Like smoke rising from a chimney at the Vatican when a new pope is elected, advocates and lobbyists of all stripes await the announcement of a final budget deal with much hope and anxiety, wondering if and to what degree their efforts over a 2-1/2 month period paid off, or will they go home empty handed.

The good news for that this year, much of what health care advocates pushed for was included in the final enacted budget for FY 2015 that began on April 1^st, after being adopted by the State Legislature the day before and signed into law by Governor Cuomo that morning.

Among the health care provisions negotiated between the Governor and legislatures are:

• Authorization to move forward with implementation of a new “Basic Health Program” that will provide very low-cost insurance coverage to people just above the Medicaid level up to 200% of the Federal Poverty Level ($23,000 for an individual, $42,000 for a family of four.)  Estimates are that monthly premiums would be up to $20 per person.  Advocates hope this new program will become available starting in 2015.

• New expanded consumer rights and protections, starting in 2015, for out-of-network services and providers, including:

• Protection from “surprise medical bills” – Consumers will only be responsible for paying the in-network rate for emergency services, and for scheduled services when an in-network provider is not available or the consumer is not informed in advance that out-of-network providers will be involved in providing care.  It will now be up to insurers and providers to resolve between themselves any billing disputes via an independent process, and the patient will be held harmless.

• The right to go out-of-network at the in-network rate – either for services that an insurer’s network doesn’t provide, or when an insurer’s network does not have an appropriate provider in-network.  Out-of-network referrals must be made by in-network providers.  An independent, external review process can be utilized when needed.

• Improved disclosure of information – Insurers must keep their network lists up-to-date (within 30 days), and disclose at what rate they reimburse for out-of-network services (when they are covered.)  Providers must keep their list of what plans they take up to date (within 30 days) and disclose how much they charge for given service when it is provided out-of-network.

• Consumers must be allowed to submit out-of-network coverage requests and claims electronically.

• Insurers that do offer across-the-board out-of-network coverage will have to market at least one plan that provides it at a decent, fairly robust reimbursement level.

• All health care plans will now have to meet the same level of network adequacy standards, whether they are HMOs, PPOs, EPOs, or other types.

• Continued funding for community-based consumer assistance programs across the state.  Now that over 900,000 New Yorkers (and counting!) have gotten health insurance through the “New York State of Health” marketplace, these programs will help them to use their new coverage and troubleshoot any problems with it.  They will also help uninsured New Yorkers to access needed services when they are injured or become ill.  New York’s official program is known as “Community Health Advocates”, a statewide network of non-profits

• A variety of provisions in the budget will be of benefit to people on Medicaid.  Medicaid Matters New York is preparing a summary of them

Finally, while health care advocates are very pleased with these results, many are also very disappointed that the Governor and Legislature refused to move forward on historic campaign finance and ethics reform measures.  These provisions would have enabled a variety of long-stymied measures to move forward in the legislative process, strengthened efforts to combat political corruption, and incentivized community-based leaders to pursue elective office so as to create a state government that is more reflective of the diversity of New York’s population.  In addition, regressive tax measures were enacted that favor the wealthy and large corporations, and further lock-in structural deficits in future budgets, thereby threatening ongoing funding for health care and other social programs in future years.

As the end of this month nears, individuals and families who lack health insurance are flocking to sign-up for affordable coverage through New York’s new health benefits exchange, known as “New York State of Health”.  If enrolled in a plan by March 31^st, they will escape an additional tax next year, provided they don’t qualify for a special exemption (see complete list at www.healthcare.gov/exemptions/).  Meanwhile, advocates and activists are hitting the streets, church halls, community centers, etc. in one last effort to find the uninsured and get them enrolled in a health plan.

The Good News!

