Ryan/House Majority Health Care Reform Proposals Offer Radical Reactionary Changes

Last month, after a YEARS-LONG delay, House or Representatives’ Speaker Paul Ryan and his Republican majority colleagues FINALLY released their “repeal and replace” plan for health care reform, should they maintain control of the House in this fall’s elections along with their Senate colleagues, and a Republican be elected President.  Their plan, dubbed “A Better Way”, would essentially return the nation to pre-Affordable Care Act days, while moving in additional conservative, market-driven/oriented directions, and giving private insurance much more hegemony and free rein.

paul-ryan-a-better-way-intro

Much of the document is nothing but political rhetoric and “Obamacare bashing”, offering few policy specifics.  Here’s the main elements:

General Insurance Reforms:

  • Allow Insurers to offer plans across state lines.
  • Promote “health savings accounts” (HSAs) and “consumer-directed” plans.
  • Return health insurance regulation to the states, repealing the role of federal government.
  • Establish (undefined) “State Innovation Grants” to lower premium costs and/or number of uninsured.

Individual Market Reforms:

Repeal the Affordable Care Act but…

  • Allow young adults to stay on their parents’ plan
  • Prohibit insurers from charging higher premiums to those with pre-existing conditions
  • Prohibit insurers from dropping coverage for people who get sick
  • Continue bans on lifetime coverage limits
  • Eliminate the “individual mandate” tax penalty
  • Eliminate state-based and federal “public” health insurance exchanges/marketplaces, along with the advanced premium tax credits (APTCs) to help the uninsured purchase insurance. Instead provide a fixed/flat tax credit to everyone in the individual market, adjusted by age, who would buy coverage through “private exchanges”.
  • Prohibit insurers from charging higher rates to people with pre-existing conditions provided they keep continuous coverage.
  • Provide a one-time open enrollment period for the uninsured regardless of health history.
  • Establish separate state-based high-risk insurance pools for people with pre-existing conditions, for people who have breaks in coverage.
  • Allow insurers to charge more to older people for the same plan/policy, beyond the current ACA standard of 3:1 ratio. Standard range would be 5:1 with state flexibility to go higher or lower.
  • Unclear: What happens to 20M people currently covered under the new ACA plans?

Employer-Sponsored Coverage Reforms:

  • End the “employer mandate” tax penalty.
  • Cap the tax preference and tax deduction for employer-sponsored coverage.
  • Allow employers to reward employees who participate in wellness programs.
  • Allow small businesses and individuals to join together in “association” health plans.
  • Allow small employers who self-insure to buy private “stop-loss” coverage.

Medicare Reforms:

  • Raise eligibility age to 67 (matching Social Security.)
  • Transform Medicare from a “guaranteed benefit” to a “defined contribution”/”premium support” program, with lower premiums for sicker people, lower out-of-pocket limits for low-income people, and higher premiums for wealthier beneficiaries.
  • Create regional “Medicare Compare” websites/exchanges to list private Medicare plans and traditional Medicare.
  • Combine Medicare Parts A and B, with a unified deductible, and a maximum annual out-of-pocket cost cap.
  • Combine all four current Medicare Savings Plans (“MSPs”) into one program with a uniform asset test, to be run/set by states.
  • Eliminates the new ACA-authorized “Independent Payment Advisory Board” (not yet implemented), and new the Center for Medicare and Medicaid Innovation.
  • End mandatory cuts in subsidies to private Medicare Advantage plans.
  • Allow private Medicare Advantage plans greater flexibility to offer “value-based” benefit designs.
  • End “first dollar coverage” for private Medicare Supplemental (“Medigap”) plans.
  • Allow physicians to enter into private financial contracts with Medicare patients for selected medical services covered by Medicare, but outside of Medicare per se.
  • Repeal Medicare Disproportionate Share (“DSH”) cuts to hospitals for 2018-2019.

Medicaid Reforms:

  • Transform Medicaid into a block grant program to states. States could choose either a “per-capita cap” or straight block grant.
  • Eliminate many coverage requirements for state Medicaid programs.
  • Allow states to create incentives for various healthier and personal behaviors.
  • Repeal Medicaid Disproportionate Share (“DSH”) cuts for 2018-2020.

Health Insurance Tax Reforms:

Repeals new ACA funding streams:

  • Excise (“Cadillac”) tax on high-cost, employer-sponsored/union health plans
  • Increased Medicare taxes on high-income taxpayers, including investment income
  • Penalties for non-qualified distributions from HSAs
  • “Windfall profits” taxes on insurers, drug makers, and medical device manufacturers

Other Reforms:

  • Combine Medicare and Medicaid “Disproportionate Share” (DSH) funds into one pool/program starting in 2021.
  • Cap medical malpractice awards.
  • Codify the anti-choice “Hyde Amendment” and “conscience clauses” for providers.
  • Allow physician-owned hospitals.
  • Reduce regulation of NIH research.
  • Promote “personalized medicine”.
  • Modernize clinical trials and reduce red tape.
  • Reduce regulation of medical app development.
  • Facilitate repurposing of drugs for patients with rare diseases.
  • Reduce regulation on development of electronic health records.

