Health
	update
	From the New York State Assembly Health Committee

Sheldon Silver, Speaker Richard N. Gottfried, Chair January 2001

Removing Obstacles to Coverage
for the Uninsured

By Richard N. Gottfried, Chair, Assembly Health Committee

     Half the uninsured people in New York are working people and their families who are entitled to free or low-cost health coverage but are not getting it. We can do more than any other state to reduce the number of uninsured without creating any new program if we overcome the obstacles to enrollment and retention in Medicaid, Child Health Plus, and Family Health Plus.

     There are enormous bureaucratic and eligibility roadblocks to signing up for this coverage and staying signed up. When New York “ended welfare as we knew it,” we didn’t get rid of these elements. Health coverage should be seen as something we want people to have. New York needs to get past the outmoded welfare mentality that it is something we want to stop people from having.

     The Assembly Health Committee, with the Committee on Insurance and Committee on Social Services, held hearings on the issue in December.

     It is clear that there is an agenda for change that is broadly supported by an extraordinary coalition of consumer advocacy groups, health care provider associations, labor, managed care companies, and Comptroller H. Carl McCall. This includes making the eligibility criteria and procedures simpler and more uniform for the different programs, relying more on information already in government hands (e.g., food stamp eligibility, school records, tax records), and getting rid of useless red tape like face-to-face applications and asset tests. Both Governor Pataki and Mayor Giuliani have shown their concern about the problem as well.

     The Assembly has succeeded in getting legislation passed on some of these issues in the last two years, including creating and funding the “facilitated enrollment” program and getting prompt Medicaid coverage for newborns.

     Removing obstacles to health coverage should be a major priority of the 2001 Legislative Session.

Relief on Prescription
Drug Prices Proposed

     Consumers who lack health coverage for prescription drugs would get discounted drug prices under an Assembly proposal that will be taken up during the 2001 Legislative Session.

     Millions of New Yorkers pay for prescription drugs out-of-pocket. The cost of drugs is a heavy burden for consumers and health plans. One 1999 study found that prescription drugs accounted for 44 percent of the increase in health care costs. Some health plans are now paying more for prescription drugs than for hospital stays. Large health plans, as well as Medicaid and EPIC, negotiate large discounts with drug companies. But individuals without drug coverage pay the full price.

     Under the proposal, the State would use the bargaining clout of its large pool of customers to negotiate reduced prices with drug manufacturers. Pharmacies that participate in the program would have to agree to a fixed dispensing fee (price mark-up). The discount would be passed on to the consumer.

     The legislation, which was first introduced toward the end of the 2000 Legislative Session by Assembly Health Chair Richard N. Gottfried, would allow any individual consumer to sign up for the discount plan to cover any prescription drug purchases not covered by insurance. Health plans and health care providers (e.g. hospitals, nursing homes, clinics, or health care practitioners) could also choose to participate. The more individuals and groups participate, the more bargaining power the State would have for better discounts.

     Last year, Maine enacted a plan for the state to negotiate discounts for people without drug coverage, but with price regulation as a back-up to kick in in a few years if the discounts were not enough. However, that plan has been held up by a Federal court preliminary injunction. The Interstate Commerce clause in the U.S. Constitution prevents a state from regulating drug company prices (at least for out-of-state drug companies). But a negotiated discount plan would produce almost the same benefit as regulation.

     Vermont just got Federal approval to use its Medicaid system to let people without drug coverage, who are over 65 or with income up to 300% of poverty, buy drugs at a discount, using the Medicaid rebate to lower the consumer’s price.

     The Assembly bill would cover all New Yorkers who wish to participate. However, the Health Committee is also studying the Vermont approach, because it already has Federal approval.

Family Health Plus Delayed

     As this Health Update goes to press, the January 1 start date for Family Health Plus has been delayed because the State has not yet received a necessary Federal Medicaid waiver. The State Department of Health submitted a waiver application to the Federal Department of Health and Human Services on June 30, 2000. However, the State has not provided the supporting data requested by Washington. Once Federal approval is received, it will still take the State weeks or months to get the program up and running.

     Family Health Plus was enacted as part of the “Health Care Reform Act of 2000” and modeled on the highly successful Child Health Plus program. The program will provide free health insurance to adults with children with household incomes (gross) up to 150% of the Federal poverty level and to adults without children up to 100% of poverty. The program is expected to enroll over 300,000 adults when fully implemented.

Ensuring Access to Breast and Cervical Cancer Treatment

     Assembly Speaker Sheldon Silver and Health Committee Chair Gottfried are calling for the speedy passage of legislation to give uninsured women in New York guaranteed access to treatment for breast and cervical cancer.

     Under a new Federal law signed by President Clinton, New York State is eligible to receive 65% in Federal matching funding for breast and cervical cancer treatment through Medicaid. Eligibility would be for uninsured women whose income is up to 250% of the Federal poverty level (substantially higher than the eligibility levels for Medicaid or Family Health Plus). The Assembly bill would amend the State’s Medicaid law to take advantage of the Federal program.

     Currently in New York State, the Healthy Women’s Partnership (a State and Federally funded program) pays for breast cancer and cervical cancer screening, but not treatment. Participating agencies also attempt to ensure that women get appropriate care. However, finding treatment is often difficult and care can be delayed.

     In New York State 13,000 women are diagnosed with breast cancer annually, and 900 women are diagnosed with cervical cancer. An estimated 3,200 women die of breast cancer and 400 die of cervical cancer each year.

     Silver and Gottfried expect overwhelming support from the Assembly. Governor Pataki endorsed the concept in the State of the State address. State Senate support is also expected.