Financial Assistance:  The vast majority of applicants will likely qualify for:

• No-cost coverage through Medicaid if they have low or no income (approx. $15,000 for an individual.)
• No-cost or very low cost coverage for most children through New York’s “Child Health Plus” program (up to approx. $94,000 for a family of four.)
• Premium subsidies to help them purchase private “Qualified Health Plans” (QHPs) offered on the exchange, per a sliding-scale based on family size and income.  The subsidies are available to individuals who make up to approx. $45,000 annual income, and up to $94,000 for a family of four.
• Additional help paying for deductibles, co-pays, and co-insurance if they have modest incomes just above the Medicaid eligibility level.

Thanks to the historic Affordable Care Act, much more affordable health coverage is now available to uninsured New Yorkers through New York State of Health.  Premium prices have, on average, dropped 53% compared to 2013 prices.   As of March 24, one week out from the enrollment deadline, over a million New Yorkers had created an account and completed an application, and over 700,000 had completed the process and enrolled in a health plan.  These numbers are higher than anticipated projections.

Where and How to Get FREE HELP Enrolling in Coverage:

• Via the state’s website:  www.nystateofhealth.ny.gov  (includes a live chat function to provide assistance)
• Via the state’s Call Center:  855-355-5777 (Mon.-Fri. from 8 a.m. to 9 p.m.; Sat. from 9 a.m. to 1 p.m.)
• Via community-based “Navigators” in each county/borough (http://info.nystateofhealth.ny.gov/IPANavigatorSiteLocations)
•  Via “Certified Application Counselors” (CACs) at local hospitals and community health centers
• Via traditional insurance agents and brokers (note: they are not allowed to charge commissions.)

People can also contact New York’s designated Consumer Assistance Program known as “Community Health Advocates” (www.communityhealthadvocates.org or 888-614-5400).  This program, created and funded under the ACA, is a statewide network of community-based organizations that provides insurance counseling to people.  They can also refer people to Navigators and answer basic questions about enrollment in plans.  Some of them may also Navigators who can enroll people, while others are not.

After the “2014 Open Enrollment” period closes on March 31^st, people can still enroll in a plan in the following circumstances:

• Low-income people who qualify for Medicaid can enroll at any time (up to approx. $15,000 annual income for an individual, or higher income amounts depending on family size.)
• Children can enroll in Family Health Plus at any time (up to $94,000 annual income for a family of four.)
• Small employers (50 or less full-time workers) can purchase coverage for their employees at any time.
• People who have special “life changing” events (marriage/divorce, birth of a child, move to a new town/state/region, age-off of parent’s plan, lose or change jobs, etc.) are allowed to enroll in QHPs at any time.

Some caveats:

• DON’T DELAY!  Uninsured people should start the process as soon as possible.  As the deadline approaches, Call Center phone lines will be busy, websites will slow down, and Navigators and CACs will be booked up for appointments.  ACT NOW!
• People on Medicare don’t have to worry about any of this – they stay in the separate Medicare system just as is.
• Workers who have employer-sponsored insurance that complies with Affordable Care Act (ACA) standards also don’t have to worry about any of this.  Check with your human resources dept. to confirm if your current coverage is OK.

FINALLY… our job as those who care….

• Reach out to the uninsured to provide them with this basic information
• Encourage them to go online or call the Call Center to get things started …NOW!
• Help them create an online account and get the basic information entered about their family size and expected income for 2014
• Get them to a Navigator, CAC, insurance broker or agent for in-person assistance in enrolling in a plan, if needed

Scores of New Yorkers from trade unions, community groups, and school children gathered just off Washington Square in Greenwich Village on March 25 to commemorate the infamous Triangle Shirtwaist Factory Fire of 1911 and remember those who died in the fire, many of whom were young immigrant workers, most of them women.  The ceremony was held outside the building that housed the factory back then, which is now part of the campus of New York University.  Speakers included local trade union leaders, public officials, clergy, and first responders, including Rabbi Michael Feinberg of the Greater New York Labor-Religion Coalition, Stuart Appelbaum of the Retail, Wholesale, and Department Store Workers, NYC Comptroller Scott Stringer, and NYC Council Speaker Melissa Mark-Viverito.  Specially-featured speakers were leaders from the “new labor organizing movement” that focuses on fast-food workers, airport workers, and “car washeros”, many of whom are immigrants and work in potentially-dangerous circumstances.