Summary: http://abetterway.speaker.gov/_assets/pdf/ABetterWay-HealthCare-Snapshot.pdf

Full document: http://abetterway.speaker.gov/_assets/pdf/ABetterWay-HealthCare-PolicyPaper.pdf

Unexpected Advances on Health Bills Made as NY State Legislature Winds Up Its 2016 Session

As this year’s state legislative session drew to a close late last month, several bills important to consumer health advocates and our allies advanced: some to Governor Cuomo’s desk for signing or veto, others to firmer footing for next year’s session.  Depending on how this fall’s elections turn out will determine prospects for these latter set of bills come 2017.

NYS capitol

Things started off well with the overwhelming passage on June 1st, for the second year in a row, of the New York Health Act (A.5062-A, Gottfried) by the New York State Assembly, by an 86 to 53 vote.  The bill would create a fully-public universal health care program covering all New York residents.   While New York’s uninsurance rate has dropped to less than 5% under the Affordable Care Act (ACA), we still need to cover those for whom the law offers no options.  This bill would draw on provisions of the ACA which allow states to move forward beyond and building upon the ACA, including implementing so-called “single-payer” systems, as embodied in this bill.  The Campaign to New York Health has been the lead coalition promoting it.

Next up was the Safe Staffing and Quality Care Act (A.8580-A, Gunther), which overwhelmingly passed the NYS Assembly on June 14 by a vote of 103 to 31. This bill sets minimum nurse staffing ratios in hospitals and nursing homes, by department. Nurse are WAY overworked and overburdened in many of these settings, and find it very challenging to provide quality, timely care to their patients. This bill helps remedy this crisis.  A similar law in effect in California for over a decade now has significantly improved patient care, the working conditions of nurses, AND saved money for hospitals and nursing homes.  The NY Campaign for Patient Safety, led by the NYS Nurses Association and the Communications Workers of America, has been the coalition promoting the bill.

In the literal final hours of the session, three bills actually moved to enactment, for signature by the governor:

  • Enhanced Safety Net Hospitals Act (S6948-A/Hannon, A9476-A/Gottfried) – This bill raises the Medicaid reimbursement rate to hospitals for whom their over 50% or their patients are either uninsured and/or covered by Medicaid. These are hospitals that are suffering because of federal funding cutbacks for indigent care. This bill was promoted by the Save Our Safety Net Campaign and various public sector unions, and came out of nowhere in about 3 months, highly unusual for the legislative process.
  • Advanced Home Health Aide Act (S.8110/LaValle, A.10707/Glick) – This bill creates a new category of nursing professional to provide certain services in home and community-based settings so that patients with complex health needs can live at home/in the community if they choose, rather than be forced only to live in skilled nursing facilities/nursing homes.  This bill was promoted by Medicaid Matters New York, the New York Independent Association for Independent Living, and various senior citizen and disability rights groups after a multi-year effort.
  • Expedited Utilization Review for Prescription Drugs Act (S,3419/Young, A.2834-D/Titone) – This allows physicians to request overrides of insurers’ “step therapy” and “fail first” limitations on certain drugs on a case-by-case basis when needed.  The bill was promoted by New Yorkers for Accessible Health Coverage and their allies after a multi-year effort. 

Unfortunately, two other bills were “left on the table”:

  • Comprehensive Contraceptive Coverage Act (S.6013/Bonacic, A.8135-B/Cahill) – would mandate that health insurers cover all forms of FDA-approved contraception. It passed the Assembly back in January and has been stuck in the Senate Insurance Committee since.
  • “Lavern’s Law” (S.6596-B/DeFrancisco, A.10719-A/Weinstein) – would to change the filing deadline for medical negligence/malpractice suits from the physician’s date of diagnosis of a given condition to the patient’s date of notification. It passed the Assembly in 2015 and is now before the Judiciary Committees in both chambers.

Health Advocates Assess Adopted 2016-17 State Budget as a Mixed Bag

The first three months of each year’s state legislative session in Albany always centers around adopting a tax and spending plan for the new fiscal year that starts on April 1st.  Advocates and other stakeholders pour over the governor’s initial proposals in late January, urge the legislature to make changes to it during February and early March, and hope for the best as the final negotiations transpire behind closed doors in the closing week or two.

scrabble money This year, health care advocates involved in the Health Care for All NY and Medicaid Matters NY coalitions promoted several ideas, and pushed-back against others.  Pro-actively, they sought:

