Author Archives: metrohealth_editor

Congress Begins to Attack Health Care Programs, and New Yorkers Mobilize to Fight Back

If you’ve been following the news out of Washington, DC lately, you know that health care is under attack.  Congress is rushing to repeal the Affordable Care Act and end funding for family planning services.  However, these moves are only the first wave, with more to come later this spring that will affect Medicare, Medicaid, the Children’s Health Insurance Program, and employer coverage.

It’s a wild ride so far and will only intensify.  Everyone’s health care coverage is at risk, no matter what kind you have.  Just looking at the ACA repeal (with NO replacement, so far) alone, 2.7 million New Yorkers will lose their coverage, including 1.6 million here in New York City.

fists-raised-in air

It’s all-hands-on-deck, big time!

Fortunately, lots of groups of forces are starting to mobilize and fight back, and we here at Metro are at the center of many of these efforts and events.  The national Health Care for America Now (HCAN) campaign that functioned during the 2009-10 health care reform fight is back, and will be focusing on all the current and upcoming fights.  HCAN action coalitions are forming across New York State, and we are leading the effort here in NYC.  Staten Island and southwest Brooklyn is a particular focus, among others.

How to keep on top of it all?  

We urge you to keep checking our website calendar, action alert page, and blog.  There’s new events and developments happening almost every day.  Additionally, as you hear of activities or plan some yourself, please let us know of them so that we can list them to inform others.

You can also follow us on Facebook.  We post things many things there (particularly timely news stories), and you can easily share out items from there to your own social media networks.

Why is the health care fight back is SO important?

Of course, health care is not the only issue that New Yorkers and those who care about social justice are worried about.  Many really bad ideas are in the works coming out of the new Congress and incoming Trump administration, so we all have to have each others’ backs if we’re going to succeed.  We cannot just stay in our own silos and have parochial perspectives.  We will all lose if that happens.

That said, health care just happens to be the first thing out of the gate.  If we can successfully beat back what Congress wants to do on that front, or at the very least throw sand in the gears of the legislative process, that will slow or stop EVERYTHING ELSE that’s lined up right behind it.  By focusing NOW on the ACA and women’s health care fights, we pushback on what’s coming next on a whole variety of health care, social, and economic issues.

What to do?  “Think global, act local.”  

First and foremost, keep contacting your member of Congress about your views on whatever is happening, including our two Senators:  Charles Schumer and Kirsten Gillibrand.  Put them on your speed dial.  Many of them are very supportive of health care, and are fighting hard against the coming onslaught.  It is very important that we support them, and that any damage coming out of any setbacks is minimal.  For those lawmakers who don’t support health care programs, we must hold them accountable for their positions and votes, and inform their constituents of what they are doing.

While all these fights right now are defensive ones, we all know that what we truly need is a universal health care program here in the U.S. and New York.  By fighting to preserve and improve the health care gains that we have made over the last 50 years, we will gain the political momentum to push forward toward that broader, ultimate goal.  If we lose on these current fights, we will be badly set back.

Thanks, as always, for all you do to fight for health care for all and health care justice.  We look forward to partnering with your community organization, trade union, professional association, and faith congregation in the days, weeks, and months ahead.  Onward!

A Post-Election Open Letter: The New Fight for Health Care Justice

It’s been a very busy time for health care justice advocates and activists since Election Day.  The results present us with a very different and much more challenging political and policymaking landscape than we had anticipated.  Meetings and conference calls have been numerous in recent days as we try to assess our new environment and brainstorm contingencies and options.  At the same time, many of us are very fearful for the future of a humane society and our fundamental democracy.  Nevertheless, we’re lifted up and inspired by the tried-and-true adage, “Don’t mourn, organize.”

Multiracial Hands Making a Circle

What we now know for sure is that we really are “all in this together” across the broad social justice spectrum, both in terms of what’s at stake, and how we must respond.  To both protect our current health care and coverage system (imperfect as it is) and advance toward a more just one we’ve long sought, we cannot function solely in our own silos.  We must link up with others and support them as we also rely on support from them.  We must become much more strategic, and utilize a broad range of tactics that complement each other, not necessarily in lock-step but in respectful solidarity.