Members of Workers United, a successor union to the International Ladies Garment Workers Union, held aloft on poles dresses and shirts each bearing the name of one of the casualties of the historic fire.  At the end of the ceremony, a stream of people read off their names and placed a white carnation for each at the foot of the building adjacent to a fire truck with its ladder raised against it.  A uniformed fire fighter rang a bell for each name as a recording of bag pipe music played in the background.  Among those reading off the names were public school students, immigrant trade unionists, and some descendants of those who died in the fire, who directly referenced their own ancestors.  Following those names, red carnations were added for the many garment workers who’ve died in similar factory fires and accidents in Asia in recent years.

146 workers, 123 women and 23 men, perished on the late Saturday afternoon in 1911 when a fire engulfed floors eight through ten of the Asch Building on the corner of Washington Place and Greene Street. Though firefighters responded promptly, their ladders only reached up to the sixth floor. The shoddy fire escape quickly collapsed, taking 20 workers down with it. With one stairway exit blocked by flames and the others locked by the owners, workers faced a choice between jumping to their deaths or succumbing to flame and smoke. The horror of the fire led to the fight for and implementation of a wide array of new health and safety standards in the workplace at the city, state, and federal levels, as well as the formation of the American Society of Safety Engineers.

Political activists of various stripes who work on various issues, including health care, converged at the top of the “Million Dollar Staircase” inside the State Capitol on March 11th to demand that lawmakers clean up Albany politics.  They called on legislators to move forward with a plan to curtail the influence of “Big Money” in election campaigns, and replace it with a system of public matching funds linked to small donations collected from constituents.  Known as a “Fair Elections” approach, the plan would replicate a system in New York City that has been in place for well over a decade and take it statewide.  The result in the City has been to completely transform municipal government so that it is much more reflective of the city’s demographics, and much more responsive to everyday residents’ concerns and priorities, such as access to affordable health care.

Before a throng of cameras and reporters, State Assembly Speaker Sheldon Silver addressed an enthusiastic  crowd of over 200 people who were jammed into the stairwell and hanging over balconies.  He announced that the Assembly was including a Fair Elections proposal in its own just-released budget bill (to be voted on by the end of the week), saying it was time to “get it done.”  Over the past decade, there have been numerous financial corruption scandals involving leaders and members of the State Legislature, leading to indictments, resignations, convictions, and jail time.

A Fair Elections proposal has been enacted by the State Assembly numerous times over the past decade, and Governor Cuomo included such a proposal in his own proposed budget released in January.  It will now go forward into final negotiations with State Senate leaders where there are differences within the coalition governing majority comprised of Republicans and five (renegade) Independent Democrats.  Here in New York City, there is only one Republican Senator (Martin Golden of Brooklyn), and three Independent Democrats (Jeff Klein of the Bronx, who leads the faction, Diane Savino of Staten Island and southwest Brooklyn, and Tony Avella of eastern Queens.)  The budget process is to be concluded by the end of March when the new fiscal year begins for the state on April 1.

Issue advocates, including those who work on health care reform, have long believed that many of our aspirations and good ideas to make things better for everyday New Yorkers have been stopped dead in their tracks because of the inordinate influence of Big Money forces, such as millionaires and large, powerful corporations.  Historically, they have had disproportionate sway over individual legislators because of the money they contribute to candidates’ election campaigns.  In the area of health care, many believe New York would have enacted a truly universal health care program years ago had it not been for the dominance of the insurance companies and other stakeholders striving to protect, if not expand, their profiteering off the health care system.  While New York has certainly been a “leader state” in the area of health care compared to most other states, prospects for much more progress will be possible under a Fair Elections system because elected officials will be much more beholden to the electorate rather than Big Money donors.  We look forward to that day with eagerness and hope.