     The cost to the State, after deducting the Federal reimbursement, would be under $3 million a year. Under New York law, counties and New York City are ordinarily required to pay a portion of any Medicaid cost not reimbursed by the Federal government. However, the Assembly proposal will not require a local share.

     Publicly sponsored and funded health coverage is a success for senior citizens, children in low-income families and the poor. New York is expanding it for low-income uninsured adults through Family Health Plus. Expanding it for uninsured women with breast or cervical cancer will be one more step towards universal quality health coverage.

Help for the Working Disabled

     People with severe disabilities who are capable of working often must keep their earnings low in order to retain the Medicaid coverage they need to survive. Ordinary insurance policies do not cover their exceptional health care needs, especially home care.

     Under the Federal “Work Incentives Improvement Act,” Federal matching funds enable states to extend their Medicaid programs so disabled people can get jobs without losing Medicaid. However, state legislation is necessary for this program to take effect in New York.

     The Assembly’s “Work and Wellness” bill would allow disabled individuals to accept jobs with wages above the poverty level and keep the Medicaid coverage they need. Disabled workers would “buy-in” to the Medicaid program by paying premiums on a sliding fee scale based on income.

     The Assembly passed the Work and Wellness bill in 2000 and fought for it during budget negotiations but the Governor and the State Senate blocked it. The Assembly will take up the bill early in the 2001 Legislative Session. Governor Pataki has now endorsed the concept in his State of the State address.

New Law Opens Physician Information to Consumers

     Legislation giving patients the right to find out about the record and background of the physicians treating them has been signed into law by Governor Pataki.

     The Physician Profiling law (Public Health Law Art. 29-D; Chapter 542 of the Laws of 2000, sponsored by Gottfried and Senate Health Committee Chair Kemp Hannon) requires the New York State Department of Health to give patients access to information about a doctor’s record. It will include education and practice background, plus the doctor’s record on malpractice, loss of hospital privileges, professional discipline, and any criminal convictions. When the Health Department gets the system running, information will be accessed through a toll-free telephone number and over the Internet.

     The new law also creates a Patient Safety Center within the Department of Health to help reduce medical errors. The Center will collect, analyze and publish data on health care quality, including “report cards” on hospitals, HMOs and other health plans and providers.

     The Assembly Health Committee will be working to ensure that the implementation of the new law is effective and timely.

Governor Vetoes Ambulance Coverage for Poor Children

     A bill sponsored by Assembly Member Robert Sweeney to provide coverage under the Child Health Plus program for emergency ambulance transportation has been vetoed by Gov. Pataki. This means if a family whose child is on Child Health Plus is transported by ambulance, the family may have to pay out-of-pocket.

     The Child Health Plus program will be up for reauthorization in 2001, and this issue will be on the agenda.

Senior Citizen Prescription Drug
Program Doubled
EPIC improvements give 80,000 more seniors access to low-cost prescriptions

     New York’s Elderly Pharmaceutical Insurance Coverage (EPIC) program is now able to significantly cut out-of-pocket prescription expenses for an additional 80,000 more adults, and for those already eligible for EPIC.

     The expanded EPIC plan raises income eligibility levels from $18,500 to $35,000 for individuals and from $24,000 to $50,000 for married couples. The Legislature also reduced co-payments by 20 percent and simplified the co-payment schedule.

Keeping Health Care Workers Safe from “Sharps”

    An Assembly initiative to protect health care workers from Hepatitis B, Hepatitis C, HIV and other bloodborne diseases has been signed into law by Governor Pataki.

    The use, disposal or handling of “sharps” (needles and other skin-piercing instruments) by health care workers significantly increases the risk of transmission of infectious diseases. Advances in modern medical technology have made safer sharps and disposal devices widely available.

    The new law (Public Health Law Art. 13-G; Chapter 558 of the Laws of 2000, sponsored by Assembly Member Brian McLaughlin) requires the use of safer sharps that have been engineered to protect against injury. The law exempts needles used in self-administration.

    Regulations will be developed in consultation with a technical advisory committee appointed jointly by the Commissioner of Health and the legislative leadership. The regulations must be issued by November 1, 2001 and will take effect six months later.

Legal Needles Law a Victory Against HIV

    A new law that legalizes the non-prescription sale and possession of hypodermics took effect on January 1, 2001.

    Sharing needles is a major source of spreading HIV infection in New York. Drug abusers share needles because our prescription-only law made them an expensive black-market item. The HIV epidemic in New York would be half of what it is were it not for needle sharing.

    Studies around the country have shown that the legal availability of clean needles dramatically reduces needle sharing and HIV infection without increasing drug use.

    The new law, written by Assembly Health Committee chair Richard N. Gottfried, is the result of 11 years of lobbying by advocates. It is an important development in our effort against HIV/AIDS.

Hearings Target Nursing Home Quality, Staffing and Regulation

    In December, the Health Committee and the Aging Committee held the first of their hearings on nursing home quality of care. Nursing home residents, consumer advocates, employees, and operators, Attorney General Eliot Spitzer, and The Daily News have all raised concerns about issues that undermine the care and safety of nursing home residents.

    At the hearing, health advocates, representatives of nursing homes, labor unions and government officials focused on topics including availability of staff, staffing standards, and adequacy of government oversight. Another hearing is planned for January 31 in Rochester.

    Home health care agencies and hospitals also report serious shortages of qualified people. Part of the reason for it is that in a tight labor market, accumulated cuts in Federal and State reimbursement and managed care payments make it hard for them to compete for employees. Many groups argue that the staffing crisis is affecting quality of care and patient safety.

    There is broad consumer, labor and provider support for targeted Medicaid reimbursement increases for labor recruitment and retention. Dealing with the problem will be a priority for 2001.

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