It is still early days, and we have a lot to share with and learn from each other as we forge our plans.  Yet given the urgency of the coming mere weeks ahead, we will likely have to build our plane while we are flying it.  It won’t be easy, but we dare say we’ve done it before, and we can do it again.  It will require putting our shoulders to our wheel while linking arms with each other.

With all that in mind, in the days ahead we will be reaching out to you, our partners here in Metro, to share what we know, and to hear from you.  We welcome opportunities to meet with you, so please reach out to us about that …and we’ll also be contacting you.  We also seek to join with others who are jointly mobilizing for the new era, to particularly be a resource on health care issues, so please feel free to call on us.


We are expecting a broad and aggressive attack on health care programs fairly soon in the coming new year.  Everything will be in the bullseye:  Affordable Care Act, women’s health care, children’s health insurance, Medicare, Medicaid, and various aspects of employer-sponsored coverage.

We will be calling on and supporting our champions to stand strong.  We will confront those who move to rollback these programs.  We will be reaching out to help the media understand what’s at stake.  We will be creating our own media (traditional and new.)  We’ll be helping the public and various constituencies understand the options and consequences of various decisions, and how they can assert their needs.  We’ll be building and leading coalition efforts to bring various forces together synergistically.  We will be planning convenings to share information and strategize collectively about what can be done here in New York to protect and improve health care.

We’ve got our work cut out of us.  Our upcoming annual gala on Thursday evening December 8th is an opportunity to gather up some needed financial resources for the fight ahead, and we hope you will attend and support it generously.  However, it will take more than money for us to succeed in the coming days, weeks, months, and years.  It will also take active participation and engagement with each other, each playing our own role and making our unique contributions.  Our whole WILL be greater than the sum of its parts.


We look forward to continuing to work with each and every one of you in the fight for health care justice here in New York and across the U.S.  Here we go — let’s do it!

2016 Election Results Threaten Health Care for Millions of New Yorkers

Our next President and Congress are coming after our health care …BIG TIME.

Whether you and/or your kids get your coverage through Medicare, Medicaid, Child Health Plus, or an Affordable Care Act plan, they’re ALL in the cross-hairs now.  Employer coverage may also be further dumbed down so that you end up in a high-deductible plan with a measly health savings account. (And that’s not even mentioning what they’ve got in mind for Social Security.)


We all have our work cut out for us for the next four years on many social justice issues, and health care will be one of the major ones and one of the first things out of the Washington chute in 2017.  It’s all hands on deck time!

….Which is why we need your support of our upcoming annual gala.  We’ve got to step-up our game to a whole new level – the status quo and same-old, same-old won’t cut it.  We’ll be working with our union and community partners to form a united and powerful fight back, and your generous contributions will make that possible.

Individuals can support our Gala by attending and making a contribution. The suggested donation is $75, but everyone is welcome, whatever you give.  If you can’t attend, we’ll miss you, but will still welcome your contribution!  You can make your contribution by using the donate button here or at the door.

Your organization or union can also support our 2016 Annual Gala by:
• Joining our Host Committee
• Placing an announcement in our Commemorative Journal
• Reserving a group of tickets (at discount)
Please contact us about these methods of support.

Our gala will be held on Thursday evening, December 8th, in the auditorium at District Council 1707 AFSCME, located at 420 West 45th Street in Manhattan.  We’re very excited that our honorees this year will be:
• New York State Assembly Speaker Carl Heastie, for political leadership.
• Communications Workers of America, Local 1102, for trade union leadership.
• New York Paid Leave Insurance Campaign, for community leadership.

Our keynote speaker will be Althea Maybank, MD, Deputy Commissioner for the NYC Department of Health and Mental Hygiene, and Director of its Center for Health Equity.

Looking forward to meeting you then!