  • Continued and stable funding ($4M) for the Community Health Advocates (CHA) program that helps health insurance policyholders of all sorts (public, private, employer) solve coverage problems they may experience with either their health plan and/or care providers. They also help uninsured people located free or low-cost care in their community.  (CHA is a statewide network of non-profit organizations serving all counties, and is anchored by the Community Service Society of NY, Empire Justice Center, Legal Aid Society, and Medicare Rights Center.  CHA is the state’s official “consumer assistance program” created under the Affordable Care Act.)  Result: $3.25M in funding approved.
  • New funding ($2M) for community-based, non-profit organizations to undertake public education and outreach programs to the still-uninsured to inform them about their possible new coverage options under the Affordable Care Act, and direct them to enrollers located in the community, or at hospitals and health centers. Result: no funding included.
  • New funding ($10.3M) to expand health insurance coverage under the state’s new (and very successful) “Essential Plan” (EP) to certain lawfully-present immigrants (primarily young adults) who can enroll in Medicaid, but not this new option when their income rises above the Medicaid level. (EP coverage is very low-cost, and available for working poor individuals and families who are not eligible for Medicaid.) Result: no funding included.
  • Allow people leaving incarceration to apply for Medicaid 30 days before their release, rather than have to wait until afterwards. Result: approved.
  • Expand Medicaid coverage for additional mental health services for children, including crisis intervention, community psychiatric treatment, psycho-social rehab, family peer support, youth peer support, and services from additional licensed providers. Result:  approved
  • Provide capital funding to community-based health care providers for delivery system reform, and not just institutional ones. Result: $30M approved (out of $200M allocated system-wide)

 

leg body

More successfully, advocates were able to get the legislature to reject several troubling proposals from the governor, including:

  • Ending the rights of spouses and parents to refuse to have their own income and assets taken in consideration when applying for Medicaid coverage for long-term care services for their disabled spouses and children.
  • Drastically reducing the amount of assets that spouses can maintain when their spouses apply for Medicaid coverage for long-term care services.
  • Ending current “prescriber prevails” policies that allow doctors to appeal denials of coverage for particular drugs by a given Medicaid health plan.
  • Tightening eligibility standards for managed long-term care under Medicaid.
  • Remove coverage for medically-related transportation services from Medicaid-covered managed long-term care plans, and shifting them to a separate third-party contractor.
  • Shift $500M in Medicaid costs to New York City as part of their “local share”.

 

One issue that got “punted” concerned the creation of a new “Health Insurance Guaranty Fund.”  In the wake of the financial collapse of Health Republic (New York’s non-profit health insurance co-op) last fall, it turned out that New York is the only state not to have a “guaranty fund” in place for health insurers.  The state does have such funds for other insurance product lines.  Such funds help pay-off the insurers debts that may exceed the value of a company’s assets once liquidated.  Instead, the Legislature directed state officials to create a one-time fund to reimburse doctors and hospitals that are owed payments, using proceeds from fines and financial settlements in legal and regulatory cases.  Advocates had supported the general concept of a health guaranty fund, but urged that it not be funded by additional assessments on consumers’ insurance premiums, a position also supported by insurers.

New York Creates New Landmark Paid Family Leave Program

After more than a decade of effort, as part of the final deal for the 2016-17 state budget, New York will soon have a new Paid Family Leave (PFL) program, and it will be the most ambitious and comprehensive one in the country. Gov. Andrew Cuomo and the State Assembly made it one of their top priorities during the budget negotiations, and participants in the New York Paid Family Leave Campaign pushed it through the State Senate. Key campaign leaders included AARP, A Better Balance, Citizen Action of NY, Community Service Society of NY, NY Civil Liberties Union, NY State AFL-CIO, NY Statewide Senior Action Council, Working Families Organization, 1199 SEIU and 32BJ SEIU.  We were proud to have been a rank-and-file member of the campaign.

NYPFLIC photo1

The U.S. is only one of two nations globally that does not guarantee some sort of PFL program for workers to care for a new borne or an ill family member. The national Family and Medical Leave Act (FMLA), enacted in the 1990s, has provided up to 12 weeks unpaid leave while protecting one’s job, but more than 40% of workers are not eligible, and many other low-income workers could not afford to take unpaid leave.

With this new law, New York now joins 3 other states that have paid family leave programs: California, New Jersey, and Rhode Island.  Since the 1950s, New York’s Temporary Disability Insurance ITDI) program has guaranteed up to 7 weeks for the birth of a child, but it currently only provides a meager $170/week in replacement income, an amount not raised since the early 1990s. (Most other states provide a much larger benefit, up to a maximum of more than $750/wk.) On the positive side, a good number of New York employers have voluntary provided some amount of paid family leave on their own, but 6.4 million New York workers have had no such option available.

NYPFLIC photo2

As the campaign heated up this year, many employers, especially small ones, resisted creation of a PFL program. They were worried about having to pay a new tax, the impact on profitability, being put at a competitive disadvantage vis-à-vis companies in other states, abuse of the program by employees, and new administrative burdens. Looking at other states’ experiences, the realities are that PFL programs can be funded solely by employee contributions (thereby costing employers nothing, and creating no market disadvantage), and employers have reported positive or neutral impacts on employee morale, loyalty, productivity, and performance. Further, most workers have typically taken less than the full amount of PFL time allowed, nor have there any new onerous compliance requirements.