Members of various health care unions and community health care activists took to the streets of Manhattan’s Upper East Side on March 8^th to commemorate International Women’s Day, and call-out the influence of billionaire brothers David and Charles Koch in funding campaigns to restrict health care choices for women.  The two brothers are Midwest industrialists and investors who are well-known for financially supporting conservative political causes and candidates, including efforts by states to curtail women’s access to comprehensive reproductive health care and collective bargaining rights.

The event was organized by the New York State Nurses Association, 1199 SEIU United Healthcare Workers East, and local chapters of the NAACP.  Other sponsoring groups included ACT UP/NY, Doctors for the 99%, Healthcare for the 99%, Healthcare Now NYC, Metro NY Health Care for All Campaign, the NY Metro chapter of Physicians for a National Health Program, and others.

The day began with a “pancake-breakfast-in-the-streets” outside New York Hospital.  David Koch recently gave them a $100M donation to fund construction of a new building there to be named after him.  From there, the group marched to a nearby Chase bank branch for a rally decrying the casino-like gambling of Wall St. speculators and their investor clientele (like the Koch brothers) that brought about the Great Recession which is still an ongoing reality for millions of struggling New Yorkers.  They were joined there by City Council Speaker Melissa Mark-Viverito.  After the rally, the group marched over to the Park Ave. location where David Koch has an apartment that he uses when in New York.

NYC labor leaders and their community allies are sitting down to discuss the current state of health care in America, particularly for workers and trade unions.  In the wake of the enactment of the Affordable Care Act in 2010, much change is underway: beneficial, problematic, and otherwise.

On Thurs. morning Feb. 27, Labor Press, an online news source, is hosting a gathering to bring various union movement stakeholders together to talk about how things are going, what’s been accomplished, what challenges they are facing, and a the vision for the longer-term.  The summit kicks off with remarks from the new Speaker of the New York City Council, Melissa Mark-Viverito, and features R. Thomas Buffenberger, President of the International Association of Machinists and Aerospace Workers, as the keynoter.  Three panels then follow.

The first panel, “Navigating the New Healthcare World”, moderated by Mark Hannay (Metro New York Health Care for All Campaign), features Tom Canty (Empire Blue Cross Blue Shield), Frank Proscia (Doctors’ Council, SEIU), Michael Jordon (MagnaCare), William Friedman (Health Republic), Joseph Malloy (North Shore LIJ), and Jerry Gallo (EmblemHealth).

The second panel, “Meeting New Healthcare Challenges”, moderated by Oren Levin-Waldman, (Metropolitan College of NY), features Jack Lepetich (Empire Blue Cross Blue Shield), Joseph Berardo (MagnaCare), William Friedman (Health Republic), Stephen Magla (Pitta Giblin LLP), Susan McQuade (NY Committee on Occupational Safety and Health), and Larry Cary (Cary Kane LLP).

The summit’s final panel, “ACA Passage and Winning an Improved and Better Plan”, moderated by Gene Carrol (NYS AFL-CIO/Cornell Union Leadership Institute), features Richard Gottfried (NYS Assembly), Mitra Behroozi (1199 SEIU Pension and Benefit Funds), Oliver Fein (Physicians for a National Health Program), Edward Kaplan (Segal and Co.), George Bueno (Office and Professional Employees International Union), John August (Cornell ILR School), Howard Raphaelson (Raphaelson and Levine), Howard Gold (North Shore LIJ), Paul Zurlo (EmblemHealth).