NYC Universal Health Care Advocates to Gather and Celebrate Health Care Justice Leaders

You’re invited!

At our Leaders for Health Care Justice Annual Gala, our members, supporters, and friends gather to look back over and celebrate our accomplishments of the year, and commit ourselves to the work of the year ahead …all over some good food and drink.

20th Anniversary Champagne Toast

We will also recognize some worthy groups and individuals who have advanced the cause of health care justice and universal health care.  We’re very excited that our honorees this year will be:


  • New York State Assembly Speaker Carl Heastie, for political leadership – Several major long-stalled health care proposals have moved forward under his leadership, including the New York Health Act, Safe Staffing for Quality Care Act, enhanced funding for safety net hospitals, and paid family leave.


  • Communications Workers of America, Local 1102, for trade union leadership – For the past eight years, they have provided leadership on Staten Island to bring together local trade unions and community advocates to engage their local Congressmembers, media, and the public on issues related to health care reform, and protecting and improving federal vital health care and social safety net programs like Medicare, Medicaid, Social Security, Child Health Insurance, SNAP/food stamps, etc.


  • New York Paid Leave Insurance Campaign, for community leadership – For nearly two decades, they have brought together a variety of forces across the state to advocate for a state-based paid family leave program, so that family members can provide care to loved ones without fear of losing their job or a loss of income. Their goal was achieved earlier this year, and soon New York will become the fourth state to have one, and it will be the most robust in the nation.


Our keynote speaker will be Althea Maybank, MD, Deputy Commissioner for the NYC Department of Health and Mental Hygiene, and Director of its Center for Health Equity.  She will inform us of her Center’s important work to address racial and ethnic disparities in health and health care and how we can support it, and connect the struggle for health equity to that of universal health care.



Our gala will be held on Thursday evening, December 8th, in the auditorium at District Council 1707 AFSCME, located at 420 West 45th Street in Manhattan.

You can support our Gala by attending and making a contribution.  The suggested donation is $75, but everyone is welcome, whatever you can give (more if you can, less if you can’t.)  Just use the donate button here on our website to make your donation, and we’ll reserve you a ticket at the door.  (If you can’t make it, we’ll still welcome your contribution!)


Your organization or union can also support our 2015 Annual Gala by:

  • Joining our Host Committee.
  • Placing an announcement in our Commemorative Journal.
  • Reserving a group of tickets (at discount.)


Contact our office (646-527-6612) for information on these group contribution options.


2017 will present us all with new opportunities and challenges under a new President and Congress, as well as a possible new balance of power in Albany.  Your financial support of our gala will provide us the resources needed to continue our mission of fostering community and labor collaboration toward our shared goal of universal health care and health care justice.


See you then!

Advocates and Allies Organize Regional ACA Summits Across New York in Advance of Upcoming Open Enrollment Period

The latest reports from the New York State Dept. of Health indicate that approximately 3 million New Yorkers have enrolled in health coverage since our state’s new health benefits exchange marketplace, branded “New York State of Health”, opened four years ago.  Thanks to the Affordable Care Act (ACA), the state’s insurance rate is now below 5%.  That’s a tremendous achievement!


However, approximately 1 million state residents remain uninsured, and they are the hardest to reach, often living in the shadows and on the edges of our economy and society.  Many of them can enroll in public programs at any time if they have incomes less than 200% of the federal poverty level (about $24,000/year or $2,000/month.)  For those above that amount, they have to wait for “annual open enrollment periods” for uninsured people to choose a private health insurance plan.  The good news is that the next one starts next month and runs through the end of January, so now is the time to get ready to act.

To help gear up for this period, members of Health Care for All New York, one of our state’s major consumer health advocacy coalitions, have joined forces again with the Healthcare Education Project, a joint program of 1199SEIU United Healthcare Workers East and the Greater New York Hospital Association, to organize another round of annual Outreach and Enrollment Summits across the state.  Since 2013, these events typically bring together of variety of stakeholders to get updates from state officials, hear from experts on outreach, enrollment, and post-enrollment issues, and talk among themselves about best practices and explore possible collaborations.