The campaign to enact the law in NY rested on 4 core strategies: sharing workers’ personal stories of why they wanted and needed PFL (and what happened when they didn’t have it), making a “public health” case for PFL (citing research showing the health and child development results), engaging supportive small employers and giving them visible roles, and address the myths and fears of initial opponents.

woman and aging father                   couple and baby antique

The state’s new PFL program will be operated through the state’s existing TDI system, and will be a social insurance program whereby funds are pooled and paid out to individual families based on need. It will start in 2017 and fully phase-in over a 4-year period. All contributions will be made by employees, estimated to phase up to $1.40/wk. Self-employed people and public sector unions can opt into it. The state’s Disability Benefits Bureau of the Workers’ Compensation Board will enforce the law.

The program’s “four pillars” are: up to 12 weeks paid leave, job protection while out on leave, inclusion of all employers (regardless of size), and a maximum benefit level of up to two-thirds of a worker’s weekly wage up to a cap of two-thirds of the statewide average weekly wage. Birth mothers can receive separate time off from childbirth, and each parent can take up to 12 weeks, either simultaneously or sequentially. Leave can be taken for childbirth, adoption, or foster care placement, caring for a seriously ill family member (child, parent/parent-in-law, spouse/domestic partner, grandparent, grandchild), or certain needs arising from a family member’s military service. Full-time workers can access the benefits after 26 weeks (6 months) of employment, and part-time workers after 175 days. The leave will run concurrently to any leave eligibility under the existing federal FMLA system. Workers with employer-sponsored health insurance will continue such coverage during their leave.

Nationally, New York Senator Kirsten Gillibrand and Rep. Rosa DeLauro (CT) have introduced the FAMILY Act in Congress (S.786, H.R.1439), which would create a federal PFL program under the Social Security Act. As PFL programs develop in other states, pressure will be created for Congress to act. Once again, New York and other states are proving to be the laboratories of democracy!

BRAVO! Financial Supporters Make a Difference …and Make It All Possible.

We’d like to thank the following groups, unions, and individuals who financially supported us in various ways during 2015.  Their support made our work in 2015 possible, and lays a foundation for our work to come in 2016.  If you’d like to do so before the ball drops nearby in Times Square, please us the donate button here, or mail a check to 420 West 45th St., DC 1707, New York, NY 10009. 

MDs applauding

Annual Spring Dues Campaign

Groups and Unions:

  • Alliance for a Greater New York
  • *Center for Health Care Initiatives
  • *Center for Independence of the Disabled in NY
  • Children’s Defense Fund of NY
  • Citizen Action of New York
  • Commission on the Public’s Health System in NYC
  • Committee of Interns and Residents, SEIU Healthcare
  • *Communications Workers of America, District 1
  • *Communications Workers of America, Local 1102
  • Communications Workers of America, Local 1180
  • Community Health Care Association of New York
  • *Community Healthcare Network
  • DC 37 Retirees Association
  • District Council 37, AFSCME
  • Doctors’ Council, SEIU Healthcare
  • Federation of Protestant Welfare Agencies
  • Gay Men’s Health Crisis
  • *GuildNet/Lighthouse Guild
  • Healthcare Education Project, 1199SEIU/GNYHA
  • *Hudson Center for Health Equity and Quality
  • International Association of Stage and Theatrical Employees, Local 1
  • Long Island Coalition for a National Health Program
  • Make the Road New York
  • Medicare Rights Center
  • *New York Committees of Correspondence
  • *New York Gray Panthers
  • 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
  • *Primary Care Development Corp.
  • Physicians for a National Health Program, New York Metro Chapter
  • Planned Parenthood of New York City
  • Professional Staff Congress, CUNY
  • Public Health Solutions
  • *Ryan Center
  • *Social Service Employees Union, Local 371, DC 37
  • 1199 SEIU United Healthcare Workers East

(* new contributors from 2015)

Individuals:

  • Deborah Bell
  • Richard Bergman
  • Carmelita Blake
  • Francine Brewer
  • Gene Carroll
  • Jim Collins
  • Moira Dolan & David Mandelbaum
  • Anne and Sid Emerman
  • Shaurain Farber
  • Tim Foley & Susan Lee
  • Jay Gumbiner
  • Marica Hunte
  • John and Patricia Hyland
  • Nadia Jakoubek
  • Pauline Kuyler, MD
  • Lou and Sara Levitt
  • Jose Matta
  • R. Mayer
  • Cheryl Merzel, MD
  • Terry Mizrahi
  • Ethel Paley
  • Alec Pruchnicki, MD
  • Lois Steinberg
  • Katharine Wolpe

2015 Health Care Justice Leadership Annual Gala

Groups and Unions:

  • AARP New York
  • Alliance for a Greater New York
  • Associated Musicians of Greater New York, Local 802 AFM
  • Center for Independence of the Disabled in New York
  • Citizen Action of New York
  • Coalition of Asian-American Children and Families
  • Commission on the Public’s Health System
  • Committee of Interns and Residents
  • Communication Workers of America, Local 1180
  • Communications Workers of America, District 1
  • Communications Workers of America, Local 1102
  • Community Health Care Association of New York State
  • Community Healthcare Network
  • Community Service Society of New York
  • Consumers Union
  • Council of School Supervisors and Administrators, AFT Local 1
  • Doctor’s Council
  • Federation of Protestant Welfare Agencies
  • Freelancers’ Union
  • Gray Panthers, New York City Network
  • Greater NY Laborers-Employers Cooperation and Education Trust
  • GuildNet
  • Healthcare Education Project, 1199 SEIU-GNYHA
  • Housing Works
  • Hudson Center for Health Equity
  • International Cinematographers Guild, Local 600, IATSE
  • Medicare Rights Center
  • Municipal Hospital Employees, Local 420, DC 37
  • National Association of Social Workers, New York City Chapter
  • New York City Central Labor Council
  • New York Committee for Occupational Safety and Health
  • New York Immigration Coalition
  • New York State Nurses Association
  • New York Therapeutic Riding Center
  • Open Door Family Medical Centers
  • 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, AFT Local 2334
  • Raising Women’s Voices-NY
  • Ryan Community Health Center
  • 1199 SEIU United Healthcare Workers East
  • Social Service Employees Local 371, DC 37 AFSCME
  • Systonic Systems
  • Theatrical Stage Employees, Local One, IATSE
  • Transport Workers Union, Local 100
  • United Auto Workers, Region 9A
  • United Federation of Teachers, AFT Local 2
  • United University Professions

Individuals:

  • Alec Pruchnicki
  • Alice and Jon Fisher
  • Barbara Edmonds
  • Bob Ambaras
  • Carmelita Blake
  • Chris Verber
  • Nick Unger
  • Edwin Weber
  • Ester Lok
  • George Carter
  • Janet Sussin
  • Jim Perlstein
  • Joel Shufro
  • Kate Linker
  • Susan Moscou and Dan O’Connell
  • Kate Pfordresher
  • Lloyd Bishop
  • Marianne Kosits
  • Mark Seddun
  • Mary Tucker
  • Mike Rabinowitz
  • Moira Dolan
  • Paul Stein
  • Stanley Lave
  • Steve Oliver
  • Tom Shcherbenko

Health Care for All New York Subgrants

  • Community Service Society of New York (funding from the ACA Implementation Fund, and the Robert Wood Johnson Foundation)
  • Schuyler Center for Analysis and Advocacy (funding from the New York State Health Foundation)

Restore the American Promise Subgrant

Public Policy and Education Fund of New York (funding from Americans for Tax Fairness)

Grant Support for Our Internship Program

Anthony DeMarco Health Care for All of US Fund

Looking Back Over 2015, and Ahead to 2016

As this year draws to a close, we want to thank all those groups, unions, and individuals who partnered in and/or financially supported our work in 2015.  We couldn’t have done all we have without you!

people cheering

Some of our accomplishments this past year have included:

  • Passage of the “New York Health Act” universal health care bill by the State Assembly in May (by over a 2/3rds majority) – via the Campaign for New York Health
  • Advocating for New York to robustly maximize its options under the Affordable Care Act, including creating the exciting new “Essential Plan” that offers very low-cost coverage to the working poor – via Health Care for All New York
  • Educating uninsured New Yorkers about their new coverage options under the Affordable Care Act (nearly 3 million have signed up so far since 2 years ago.) – via Health Care for All New York
  • Securing dedicated funding from both New York State and New York City to enable community-based groups to reach out to uninsured people to get them enrolled in coverage and newly-insured people to help them learn how to use their coverage – via the People’s Budget Coalition for Public Health
  • Celebrating and calling attention to the 50th anniversary of Medicare and Medicaid as bedrock social programs for America and millions of New Yorkers over the decades – via No Bad Grand Bargain
  • Leading efforts statewide and here in New York City to protect federal funding for health care and related social programs by resisting austerity policies, advocating for tax fairness, and promoting general economic development – via Restore the American Promise
  • Contributing to new State and City government initiatives to improve access to services, improve the quality of care, promote population health, and make health care more affordable – via Health Care for All New York, Medicaid Matters New York, and the New York City Dept. of Health and Mental Hygiene
  • Production of 9 cable TV shows (check them out on our website here), and 28 segments for WBAI’s “Health Action” show, including 3 listener call-ins.

binoculars looking ahead

We will be continuing and building on all these efforts in 2016, and look forward to joining with you on them.  In particular, we will be working to inject these issues into the election year discourse, to educate voters about what’s at stake for state and national government policies, concerning both those enacted and desired. 

writing out a check

If your group or union, or yourself personally, have not yet had time to support our recent “Health Care Justice Leadership Annual Gala”, please take a moment now to do so, before the end of this year.  You can either send us a check (420 West 45th Street, DC 1707 AFSCME, New York, NY 10036), or contribute online via the donate button on this page.  Doing so will enable us to begin 2016 on strong footing.

