Following up on our two previous blog posts of this week, we want to now close out this series with our thoughts about two other major areas of our work ahead for 2023:

Improving access to hospital care, hospital-community relations, and supporting safety net hospitals:

A cluster of issues centering around hospitals is increasingly coming to the fore for advocates and lawmakers, and will likely be prominent in this year’s New York legislative session. Ideas that we and our fellow advocates will be pushing include:

• Providing relief to patients with hospital medical debt they simply cannot pay.
• Updating and streamlining hospital financial assistance programs for low and moderate-income patients.
• Taking action to curb and lower skyrocketing hospital prices that saddle patients with bills they cannot pay, and that threaten the financial viability of union and employer health benefit programs.
• Revamping the distribution of State indigent care funds to prioritize safety net hospitals.
• Increasing Medicaid reimbursement rates for safety net hospitals.
• Strengthening government oversight of large hospital systems as they continue to build-out and consolidate, with an emphasis on addressing the needs and concerns of affected local communities, particularly with regard to health equity.
• Increasing community representation on government oversight bodies.
• Creating mechanisms to foster accountability of hospitals to their local communities.
• Accurately and robustly assessing if and how non-profit hospitals are meeting their charitable and community-serving missions as required under law.
• Requiring hospitals to disclose what services they don’t offer based on non-medical reasons.

In addition, at the federal level consumer advocates will be urging Congress and the Biden administration to:

• Begin asserting anti-trust concerns with regard to hospital consolidation, and its impact on price increases and access to comprehensive care in local communities.
• Hold non-profit hospitals and hospital networks (who benefit from billions of dollars in tax breaks as legal “charities”) accountable for the community needs assessments and benefit programs they are required to provide under law.
• Look into the adverse effects of private equity investors on for-profit hospitals, nursing homes, and medical practices, and broader regional health care markets.

Lowering Rx drug prices and costs:

Advocates and our congressional champions successfully took on and prevailed over Big Pharma during the Build Back Better debate of the past two years which resulted in the new Inflation Reduction Act (IRA) law. For the first time ever, the federal government will start negotiating lower prices with drug corporations for people on Medicare. Already starting this week, people on Medicare now get free vaccines and pay only $35 per month for insulin, and drug corporations pay large tax penalties if they raise their prices higher than the rate of general inflation.

However, the IRA was but a first step of what needs to be done to lower drug prices for everyone else. Most of the IRA’s provisions were limited to helping people on Medicare, and that law now needs to be expanded into the realm of private insurance so that everyone can benefit.

We will also be pushing Congress to regulate pharmacy benefit managers (PBMs), companies that serve as brokers between drug corporations and insurance companies. They purportedly looking out for the interests of patients with regard to lowering prices and out-of-pocket costs, and maximizing access to as many drugs as possible on their formulary lists. However, the reality is that PBMs are complete black boxes, and many believe they just leverage their broker role to generate outsize profits for investors, and patients’ concerns are secondary at best. Three of them control 80% of the market, and they all have sweetheart relationships with insurers.

Finally, Congress must also overhaul our entire Rx drug patent system that has been totally dominated by the industry for years. Drug corporations have learned to successfully manipulate it to keep maximizing their price-gouging and profiteering by extending their patents far beyond what is reasonable. As a result, many patients cannot afford the drugs they need, and low-cost generics are prevented from coming onto the market for many years.

We can do it!

Our list for 2023 is long and ambitious. By bringing community and labor together across New York, we can make progress step-by-step, year-by-year, as we’ve done since our founding 30 years ago. YOU make that happen with your participation and support, and we value you on our team!

Best wishes for all of us for 2023!

We have been busily working with our partners in various coalition groupings since the midterm elections to finalize our shared policy and legislative goals for the year ahead. Two days ago, a new congressional session began down in Washington DC (at least on the Senate side), and yesterday a new state legislative session got underway up in Albany. We’re off to the races!

No bills of any sort have yet been introduced in Congress or the State Legislature, so we can’t yet speak about any specific ones. Nevertheless, here’s how we’re starting things out as of this moment in early January as we focus on health insurance issues. (Other issues to be discussed in our next email, focusing on hospitals and Rx drugs.)

Universal health care:

At the national level, we will continue to support Medicare-for-All proposals in Congress, and other ideas that build on Medicare and other existing public programs. We will take a similar approach here in New York, to support comprehensive proposals as well as step-by-step ones. For us, it’s not an either-or approach but a both-and one. It’s all good!

Expanding and improving health insurance coverage:

National:  Over the past two years, ideas to improve and expand Medicare have gained traction, including adding dental, hearing, and vision coverage, capping total out-of-pocket costs for hospital and medical coverage (like what was just done for drug coverage within the new Inflation Reduction Act law.), and leveling the playing field between Traditional Medicare and private Medicare plans (aka “Medicare Advantage”) by ending overpayments to private insurers.

New York: Historically we have been a “leader state” when it comes to health care programs (compared to many other states), and we should be proud of that. Currently, over 40% of our state’s population is enrolled in a public insurance program. Nevertheless, approximately 1 million people still remain uninsured, and there are some things we can do in the immediate term to help them, such as:

• Expanding public health insurance programs to all low-income immigrants regardless of legal status issues (aka “Coverage for All”)
• Creating a robust community-based outreach programs to seek out and enroll people who lack coverage.
• Providing continuous Medicaid coverage for all young children in low-income families, from birth to age 3 (aka “First Thousand Days”)

In addition to getting coverage in place for people, a parallel concern is the quality of the coverage they get.  The federal Affordable Care Act (ACA) sets comprehensive benefit standards for health coverage.  However, the ACA leaves the matter of standards for provider networks and drug formularies up to states to set and enforce.  Here in New York, our network adequacy standards have not been updated in a few decades. In addition, insurers are allowed to change their provider and Rx drug lists at will at any time even though people enrolled in a health plan are stuck in it for a whole year. These problems can be addressed by the State for the types of health insurance that it has jurisdiction over, either in legislation or regulation.

