The first three months of each year’s state legislative session in Albany always centers around adopting a tax and spending plan for the new fiscal year that starts on April 1^st.  Advocates and other stakeholders pour over the governor’s initial proposals in late January, urge the legislature to make changes to it during February and early March, and hope for the best as the final negotiations transpire behind closed doors in the closing week or two.

 This year, health care advocates involved in the Health Care for All NY and Medicaid Matters NY coalitions promoted several ideas, and pushed-back against others.  Pro-actively, they sought:

• Continued and stable funding ($4M) for the Community Health Advocates (CHA) program that helps health insurance policyholders of all sorts (public, private, employer) solve coverage problems they may experience with either their health plan and/or care providers. They also help uninsured people located free or low-cost care in their community.  (CHA is a statewide network of non-profit organizations serving all counties, and is anchored by the Community Service Society of NY, Empire Justice Center, Legal Aid Society, and Medicare Rights Center.  CHA is the state’s official “consumer assistance program” created under the Affordable Care Act.)  Result: $3.25M in funding approved.

• New funding ($2M) for community-based, non-profit organizations to undertake public education and outreach programs to the still-uninsured to inform them about their possible new coverage options under the Affordable Care Act, and direct them to enrollers located in the community, or at hospitals and health centers. Result: no funding included.

• New funding ($10.3M) to expand health insurance coverage under the state’s new (and very successful) “Essential Plan” (EP) to certain lawfully-present immigrants (primarily young adults) who can enroll in Medicaid, but not this new option when their income rises above the Medicaid level. (EP coverage is very low-cost, and available for working poor individuals and families who are not eligible for Medicaid.) Result: no funding included.

• Allow people leaving incarceration to apply for Medicaid 30 days before their release, rather than have to wait until afterwards. Result: approved.

• Expand Medicaid coverage for additional mental health services for children, including crisis intervention, community psychiatric treatment, psycho-social rehab, family peer support, youth peer support, and services from additional licensed providers. Result:  approved

• Provide capital funding to community-based health care providers for delivery system reform, and not just institutional ones. Result: $30M approved (out of $200M allocated system-wide)

 

More successfully, advocates were able to get the legislature to reject several troubling proposals from the governor, including:

• Ending the rights of spouses and parents to refuse to have their own income and assets taken in consideration when applying for Medicaid coverage for long-term care services for their disabled spouses and children.

• Drastically reducing the amount of assets that spouses can maintain when their spouses apply for Medicaid coverage for long-term care services.

• Ending current “prescriber prevails” policies that allow doctors to appeal denials of coverage for particular drugs by a given Medicaid health plan.

• Tightening eligibility standards for managed long-term care under Medicaid.

• Remove coverage for medically-related transportation services from Medicaid-covered managed long-term care plans, and shifting them to a separate third-party contractor.

• Shift $500M in Medicaid costs to New York City as part of their “local share”.

 

One issue that got “punted” concerned the creation of a new “Health Insurance Guaranty Fund.”  In the wake of the financial collapse of Health Republic (New York’s non-profit health insurance co-op) last fall, it turned out that New York is the only state not to have a “guaranty fund” in place for health insurers.  The state does have such funds for other insurance product lines.  Such funds help pay-off the insurers debts that may exceed the value of a company’s assets once liquidated.  Instead, the Legislature directed state officials to create a one-time fund to reimburse doctors and hospitals that are owed payments, using proceeds from fines and financial settlements in legal and regulatory cases.  Advocates had supported the general concept of a health guaranty fund, but urged that it not be funded by additional assessments on consumers’ insurance premiums, a position also supported by insurers.

After more than a decade of effort, as part of the final deal for the 2016-17 state budget, New York will soon have a new Paid Family Leave (PFL) program, and it will be the most ambitious and comprehensive one in the country. Gov. Andrew Cuomo and the State Assembly made it one of their top priorities during the budget negotiations, and participants in the New York Paid Family Leave Campaign pushed it through the State Senate. Key campaign leaders included AARP, A Better Balance, Citizen Action of NY, Community Service Society of NY, NY Civil Liberties Union, NY State AFL-CIO, NY Statewide Senior Action Council, Working Families Organization, 1199 SEIU and 32BJ SEIU.  We were proud to have been a rank-and-file member of the campaign.

The U.S. is only one of two nations globally that does not guarantee some sort of PFL program for workers to care for a new borne or an ill family member. The national Family and Medical Leave Act (FMLA), enacted in the 1990s, has provided up to 12 weeks unpaid leave while protecting one’s job, but more than 40% of workers are not eligible, and many other low-income workers could not afford to take unpaid leave.

With this new law, New York now joins 3 other states that have paid family leave programs: California, New Jersey, and Rhode Island.  Since the 1950s, New York’s Temporary Disability Insurance ITDI) program has guaranteed up to 7 weeks for the birth of a child, but it currently only provides a meager $170/week in replacement income, an amount not raised since the early 1990s. (Most other states provide a much larger benefit, up to a maximum of more than $750/wk.) On the positive side, a good number of New York employers have voluntary provided some amount of paid family leave on their own, but 6.4 million New York workers have had no such option available.

As the campaign heated up this year, many employers, especially small ones, resisted creation of a PFL program. They were worried about having to pay a new tax, the impact on profitability, being put at a competitive disadvantage vis-à-vis companies in other states, abuse of the program by employees, and new administrative burdens. Looking at other states’ experiences, the realities are that PFL programs can be funded solely by employee contributions (thereby costing employers nothing, and creating no market disadvantage), and employers have reported positive or neutral impacts on employee morale, loyalty, productivity, and performance. Further, most workers have typically taken less than the full amount of PFL time allowed, nor have there any new onerous compliance requirements.

The campaign to enact the law in NY rested on 4 core strategies: sharing workers’ personal stories of why they wanted and needed PFL (and what happened when they didn’t have it), making a “public health” case for PFL (citing research showing the health and child development results), engaging supportive small employers and giving them visible roles, and address the myths and fears of initial opponents.

                   

The state’s new PFL program will be operated through the state’s existing TDI system, and will be a social insurance program whereby funds are pooled and paid out to individual families based on need. It will start in 2017 and fully phase-in over a 4-year period. All contributions will be made by employees, estimated to phase up to $1.40/wk. Self-employed people and public sector unions can opt into it. The state’s Disability Benefits Bureau of the Workers’ Compensation Board will enforce the law.

The program’s “four pillars” are: up to 12 weeks paid leave, job protection while out on leave, inclusion of all employers (regardless of size), and a maximum benefit level of up to two-thirds of a worker’s weekly wage up to a cap of two-thirds of the statewide average weekly wage. Birth mothers can receive separate time off from childbirth, and each parent can take up to 12 weeks, either simultaneously or sequentially. Leave can be taken for childbirth, adoption, or foster care placement, caring for a seriously ill family member (child, parent/parent-in-law, spouse/domestic partner, grandparent, grandchild), or certain needs arising from a family member’s military service. Full-time workers can access the benefits after 26 weeks (6 months) of employment, and part-time workers after 175 days. The leave will run concurrently to any leave eligibility under the existing federal FMLA system. Workers with employer-sponsored health insurance will continue such coverage during their leave.

Nationally, New York Senator Kirsten Gillibrand and Rep. Rosa DeLauro (CT) have introduced the FAMILY Act in Congress (S.786, H.R.1439), which would create a federal PFL program under the Social Security Act. As PFL programs develop in other states, pressure will be created for Congress to act. Once again, New York and other states are proving to be the laboratories of democracy!