Finally, please be sure follow everything we’re up to and the larger context of our work via our online platforms:  our blog and monthly calendar, our Facebook page, and our Twitter feed.

In closing, we wish everyone all the best for the coming new year.  By continuing to work together, we will advance the cause of universal health care, and the various health care justice efforts strategic to that goal.

New York Health Activists and Allies to Protest Pfizer’s “Corporate Inversion” Tax Dodge

On Friday, December 4th at 12 noon, members of No Bad Grand Bargain (NBGB), a citywide network of health and social justice activists who focus on federal budget issues, and Americans for Tax Fairness (ATF), a Washington, DC-based coalition of national organizations who advocate for politically-progressive tax reform policies, are gathering outside the World Headquarters of drugmaker Pfizer in midtown Manhattan for a press conference and protest in reaction to the firm’s recently announced merger with Irish drugmaker Allergan. 

pfizerlogo

“Pfizer’s Rx for America: Dodge U.S. Taxes, Stash Profits Overseas, Stick the Rest of Us with the Tab” will feature New York State Senator Liz Krueger, and speakers from ATF, UFT Retired Teachers Chapter, and Metro New York Health Care for All. The event will be held outside the company’s New York City office, located on the northwest corner of 42nd Street and 2nd Avenue.

 Sponsors of the event include Citizen Action of NY, Fiscal Policy Institute, Democracy for NYC, Doctors Council/SEIU Healthcare, Metro NY Health Care for All, MoveOn, NYS Alliance for Retired Americans, No Bad Grand Bargain, Restore the American Promise, UFT Retired Teachers Chapter.

Pfizer’s merger with Allergan is a “corporate inversion” whereby Pfizer technically becomes an Irish-based company, thereby escaping paying U.S. corporate taxes, yet all-the-while maintaining its full U.S.-based operations and New York City headquarters. Such inversions are a strategy being increasingly employed by large U.S. firms to dodge taxes.  Pfizer is one of the world’s largest and most profitable drug companies, in an industry that has one of the highest profit margins worldwide.

ATF Pfizer rpt cover

Tax dodging is nothing new for Pfizer.  It hasn’t paid its full taxes in years by using a variety of business schemes.  Meanwhile, it rakes in millions in profits by charging sky-high prices for its products, which forces up health insurance rates and rips-off Medicare, Medicaid, and other government programs.  ATF recently released a report on the company titled “Pfizer’s Tax Dodging Rx: Stash Profits Offshore”, detailing a decade of nefarious tax activities by the company.

Many large corporations engage in a slew of scams to dodge U.S. taxes, and Pfizer is one of the worst offenders.  When these companies don’t pay their fair share of taxes, the federal government doesn’t have enough money to pay for vital social and health care programs that many New Yorkers rely on to get by.

However, there IS some good news!

The “Stop Corporate Inversions Act” (S.198, H.R.415) in Congress will make it hard for large profitable companies like Pfizer to desert America for offshore tax havens, and will make large U.S. subsidiaries of small foreign parent firms pay its taxes if it is still managed and controlled from within the United States.

Schumer pic

New York’s Sen. Charles Schumer can champion this bill and push it through by the end of this year IF he makes it a priority.  There is a politically-viable “tax extenders” bill that Congress is likely to take up before it recesses for this year, and this new bill could be attached to it for easier passage.  Sen. Schumer is the #3 Democratic leader in the Senate, and sits on the powerful Finance Committee. It is anticipated that he is likely to become Democratic leader in the Senate in 2017, and depending on how the 2016 elections go, will either be the chamber’s majority or minority leader.

NBGB is the local organizing affiliate of the statewide Restore the American Promise (RAP) campaign.  NBGB, RAP, and ATF are together urging New Yorkers to contact both Senators Schumer and Gillibrand and their local members of Congress about the Stop Corporate Inversions Act within the next week.  Congress is aiming for a December 11th recess, although it’s possible the may not finish up all their work for 2015 until sometime during the following week.  In any case, there’s not much time.

Pfizer’s merger will not be completed until approved by the company’s stockholders at their annual meeting in the spring, so if this bill is enacted before then, it will make the firm’s proposed inversion much more difficult, if not impossible.  Last year, drugstore chain Walgreens proposed an inversion, but it was stopped after much public outcry, so it is possible to stop them.

New York Universal Health Care Advocates to Gather for Annual “Health Care Justice Leadership Awards” Gala

On Tuesday evening, December 8th, health care activists and advocates from across the New York City region will come together for this year’s Health Care Justice Leadership Awards. The event recognizes the exemplary efforts of selected individuals and groups in three key areas of politics, trade unionism, and community activism. The event will be held at District Council 1707 of AFSCME, located at 420 West 45th Street in Manhattan.