The summit is being held at the NYC District Council of Carpenters on Hudson St. in Manhattan.  Full details and reservations are at www.laborpress.org

Advocates from a variety of consumer health groups and coalitions are kicking into full gear as the all-too-crucial month of March arrives when the state budget will be finalized.  They are conducting advocacy days in Albany, placing paid advertising in key media outlets, circulating sign-on letters to legislative leaders, submitting legislative memos on specific budget provisions they support or oppose, dropping off packets of policy materials at legislators’ offices, holding press conferences, organizing “twitter rallies”, posting updates on Facebook, making phone calls, signing-on to email petitions, and convening annual meetings and webinars.  Whew!

One key issue many are promoting is the creation of a new “Basic Health Program” (BHP) to provide very low-cost insurance coverage to lower-income New Yorkers whose incomes are too high for Medicaid and often fluctuate significantly from month-to-month, the “working poor.”  While the state’s new health benefits exchange marketplace (“New York State of Health”) has lowered insurance premiums dramatically (more than half compared to 2013) and offers generous financial support to lower-income people to help them purchase a plan, they often still struggle to afford the coverage and/or use it given deductibles and co-pays.  In addition, a BHP will bring millions of dollars of new federal funding into New York to help relieve the state of what it spends on its own to provide coverage to lawfully-present immigrants.  BHP is an option available to states under the Affordable Care Act starting in 2015.  Health Care for All New York is leading this campaign.

A second key issue concerns various measures to improve and expand consumer protections for people who need to go “out-of-network” for care.  After a 3-year struggle to forge agreement between insurers, doctors and hospitals, and consumer, Gov. Cuomo’s Dept. of Financial Services has come out with a package of proposals to a) hold consumers harmless when they receive “surprise bills” after hospitalizations, b) establish an independent arbitration to resolve payment disputes between doctors/hospitals and insurers, c) sets standards for the quality of out-of-network coverage (when it is offered by insurers), d) improve disclosure to consumers about provider networks, reimbursement methods and formulas, and provider rates, e) strengthen standards for the adequacy of insurers’ provider networks, including the right to go out of network via an external appeal process, and f) institute a uniform electronic claim form for out-of-network services to be used by insurers and doctors/hospitals.  New Yorkers for Accessible Health Coverage is spearheading this campaign.

Another priority is continued funding for community-based consumer assistance programs (CAPs).  While a variety of “in-person assisters” (“navigators”, “certified application counselors”, brokers, and agents) are busily signing up individuals, families, and small employers into new health plans available on the New York State of Health marketplace (over 500,000 already!), once people get enrolled in a plan, they often need help figuring out how to use it and trouble-shoot any problems they encounter, particularly if they’ve been uninsured and are not familiar with the very basics of health insurance.  Fortunately, the Affordable Care Act provides funding to states to set up CAPs – ours here in New York is known as Community Health Advocates (CHA), a statewide network of many community organizations.  Gov. Cuomo has proposed a new appropriation of federal funds for CHA.  If you know someone with an insurance problem or with paying a doctor or hospital bill or getting access to a needed medical service, CHA is definitely the place to go!

Finally, advocates for people on Medicaid are promoting the need for important consumer protections as the state continues forward with its “Medicaid Redesign” process to move all Medicaid-covered services into various “care coordination” programs.  With the recent approval of the state’s latest “Medicaid Waiver” by the Obama administration, things are now expected to move forward even more expansively.  An critical issue related to this new waiver also concerns funding for “vital access” or “safety net” providers that disproportionately serve many people on Medicaid and the uninsured.  An important aspect will be funding regional health planning to make sure that all parts of our state and city have services available in their communities.  The ongoing hospital crisis in northern and central Brooklyn calls for such a priority.  Medicaid Matters New York is leading this effort.

The morning following the death of South African freedom fighter and former President Nelson Mandela, Rep. John Conyers of Michigan spoke at a breakfast meeting on December 6th sponsored by the New York City Central Labor Council and Progressive Democrats of America.  He recalled his work as a young lawyer within the U.S. civil rights movement and the Southern Christian Leadership Conference led by Rev. Dr. Martin Luther King, Jr., and hiring icon Rosa Parks who worked in his Detroit office for over 25 years.  He also spoke about the continuing fight for universal health care in America and his proposed “Improved and Expanded Medicare for All Act” (JH.R. 676), and about the need to address the nation’s current unemployment crisis in the wake of the ongoing Great Recession and his proposed “Humphrey-Hawkins Full Employment and Training Act” (H.R. 1000).

