Advancing Primary Care

Grantee Name

Schuyler Center for Analysis and Advocacy, Inc./SCAA Fiscal Sponsor for Health Care for All New York

Funding Area

Advancing Primary Care

Publication Date

May 2018

Grant Amount

$150,000

Grant Date:

January 2015–March 2016

Under the Affordable Care Act, New York State has made significant progress toward closing the coverage gap by enrolling more than 1.5 million consumers in quality, affordable health insurance. Still, those with insurance often face a health care system that can feel opaque and unaccountable to their needs.

Further, certain groups, like many undocumented immigrants, are not eligible for the existing coverage options. Since 2008, Health Care for All New York (HCFANY), a coalition of more than 160 groups, has secured numerous policy victories to ensure that New York State has some of the nation’s strongest insurance protections and a robust health insurance marketplace for consumers. NYSHealth awarded HCFANY a grant to further support strong insurance protection for consumers; promote and expand coverage options so that uninsured New Yorkers can access quality, affordable health care; and promote payment and delivery system reform.

Grant funds were distributed to the Schuyler Center for Analysis and Advocacy (HCFANY’s fiscal sponsor), the Community Service Society of New York (a HCFANY co-founder), and to seven HCFANY member organizations: Children’s Defense Fund of New York, Make the Road New York, Metro New York Health Care for All, New York Immigration Coalition, New Yorkers for Accessible Health Coverage, Public Policy and Education Fund of New York, and Raising Women’s Voices. Each group represented a different constituency, ensuring that HCFANY’s work was responsive to a broad group of consumers.

Outcomes and Lessons Learned

HCFANY maintained a strong advocacy infrastructure that was able to respond quickly to policy issues, including:

  • Affordable coverage: HCFANY submitted 10 letters to the Department of Financial Services rate review process, which helped save consumers in the individual and small business markets more than $430 million in premiums. On the individual market, rates were an average of 3.3% lower than insurers’ had requested, and in the small business market, they were 4.6% lower, as a result in part to HCFANY’s unique role in representing consumers’ interests.
  • Affordable Care Act coverage: HCFANY helped to make efforts by the NY State of Health Marketplace to enroll all uninsured New Yorkers into public or private coverage a success. For example, HCFANY offered recommendations for how the Marketplace could improve its reach into diverse communities, with a corresponding increase in the numbers of Hispanic, black, and Asian/Pacific Islander enrollees. HCFANY also advocated improvements to the Marketplace. For example, HANYS’ public program workgroup, which meets frequently with State officials, helped remove a glitch that inappropriately inflated income levels for dependents of people receiving Social Security Income, thus allowing more people to access affordable insurance. HCFANY members also comprised 46 of the 206 total seats on the Marketplace’s regional advisory committees.
  • Insurance protections: HCFANY aided the implementation of legislation to protect consumers from surprise out-of-network bills. The Department of Financial Services requested feedback from HCFANY on surprise bill educational materials, and featured HCFANY leaders in the State’s press release. HCFANY also spent significant time monitoring the aftermath of Health Republic’s closure and identifying ways to protect consumers as they transitioned to new plans. HCFANY met with State officials, provided feedback on the transition process, and drafted recommendations for protecting consumers against such situations in the future.
  • Coverage eligibility expansion: HCFANY conducted administrative advocacy to make newborns eligible for Child Health Plus and create a special enrollment period for uninsured women who become pregnant. HCFANY also made presentations and conducted administrative advocacy on insurance coverage for undocumented immigrants.
  • Consumer education: HCFANY informed consumers about their coverage options through presentations, including at ESL classes, adult day care centers, workforce development events, and outreach and enrollment summits held throughout the State. HCFANY posted more than 60 blog entries on its website, as well as disseminated materials and information through in-person meetings, community meetings, and webinars with stakeholders and decision-makers.
  • Payment and delivery system reform: HCFANY helped create a framework to give consumer advocates more opportunities to participate in and shape payment and delivery system reform. HCFANY disseminated information through blog posts, webinars, and publications, as well as supported consumer advocate participation in workgroups. For example, as part of the State’s integrated care workgroup, HCFANY provided input to the design of the advanced primary care model under the State Health Innovation Plan (SHIP). HCFANY members also reviewed the draft recommendations of the State’s value-based payment workgroup to ensure it reflected consumers’ needs. During a subsequent public comments period, HCFANY generated additional comments from a broad set of consumers.

Co-Funding and Additional Funds Leveraged: N/A