Expanding consumer and patients’ rights and protections for New Yorkers:

• Updating hospital financial assistance programs to better serve low and moderate-income patients.
• Preventing or limiting unpaid medical debt issues from adversely affecting people’s credit reports.
• Providing cost-of-living increases to state-funded, community-based consumer assistance programs that help people a) learn about and enroll in health coverage, and b) address problems that arise when using their coverage or seeking care health care providers.

In addition to our own ideas above, there will others that we will need to respond to pro or con, proposals that other stakeholders and lawmakers will put on the table.

Working with our allies and partners, and with your participation and support, we are confident that we can succeed on several or more of the above ideas and goals for this year. We look forward to continuing our successful partnership for this new year!

2022 was another busy year for us as in our quest for health care justice and universal health care. We thank everyone who helped make our achievements possible with your participation and support, even if it was only financial.  All in all, we couldn’t do it all without you! We want to provide a recap of what we worked on and helped to accomplish during 2022 in partnership with our advocate colleagues.

Here’s some highlights:

Improving access to public health insurance coverage (as part of the FY 2022-23 NY State Budget enacted in the early Spring):

Improving access to public health insurance coverage (as part of the FY 2022-23 NY State Budget enacted in the early Spring):

• The Medicaid income eligibility level for low-income seniors and people with disabilities is raised to be comparable to that for all other low-income people and households who qualify for Medicaid.
• Pending approval by the federal government, Essential Plan income eligibility level is raised to 250% of the Federal Poverty Level (FPL) (a number that varies based on household size and composition.)
• Medicaid eligibility is opened up to all immigrants over age 65 regardless of immigration status.
• Medicaid coverage for low-income women who’ve given birth is expanded to a full year post-partum, regardless of immigration status.
• Allowable Medicaid financial asset levels for low-income people on Medicare are raised to $28,000+ (individuals) and nearly $39,000 (couples).
• Income eligibility levels for Medicare Saving Programs (MSPs) are raised for low-income people up to 186% FPL.  (MSPs help low-income people on Medicare who do not also qualify for Medicaid to pay for their Medicare premiums, deductibles, and co-pays.)
• Financial asset tests for MSPs are eliminated.
• Nominal $9 per child per month premiums for Child Health Plus are eliminated for lower-income families.

Curbing medical debt in New York (stand-alone bills enacted in the late Spring):

• Prohibiting health care providers from seeking wage garnishments and liens on primary residences when suing patients with outstanding medical bills.
• Requiring health care providers to inform patients in advance of any facility fee they may be charged.
• Prohibiting health care providers from charging “facility fees” for preventive health services.

Improving Rx drug and health insurance affordability (as part of the new federal “Inflation Reduction Act”, enacted during the Summer):

• Free vaccines for people for on Medicare (started on Jan. 1, 2023.)
• $35/mo. co-pay cap for insulin prescriptions (started on Jan. 1, 2023.)
• Capping annual Rx drug price increases to the general rate of inflation (started on Jan. 1, 2023.)  (Historically, these prices have gone up much faster each year, which compound over time.)
• Eliminating the income cap to be eligible for premium subsidies for Affordable Care Act health insurance plans available on government online marketplaces (available for 2023.)
• Increasing the amount of premium subsidies for people who purchase health insurance plans available on government online marketplaces (available for 2023.)
• Eliminates the 5% co-pay rate for Rx drugs covered during the Medicare Part D catastrophic phase (starts in 2024.)
• Raises the income eligibility level for Medicare Part D “Extra Help” benefits up to 150% FPL (starts in 2024.)
• Limits annual premium increases for Medicare Part D to 6% (starts in 2024.)
• Caps total out-of-pocket costs for Rx drugs covered by Medicare Part D to $2,000 per year (starts in 2025.)
• New negotiated Rx drug prices go into effect for people on Medicare (starts in 2026.)

The midterm elections (during the Fall):

While we do not endorse candidates nor tell people who to vote for, during election seasons we do help people and media outlets understand:

• candidates’ positions and records on health care issues.
• the ins-and-outs of the salient health care issues that are being debated.
• “what’s at stake” in an election for health issues going forward.

…so that people can make informed decisions when they go to the polls.

Whew! How did we do all this?

At the state level, with our partners in Health Care for All New York and Medicaid Matters New York, both statewide coalitions that advocate for the needs and concerns of patients and consumers.

At the federal level, with our partners in the Health Care for America, Now New York State Network, a statewide coalition we coordinate that is part of a national multi-constituency coalition.

It is a truism in social justice work that passing a policy goal into law is only the first step.  Then comes making sure the new law gets properly implemented.  In addition, there’s informing directly-affected people, the general public, community leaders, and media professionals about the new law.  Finally, since any particular law rarely solves a problem fully, there’s always planning for “what’s next?”, to continue to striving toward the goal and carry the work forward step-by-step. Throughout, it’s always important to celebrate our victories, recognize and appreciate those who contribute to our successes, evaluate lessons learned, and recalibrate as we keep pushing ahead.

Again, many thanks to everyone who helped make all this happen with us– we couldn’t have done it without YOU!

Best wishes to all for the year ahead,