Rep. Conyers was introduced by veteran television talk show host Phil Donohue (lower right), who spoke about his own roots in the trade union movement as a young man in Youngstown, Ohio.  Additional speakers at the breakfast included: Vinny Alvarez, President of the New York City Central Labor Council; Bobby Score, Recording-Corresponding Secretary of Local One of the International Association of Technical and Stage Employees; and a spokesperson for Progressive Democrats of America. 

During the question period, Rep. Conyers also addressed concerns that trade unions have about some provisions of the Affordable Care Act that they would like to see changed, and aspects of an FY 2014 budget agreement emerging in Congress that may affect social, employment, and health care programs.

It’s our 20 Anniversary!

For two decades, we’re proud to have served as a place where labor and community can come together to fight for health care justice. By joining forces, we’ve made great strides toward our goal of health care for all in New Yorkers and across America, and we’re deeply appreciative of everyone who’s been part of the team. We couldn’t have done it without you!

Come celebrate with us! Join us on Tuesday evening, December 17 for our 20th Anniversary Gala, as we recall our accomplishments, salute some very worthy individuals and organizations, and look forward to our next decade.  (Click on our events link above for full details date, time, and place.)

You can support our 20th Anniversary Gala by attending and making a contribution. The suggested donation is $75, but everyone is welcome whatever you can give (more if you can, less if you can’t.) If you can’t attend, we’ll miss you but will still welcome your contribution — just use the donate button here!

Please be as generous as you can. Your financial support enables to us to continue our mission of fostering community-labor collaboration in the fight for universal health care for all in New York, and to defend and improve our nation’s important health care and social programs like Medicare, Medicaid, Social Security, and now, the Affordable Care Act.

We look forward to greeting you at our 20th Anniversary Gala, as we recommit ourselves to our work ahead.  Click on our events link above for full details date, time, and place.

 As Congress faced a looming deadline to avert the United States from defaulting on its debt and the federal government remained closed, fiesty Staten Islanders, joined by other New Yorkers, gathered on the steps of Staten Island Borough Hall on Tues. Oct. 15th to demand action from their Congressmember, Rep. Michael Grimm.  The event featured some street theater with protestors dressed as characters from Louis Carroll’s classic children’s novel “Alice in Wonderland”, including Alice and some Mad Hatters.

 The demonstration was part of a national day of action dubbed “Cease and Desist!”, spearheaded by USAction, the AFL-CIO, and their allies.  Eight protests were held across New York State alone, in communities where the local Congressmembers voted to shut down the federal government in a futile attempt to force defunding of the Affordable Care Act.  Two events were held in NYC, including one in the morning outside Rep. Grimm’s office in Bay Ridge, Brooklyn.

Since the mid-term elections of 2010, the “Tea Party Caucus”, a minority within the House majority, in conjunction with House leadership, has driven a radical “austerity agenda.” Their efforts have caused much pain and suffering to everyday New Yorkers, stymied economic recovery from the Great Recession, slashed domestic discretionary spending for programs that serve disadvantaged New Yorkers, and threatened our nation’s historic social contract and safety, including Social Security, Medicare, Medicaid, and SNAP (Food Stamps).  Rep. Michael Grimm has often supported these efforts in his statements and votes.  Meanwhile, the House Majority continues to ignore job creation and immigration reform, and protects job-killing corporate tax loopholes.

Groups involved in organizing the protest included Citizen Action of NYC, the Hunger Action Network of NYS, the Left Labor Project, Metro NY Health Care for All Campaign, MoveOn, No Bad Grand Bargain, Peace Action of Staten Island, and Staten Island for Change.