The particular focus of this year’s summits is on enrolling the hard-to-reach still-uninsured, and helping people with post-enrollment problems, including how best to use their coverage to stay healthy and connected to primary and preventive care so they can avoid relying on hospital emergency rooms.

There are 8 summits happening across New York, including 5 here in the greater New York City area:


  • Brooklyn-Queens – Wed. Oct. 5th, from 9:30 a.m. to 1 p.m., at the Jamaica Performing Arts Center, located at 153-10 Jamaica Ave. in Jamaica, Queens. Info and RSVPs at 917-593-0032.


  • Staten Island – Fri. Oct. 14th, 9:30 a.m. to 1 p.m., at Project Hospitality, 514 Bay St. on Staten Island. Info and RSVPs at 917-543-3200.


  • Long Island – Mon. Oct. 17, 9:30 a.m. to 1 p.m., at 1199SEIU, 100 Duffy Avenue, Suite 300 West, 3rd floor, in Hicksville. Info and RSVPs at 516-418-0725




Advocates, enrollers, health care and social service providers, brokers, small business owners, and insurance professionals are all invited to attend.  We’re proud to be playing a leadership role for the Bronx-Manhattan and Hudson Valley summits, and a supportive one for the Brooklyn-Queens and Staten Island ones.  Looking forward to seeing you at one of them!

Our 2016 Dues Campaign Heads into the Home Stretch

As we all turn to the final month of the summer season, we want to follow-up with everyone about your support for our annual dues campaign, launched late last spring.  (You should have received a letter about it, but if not, please send us your address for future mailings.)  We want to wrap it all up by Labor Day, so now is the time to make your contribution, if you’ve not already done so.


We want to thank the following for joining the “Health Care for All Team” for 2016 (to date):

Organizations and Unions:

  • Alliance for a Greater New York (ALIGN)
  • Associated Musicians of Greater NY, Local 802 AFM
  • Citizen Action of New York
  • Committee of Interns and Residents, SEIU Healthcare
  • Communications Workers of America, Local 1180
  • Community Health Care Association of New York
  • Community Service Society of New York
  • District Council 37 Retirees Association
  • Doctors’ Council, SEIU Healthcare
  • GuildNet/Lighthouse Guild
  • International Cinematographers Guild, Local 600, IATSE
  • Make the Road New York
  • Municipal Hospital Workers, Local 410, DC 37, AFSCME
  • New York City Americans for Democratic Action
  • New York City Central Labor Council
  • New York Immigration Coalition
  • New York Professional Nurses Union
  • New York State Nurses Association
  • Primary Care Development Corp.
  • Physicians for a National Health Program, New York Metro Chapter
  • Planned Parenthood of New York City
  • Public Health Solutions


  • Richard Bergman
  • Carmelita Blake
  • Anne Bove
  • Lou and Sara Levitt
  • Jose Matta
  • Cheryl Merzel, MD
  • Ralph Palladino
  • Alec Pruchnicki, MD
  • Te Revesz
  • Jerry Shroder

While we’re pleased with our organizational support, donations from individuals are low so far compared to previous years, so we want to challenge you to help us make our goal so that we can keep our budget in balance.  If you donate here online, you can even make it a “monthly sustainer” contribution!

Here’s how you can make your personal contribution:

  • Send a check (see our address here)
  • Make an online donation by using the donate button to the right on this page.

Contributions from individuals are welcome at the following levels:

  • $100 — giving member
  • $75 — basic member
  • $35 — low-income member
  • $_____ (other)

We also welcome contributions from groups and unions at the following levels:

  • $500 – large groups
  • $250 – medium-sized groups
  • $150 – small groups
  • $_____ (other)

Your support for our 2016 dues campaign will enable us to continue to:

Thank you for your donations, and for all you do to fight for health care justice in New York and across the U.S.  Best wishes on the rest of your summer!

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.


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.


Full document:

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.

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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!