Empowering Health Care Consumers

Grantee Name

Community Service Society of New York

Funding Area

Empowering Health Care Consumers

Publication Date

February 2019

Grant Amount

$250,000

Grant Date:

2016-2019

New York State has made substantial progress in covering the uninsured since the passage of the Affordable Care Act in 2010. However, many consumers still lack the tools to make important quality and cost decisions and remain unaware of or unable to engage in State- and industry-led efforts on health policymaking. Although key constituencies, such as insurers, hospitals, and the business community have well-financed associations that organize and present their views, consumers’ perspectives are usually not as well organized or represented. Health Care for All New York (HCFANY) is a coalition of organizations advocating for high-quality and comprehensive health coverage. As the State’s leading consumer advocacy coalition, it both educates the public and represents the consumer perspective as it works to bring affordable, high-quality health care to all New Yorkers.

In 2016, NYSHealth awarded a grant to Community Service Society of New York, a co-founder of HCFANY and a current member of its steering committee, to support HCFANY in further engaging consumers in efforts to improve the quality and value of health care purchased in New York.

Outcomes and Lessons Learned

Outcomes and Lessons Learned:

  • Created consumer education materials and conducted consumer engagement presentations, including an issue brief on understanding health system transformation and why consumers should get involved, a fact sheet on transgender health care, and guides on health insurance rate reviews for 2018 and 2019.
  • Testified at a New York State Assembly public hearing on the State’s Health/Medicaid 2018–19 budget regarding the funding allocation formula through which New York State hospitals receive indigent care pool (ICP) funds, which compensate hospitals for care provided to patients who are unable to pay. HCFANY made recommendations on how the current ICP funding methodology should be recalibrated to more equitably support safety-net hospitals that treat the neediest patients.
  • Participated in New York State’s health insurance rate review prior approval process, whereby health insurance premium adjustments are requested by health insurers, to ensure that proposed rates are fair and appropriate:
    • Analyzed rate proposals from 15 health insurers through the consumer perspective.
    • Retained Jay Angoff, former Director of the Center for Consumer Information and Insurance Oversight and former Superintendent of Insurance for Missouri, to perform detailed rate submission analyses.
    • Submitted comments to the Department of Financial Services (DFS), which oversees the prior approval process, on rate requests by all health insurers in New York State
    • Created a template for consumers to tell their stories directly to regulators.
  • Advocated for New York State to build on its landmark surprise bill law to ensure that consumers are not held responsible for out-of-network bills as a result of provider or plan misinformation given to them.
  • Successfully advocated for DFS to hold a public hearing on the merger of two major health insurance carriers in New York State, Anthem and Cigna, and then against the merger. In February 2017 a federal judge ruled against the merger, citing harm to consumers. Anthem terminated its merger agreement with Cigna in May 2017.

Despite a complicated federal health care landscape, HCFANY made great strides in empowering New York consumers in the areas of improving health system transparency, maintaining an active consumer voice in informing public policy, and securing consumer protections. As a result, these efforts have helped bring the patient voice into the health policy conversation at the federal and State levels.

In response to HCFANY’s testimony regarding ICP hospital compensation, the final State 2018–19 budget established a workgroup to review the ICP funds distribution. The 22-member workgroup, made up of representatives from hospitals, unions, insurers, and consumer advocacy organizations, met four times before submitting its findings in December 2018. Although the workgroup did not reach consensus on an exact distribution methodology, it advocated that any changes must consider the interest of patients and their access to health care services.

In February 2019, Governor Cuomo set a cap on how much charity-care funding profitable downstate hospitals can receive. Facilities in New York City, Long Island, and Westchester that earn—or are part of a system that earns—at least $68 million in operating income or have an operating margin of at least 2.98% would be capped at $10,000 in indigent care payments.

Co-Funding and Additional Funds Leveraged: Co-funding for this project was provided by the Robert Wood Johnson Foundation ($300,000) and Atlantic Philanthropies ($165,000).