20th Anniversary Champagne Toast

This year’s distinguished honorees are:

Official Portrait

U.S. Senator Kirsten Gillibrand (D-NY) for political leadership in championing renewal of the James Zagroda 9-11 Health and Compensation Act (S. 928), and the Family and Medical Leave Act (S. 768.) In addition, she has been a leader on issues of women’s health care in the military and on college campuses, and working to protect public and safety net hospitals and community health centers from funding cuts for care for the indigent and uninsured.

PSC logo

• The Retirees Chapter of the Professional Staff Congress (AFT Local 2334) for trade union leadership for their various efforts to highlight the need to protect and improve our nation’s social safety net vital to retirees and their families: Social Security, Medicare and health benefits, pensions, and general welfare. A key initiative is their Safety Net Working Group that has organized university-wide public forums, given presentations to PSC campus chapters and trade unionists and educators statewide, and published the popular education booklet, Defending the Safety Net: A Call to Action. They’ve been a key leader and resource for championing these issues within the NYC Alliance for Retired Americans, and No Bad Grand Bargain, a citywide network of activists that focus on federal budget issues as they affect social safety net and health care programs.

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• People’s Budget Coalition for Public Health for community leadership for their successful two-year campaign to secure $1 million in City Council funding for the new “Access Health NYC” initiative. Its purpose is to fund local grassroots entities that serve hard-to-reach and marginalized populations across New York City, such as racial and ethnic minorities, immigrants, LGBT people, and people with disabilities. The project’s goals is to enroll the uninsured in health insurance coverage, help them to use their coverage, and direct them to safety net providers for services.

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The keynote speaker for the gala will be Joan Malin, President and CEO of Planned Parenthood of New York City.

The gala is a fundraiser for Metro New York Health Care for All, a citywide coalition of community groups, trade unions, professional association, faith organizations, and concerned individuals that advocate for a universal health care program in New York and across America.

The event’s proceeds will support our activities for 2016, including:
Promoting the New York Health Act for a universal health care program
Improving implementation of the Affordable Care Act in New York, including expanding coverage options for all immigrants, improving provider networks, and promoting the new Essential Plan that provides very low-cost coverage for the working poor.
Advocating for improvements to existing national social insurance programs such as Medicare and Social Security that will strengthen their benefits while also saving money.
• Producing original media programming for WBAI/Pacifica radio, and local public access cable TV.
Representing health advocates on various city and state advisory bodies
• Providing leadership to various local, state, and national coalitions and groups, such as Campaign for New York Health, Medicaid Matters New York, New Yorkers for Accessible Health Coverage, No Bad Grand Bargain, Physicians for a National Health Program, Restore the American Promise, and Universal Health Care Action Network.

Groups and unions can financially support the event by either:
• Joining the Host Committee
• Placing an announcement in the commemorative journal
• Purchasing groups of tickets
Parties interested in these options can contact 646-527-6612 for further information.

The suggested contributions for individuals is $75. Donations can be made at the door, sent by mail (to: Metro NY Health Care for All, 420 W. 45th St., New York, NY 10036), or by clicking the donate button above.

NY Health Advocates & Allies Scramble to Protect Consumers as Regulators Shut Down Health Insurance Co-op “Health Republic”

ATTENTION HEALTH REPUBLIC MEMBERS in New York!

The company is closing down for business as of Nov. 30, and members’ health insurance coverage through them will end as of that date. Current Health Republic policyholders will need to enroll in a new plan by Nov. 15 in order to have coverage in place for December. This action is being taken under order of federal and state regulators because their reserve funds are inadequate to pay claims going forward.

tossed lifesaver

For information on what to do (and FAST!) and where to get help with it, here’s where to check:  http://hcfany.org/alert-health-republic-to-end-coverage-on-november-30-2015/.  Current members are urged to reach out to enrollment assistors (Navigators, Brokers, Application Counselors) for help with this effort.  Community Health Advocates (www.communityhealthadvocates.org) is the state’s largest navigator network of non-profits across the state, and a good resource.

Health Republic was a new type of insurer authorized under the Affordable Care Act: a non-profit “health insurance co-op” operated by and for its members. During Congress’ crafting of the ACA in 2009-10, it was the alternative to the concept of a “public option” health plan that conservative Democrats could live with. The co-op idea was put forward by then-Sen. Byron Dorgan (D-ND), and ended up in the bill so that Senate Democrats could secure his vote for the ACA.

Several states went ahead with setting up these co-ops, and New York’s Health Republic was by far the largest, with over 200,000 members. Its establishment was spearheaded by the Freelancers’ Union, and they initially offered among the most affordable plans on “New York State of Health”, the state’s official health insurance marketplace created under the ACA.

After the mid-term elections of 2010, as Congress crafted federal budget deals during 2011-13, they raided the ACA’s co-op fund in order to pay for other things and reduce the overall budget deficit, and also because of general hostility to the ACA. Consequently, the monies these co-ops were expecting to help them get established was drastically slashed, and many of them have since experienced financial crises and had to close. In addition, the commercial insurance industry has worked to undercut them so as to lessen competition in the new health insurance marketplaces created under the ACA.

