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  • State Update

    While Congress continues its debate on repeal and replace of the Affordable Care Act (ACA), insurers in New York State must submit their 2018 rate requests to the Department of Financial Services by May 15, 2017. Without assurances that the ACA's cost sharing subsidies would continue and at what funding levels, insurers remain skeptical about their ability to participate in the marketplace. The individual mandate is another indicator of stability and that also remains in jeopardy.

    Governor Cuomo's office recently reached out to insurers to gauge their assessment of the situation brewing in Washington, DC and the effect Washington's efforts might have on their rate setting. The rates that insurers present to the state can be approved or modified by the Department of Financial Services. Rates are finalized in the summer.

    In mid-May the Trump administration released a final insurance rule meant to stabilize the individual and small group health insurance markets. The final rule shortens the open enrollment period for the federal exchange to November 1, 2017 through December 15, 2017. The final rule includes language requiring verification of eligibility for a Special Enrollment Period and provides consumers with 30 days to provide such documentation. It also lets insurers pay a lower percentage of medical costs, effectively imposing higher out-of-pocket costs on consumers, and it allows insurers to refuse coverage to people who have not paid their premiums.

    "We remain concerned that insurance would be too expensive for low-income New Yorkers," said Stacy Villagran, who directs a state-certified Navigator Program, which is overseen by the Nassau-Suffolk Hospital Council. "With higher copays and deductibles, providers could experience more bad debt issues."


    Federal Update

    Statement on the American Health Care Act Passed by the House Kevin Dahill, President and CEO - May 9, 2017

    The revised version of the AHCA passed by the House is not sound health reform. The bill continues to decimate New York's Medicaid program, which covers six million people. The per capita Medicaid model proposed will affect everyone – not just Medicaid recipients – because a finite amount of Medicaid money to the state means cuts in services and eligibility restrictions. Those with commercial insurance will end up paying higher premiums, as providers look to close gaps left by Medicaid shortfalls. About 70 percent of Medicaid spending in our state covers care for the elderly and disabled, including children. These people will still need care. And even more disheartening is the amendment to cut $2.3 billion in Medicaid funding by shifting the cost burden from the counties to the state. This amendment was advanced by New York Congressmen Faso and Collins and it leaves a huge hole in New York's budget. The House bill brings us back to pre-ACA days, when insurers could charge those with pre-existing conditions more and it allows insurers to charge up to five times more for older Americans. Access to insurance is meaningless if premiums are unaffordable and the coverage is not comprehensive.

    The combined advocacy interests of the Nassau-Suffolk Hospital Council, representing hospitals on Long Island, and the Northern Metropolitan Hospital Association, representing hospitals in the Hudson Valley, are advanced by the Suburban Hospital Alliance of New York State, LLC.