The Public Policy and Education Fund (PPEF) addresses critical social, economic, racial and environmental issues facing low and moderate income New Yorkers. PPEF does the majority of its state health care advocacy work through Health Care for All New York (HCFANY), a statewide coalition of over 170 groups dedicated to achieving quality, affordable health coverage for all New Yorkers.  PPEF serves on the HCFANY steering committee.

Increasing Funding for Community Health Advocates and the Navigator Program

PPEF and HCFANY have consistently advocated in recent years for increased state funding for Community Health Advocates (CHA), a statewide network of local community based organizations that is supported by a central, toll-free hotline. CHA provides advice and assistance to consumers on how to understand, use and keep their health insurance. Since 2010, CHA has served more than 300,000 New Yorkers, saving them over $27 million. In addition, in 2018, PPEF and HCFANY fought for adequate state funding for the Navigator Program, established under the Affordable Care Act (ACA) to provide free, unbiased in-person assistance to consumers seeking to enroll in the New York State of Health Marketplace.  Since 2013, navigators have helped to enroll more than 300,000 consumers, disproportionately people of color.

Protecting Safety Net Hospitals

New York State annually distributes about $3.6 billion in federal, state and local Disproportionate Share Hospital (DSH) funding to support care of the uninsured. New York safety net hospitals provide a disproportionate share of the care provided to the uninsured, Medicaid recipients and other vulnerable patients.  Yet, the state provides DSH funding to virtually all hospitals, rather than restricting it to safety-net hospitals, as in other states. In addition to its federal advocacy to protect DSH funding, PPEF and HCFANY have taken a number of steps in recent years to protect funding for New York City Health + Hospitals and other safety net providers, including: 1) opposing a further extension in 2018 of 2012 legislation giving hospitals further time to transition to a system that would better target the over a billion dollars in annual Indigent Care Pool funding to hospitals serving low income people and the insured; 2) supporting a reallocation of state funding to provide enhanced reimbursement for safety net hospitals; and 3) supporting the Enhanced Safety Net Hospital Reimbursement legislation (vetoed by the Governor in 2016) to ensure adequate funding for hospitals that, among other things, adequately serve those enrolled in Medicaid and the uninsured.

Immigrant and Refugee Coverage

PPEF and HCFANY support health coverage for all New Yorkers, regardless of immigration status. Our major current proposal is to expand New York’s model Child Health Plus (CHP) program to cover immigrants from the age of 19, as at present to 29, thus reducing the number of insured, and stabilizing the finances of the safety net providers that service them; it is estimated the cost in 2018 would be $83 million.  We also support the creation of program modelled on the Essential Plan to cover New Yorkers making up to 200% of the Federal Poverty Level (FPL) who are at risk of losing their Temporary Protected Status (TPS) and therefore health insurance eligibility. TPS is a designation for nationals of countries experiencing humanitarian crises such as violent conflict, environmental disasters and epidemics.

Ensuring Network Adequacy and Guaranteeing Access to Out-of-Network Coverage

HCFANY and PPEF support additional measures to ensure that consumers have access to adequate provider networks that meet their needs. For example, at present consumers must remain in the same qualified health plan (QHP) even if their doctor leaves or is dropped from the QHP’s network. We support requiring insurance plans and providers to maintain their contract relationships for an entire plan year, except for cause. PPEF is also part of a task force of consumer organizations that are conducting listening sessions with consumers and preparing recommendations to improve network adequacy protections. HCFANY and PPEF also support ensuring that all New Yorkers who enroll in the New York State of Health Marketplace have access to out-of-network coverage for an additional affordable amount.

Protecting Health Insurance Affordability and Quality

A bedrock principle of HCFANY and PPEF is ensuring that health coverage in New York State is affordable for all consumers and that the quality of care provided to consumers is strengthened. This includes not only health insurance premiums, but out-of-pocket costs, which are a disincentive for people of limited means to use their health coverage. Among the steps we took in this area in 2018 are: 1) opposing proposals to increase premiums or cost-sharing for Essential Plan enrollees; 2) recommending a state-funding subsidy to reduce deductibles for those between 200% and 250% of FPL who purchase silver plans through the New York State of Health Marketplace; and 3) and opposing proposals to charge Medicaid beneficiaries higher co-pays for over-the-counter prescription drugs. Further, we annually participate in Department of Financial Services proceedings in opposition to unreasonable rate increase proposals by health insurers for the individual and small group markets. Finally, PPEF, HCFANY and allies like the Medicaid Matters coalition and Consumers Union are jointly raising concerns in regard to the proposed acquisition of the nonprofit Fidelis Care health plan by the Centene Corporation, a national for-profit insurance company, including: 1) ensuring that Fidelis’ health care assets are protected for the public’s benefit, including expanding coverage and care for the medically underserved; 2) maintaining quality for affected consumers; and 3) ensuring that shortfalls are not created as a result of the transaction, particularly for Medicaid and other public health programs.