Health Republic is not the only co-op plan to go under because of this situation. At least 8 have now closed down, stranding over 500,000 people who enrolled in them, and some others are expected to follow. That said, there are some which, so far, are doing OK and are financially stable, for example in Connecticut.

The radio and TV program “Democracy Now featured a segment on this whole situation:  http://www.democracynow.org/2015/11/3/the_co_ops_collapse_how_gop

Advocates Express Relief Over Federal Budget Deal; Health Care Programs Largely Unscathed

Earlier this week, the Obama administration and Congressional leaders from both sides of the aisle came to an overall federal budget framework covering the next 2 years (known as the “Bipartisan Budget Act” or BBA.)  While in the end it still embodies an overall approach of austerity politics, it is MUCH less bad than many had feared, and also has some good provisions.

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In sum, the on-again-off-again across-the-board budget sequester enacted as part of the Budget Control Act of 2011 (BCA) is temporarily suspended for the next 2 years, and new funding is provided to largely restore previous sequester cuts to slightly less than 2010 levels.  These cuts have seriously adversely affected a variety of “discretionary domestic” social programs such as meals-on-wheels, Head Start, etc.

Social insurance programs such as Social Security, Medicare, and Medicaid, are largely held harmless except for:

  • Modest changes to eligibility rules for Soc. Sec. disability (physician sign-off now required in all states.)
  • Closing of some loopholes around Soc. Sec. survivor and spousal benefits that are often exploited by the wealthy beneficiaries.
  • Continues current 2% provider cut under Medicare enacted under BCA.

There is also good news on the social program front:

  • The impending funding crisis for the Soc. Sec. Disability Trust Fund has been put off for 7 years until 2022.
  • The impending large Medicare Part B premium increase for certain Medicare beneficiaries has been suspended for 1 year, along with an large increase in the Part B deductible (given the fact that there will be no Soc. Sec. COLA in 2016.)

Other good news in the deal:

  • The debt ceiling is raised “cleanly” (without any “pay-fors” or other policy riders.)
  • New funding for the IRS for audits of hedge funds and the like, to yield some new revenue.

Left untouched by the deal – these will all have to be dealt with separately in the future:

  • Reauthorization of the transportation trust fund.
  • Renewal or sunsetting of certain “tax extenders” and tax breaks for various industries and special interests.
  • Renewal of increases in the Earned Income Tax Credit and Child Tax Credit that were created under the American Recovery and Reinvestment Act of 2009 (ARRA, aka stimulus package.)
  • Comprehensive tax reform, including (but not limited to) the taxing of U.S.-based corporate profits booked off-shore.

What’s next for Congress:

  • Negotiating out and finalizing the appropriation bills necessary to keep the government funded.  The current “continuing resolution” expires on Dec. 11.  (N.B.: A government shut-down is still theoretically possible.)
  • Parceling out the sequester restorations among various domestic programs (see above.)
  • Dealing with one or more of the matters left untouched (see above.)

In sum, we want to thank everyone for all your advocacy efforts on these matters that you directed toward the Obama administration, Senators Schumer and Gillibrand, and members of the NY congressional delegation.  Because of your work, the White House and Democrats stood strong, and even some Republicans joined in:

  • against major entitlement changes and funding cuts
  • against resumption of further sequester cuts (it has been suspended for FY 2014-15), and for restorations of previous sequester cuts (enacted in FY 2013-14.)
  • for a clean increase in the debt ceiling
  • for solving impending crises in Soc. Sec. disability and Medicare Part B

In the end, this deal is as much a political as a policy one, designed to get all parties past next year’s elections and over into 2017 when there will be a new President and Congress, who will then have to revisit these matters all over again, along with other important related issues.  Elections will matter!

Finally, our work is far from done as there are still important outstanding matters yet to be addressed by Congress concerning tax fairness, economic recovery and prosperity, and military spending, any of which may or may not rise to the fore sooner or later.  They, along with our core concerns over health care and social programs and austerity spending, are all of a whole.  We may have a bit of breathing room now to turn from a largely defensive posture to go on the offensive to promote proactive ideas we want to see happen in these various issues areas that make up the whole.  These ideas will help to frame the political debates for next year’s elections when we all hope that candidates who agree with and support our positions prevail.  The future of the kind of nation and society we want to see realized hangs in the balance.

For a fuller analysis of this budget deal:

http://www.cbpp.org/press/statements/greenstein-budget-deal-though-imperfect-represents-significant-accomplishment-and

http://docs.house.gov/meetings/RU/RU00/CPRT-114-RU00-D001.pdf

Addendum (Oct. 29):

While this new agreement settled many things related to health care funding, other matters to repeal portions of the Affordable Care Act and discontinue funding for Planned Parenthood via a “budget reconciliation” process continues to move forward.  The House passed such a bill last week, and the Senate is scheduled to take it up before Dec. 11, perhaps as soon as mid-November.