the New York State Assembly Health Committee
Richard N. Gottfried, Chair
Obstacles to Coverage
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
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.
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
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.
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.
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.
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.
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
The Assembly Health Committee will be working
to ensure that the implementation of the new law is effective and timely.
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.
Citizen Prescription Drug
EPIC improvements give 80,000 more seniors access
to low-cost prescriptions
New Yorks 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.
For more information, call the
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.
With the Bush presidency, the Assembly’s historic
role as the bulwark protecting reproductive choice for New Yorkers
is more critical than ever. Assembly Speaker Sheldon Silver and
Health Committee chair Richard N. Gottfried are firmly committed
to that role.
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.
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.
The Assembly Health Committee’s New York City office is no longer
at 270 Broadway. The new address is: 250 Broadway, #2232, New York,
NY 10007. The phone numbers are still: Tel: 212-312-1492, Fax: 212-312-1494.
Our other offices remain at: Albany office, 822 Legislative
Office Building, Albany, NY 12248; Tel: 518-455-4941; Fax: 518-455-5939;
and Assembly Member Richard N. Gottfried’s district office, 242
West 27th Street, New York, NY 10001; Tel: 212-807-7900; Fax: 212-243-2035.
You can also reach us by email: firstname.lastname@example.org