  • The “Strengthen Social Security Act” (S.567, H.R.3118), introduced by Sen. Tom Harkin and Rep. Linda Sanchez would raise the minimum base benefit, remove the cap on income subject to FICA taxes so that the wealthy pay their fair share just like the rest of us, and change the basis of the formula used to calculate the annual cost-of-living-adjustment (COLA) to more accurately reflect the spending needs of older people and people with disabilities, particularly when it comes to health care.  (You can read the ARA fact sheet here.)
  • The Retirement and Income Security Enhancement (RAISE) Act (S.2455), introduced by Senators Mark Begich and Patty Murray, would enhance Social Security benefits for widow(er)s and divorced spouses while extending benefit eligibility for children of retired, disabled, and deceased workers.  (You can read the ARA Fact Sheet here.)

We are collaborating on this event with the Alliance for Retired Americans (ARA), and Local 3369 of the American Federation of Government Employees (AFGE) which represents SSA workers at that office. AFGE’s “Save Our Social Security” campaign is encouraging their members to resist office closures and in-person service cutbacks.

Our event here in NYC will be part of several similar events taking place across New York State being organized by the Restore the American Promise (RAP) campaign.  Additional events will be taking place across the country, coordinated by ARA, AFGE, and Social Security Works.  We’ll be having party hats and cupcakes, and have invited some local members of Congress from the Queens too.  Please join us! 

Consumer Advocates Take on Big Insurance-PBM Alliance During Final Days of State Legislative Session

David v Goliath (Gebhard Fugel)

They’re at it again!  (Actually, do they ever stop?)

Three years ago, the State Legislature and Governor Cuomo enacted a law guaranteeing New Yorkers the right to receive our prescription drugs either by mail order delivery or from a local community pharmacy.  However, the insurance companies and their “pharmacy benefit manager” (PBM) pals have exploited a minor provision of that law to continue to deny consumers that right to choose.  Instead, insurers are forcing patients to use mail order only, especially for so-called “specialty drugs” (often arbitrary defined as anything costing more than $250 for a month’s supply.)  They’re also imposing onerous and ridiculous terms and conditions on community pharmacies in order to certify them as in-network.

Mail order works fine for many people.  It can be convenient and save money.  However, there can also be problems for people when packages don’t arrive on time, they get lost in the mail, they get left with neighbors (thereby violating patients’ privacy), or they get left on doorsteps and then are stolen, among other difficulties.  In such circumstances, patients then have to pay full cost for a replacement, which can often be hundreds or thousands of dollars.  In some cases, their health and well-being can be placed in jeopardy if they miss doses of maintenance drugs.

Many people prefer to use a local community pharmacy instead where they can pick up their medicines at a convenient time and not miss refills.  They also prefer to consult directly with a local professional pharmacist who has a record of all their medicines on file (often prescribed by different providers) to watch out for any complications and contraindications.  They prefer this option rather than have to deal with an often minimally-trained customer service agent at the end of a phone line far away who simply reads off a boilerplate script.

Why are insurers doing this?

Simple:  follow the money.  Many of the big PBMs are wholly-owned subsidiaries of insurance companies.  Others have sweetheart deals with them.  By denying us this right to choose, insurers and PBMs are cornering and gaming the market, and trying to put our local drugs stores out of business.

The good news:

There’s a bill in the State Legislature to restore our right to choose and eliminate insurers’ outrageous terms and conditions they want to impose on local drug stores.  This bill won’t drive up drug prices or insurance premiums at all, provided consumers use an in-network pharmacy.  There’s wide, bipartisan support for this bill, and it has already passed the Assembly unanimously.

The challenge:

The bill is now hung-up in the Senate because the chair of the Insurance Committee (Sen. James Seward of Oneonta) won’t let it out for a floor vote.  He’s parroting the industry’s specious claims that community pharmacists can’t be trusted to dispense specialty drugs (despite the fact that they’ve been handling them for years.)

How the Legislative Battle is Proceeding:

The insurance and PBM industry is running radio ads, putting up billboards, and placing ads in newspapers across the state, claiming that this bill will create a new “prescription drug tax”, raise insurance premiums, threaten patient safety, and undermine the mail-order drug business.  In particular, they are scaring seniors that their drug costs will go up.

In response, New Yorkers for Accessible Health Coverage (a statewide coalition of chronic illness and disability groups) has been joined by Gay Men’s Health Crisis, NYS Bleeding Disorders Coalition, the MS Society, Consumers’ Union, the Lupus Foundation, the Pharmacists Society of the State of NY, and the Coalition of Community and Chain Store Pharmacies.  Together, they are saying to state lawmakers, “Do it again, just like you did three years ago, but close the loophole this time.  Make sure New Yorkers maintain our right to choose how we get our medicines.”

The 2014 Legislative Session ends by this coming Friday, June 20.  Advocates are hoping that, given the broad support among rank-and-file Senators, Senate leadership will take the bill to the floor for a vote despite Senator Seward’s opposition.

What you can do: read our Action Alert here.