Health Care

SCOTUS Upholds Major Obamacare Component

A major part of the Affordable Care Act, also known as “Obamacare”, was upheld by the Supreme Court Thursday morning.

In a ruling of 6 – 3, the court ruled in favor of a part of the law that provides subsidies for low and middle-income people to purchase health insurance.

The question surrounding the case of King v. Burwell was mostly in the language of the controversial health law. The Affordable Care Act guarantees subsidies for people who may not be able to afford health insurance on their own.

The wording of the law points specifically to subsidies being provided in states that have set up their own health exchange marketplaces. New York is one of those states.

But more than thirty states did not set up such exchanges, leaving their health care system up to the federal government. The argument was whether residents in those states should also be guaranteed subsidies under the Affordable Care Act.

The six justices who ruled in favor of the Affordable Care Act said that in this case the context outweighs the plain language of the law. The three dissenting justices said the majority’s reading of the law “is of course quite absurd, and the Court’s 21 pages of explanation make it no less so.”

This is just one of many hurdles the Affordable Care Act has had to pass since it was enacted in 2010. It was also one of two major cases the Supreme Court is handling this year. The other – Obergefell v. Hodges – deals with whether same-sex couples have a constitutional right to marry.

The next opinion day for the court is Friday. Five more opinions are left for the court to rule on. If they do not deliver all five Friday, they will be back Monday for those remaining.

UPDATEDX2: Gottfried Bill Would Speed Up Medical Marijuana Program

A bill that would expedite the state’s medical marijuana program to treat patients suffering from extreme circumstances has been introduced into the state Assembly.

The bill was introduced last week by Manhattan Assemblyman Richard Gottfried, a long-time advocate of medical marijuana in New York State.

This bill would make the treatment available for patients as soon as possible, if their condition is serious enough to merit treatment from the drug.

Gottfried, along with Assembly Minority Leader Brian Kolb, who is a co-sponsor of the bill, held a hybrid press conference and rally outside the Assembly chamber Tuesday morning.

Besides this law, Gottfried said the Governor could direct the Department of Health to take emergency action to help those who may benefit from medical marijuana. He also said the state’s decades-old Olivieri Law could be used. That law is said to allow hospitals to administer medical marijuana to patients after a medical review.

But even if the law was passed as soon as possible, it’s unclear when the treatment would actually be available to patients requesting it. The drug would either need to be grown in New York, or imported from another medical marijuana approved state. For the latter, the legality is unclear, but Gottfried said he sees no barriers.

“It is still not entirely clear to me that the federal government would prohibit the movement of medical marijuana under state supervision from one legal medical marijuana state to another,” Gottfried said earlier today. “I don’t think the Governor has ever really pressed the federal government to agree to that.”

The bill currently has no sponsor in the Senate, though a similar bill was introduced earlier this session by Senator Bill Larkin. That bill would have established an emergency medical marijuana program for much of the same reason. The same bill was sponsored by Brian Kolb in the Assembly. Neither have moved since they were introduced and referred to their respective health committees.

Senator Diane Savino, who sponsored the initial medical marijuana bill in the Senate, said at the time that she did not support the Larkin bill, citing the Department of Health’s plan for implementation.

“Any deviation from that effort will delay the entire program,” Savino said during an interview.

Update: A representative from Senator Larkin’s office said they’re reviewing the new bill from Assemblyman Gottfried before they decide whether they’ll take it up in the Senate.

Update X2: A spokesman from the Cuomo administration sent a statement to State of Politics reacting to the Gottfried bill Tuesday afternoon.

“Our top priority is to deliver relief to those in pain and we are doing so as expeditiously as possible under current federal guidelines and within the confines of the Compassionate Care Act, which Assemblyman Gottfried sponsored, supported and passed through his own house. Just yesterday, applications for vendors were released per the timeline laid out in that legislation.  The last thing that anyone would want is legal complications to arise from importing marijuana products over state lines without federal approval, or for  unnecessary delays with the implementation of the current program to come as a result of layering a separate process on top of it.”


Stefanik Ad Reiterates ‘Commitment’ To Social Security, Medicare

NY-21 GOP candidate Elise Stefanik is answering the attack ad released earlier today by her Democratic opponent, Aaron Woolf, with an ad of her own on the same issue, reiterating her “commitment protect and preserve Social Security and Medicare programs for our seniors.”

The ad, which stars airing across the district today, repeats Stefanik’s claim that she doesn’t believe those who are “in or near retirement” should see any changes in these benefits. The only problem: The ad doesn’t define what “near retirement” means in Stefanik’s mind – a point that has gotten her into hot water before.

In fact, it was Stefanik’s reluctance to offer any specifics on that key point that led her to walk away from reporters at her own press conference back in August – the very press conference Woolf highlighted in his ad.

In her ad, Stefanik takes a swipe at Woolf (without mentioning him by name, of course), saying: “(M)y opponent has no proposal to modernize these programs so that they exist for my generation and your grandchildren’s.”

Moody’s: Medicaid Waiver A Credit Positive

A report released on Friday by Moody’s Investor Services found the approval of an $8 billion federal Medicaid waiver is a “credit positive” for hospitals.

New York last month received its long-sought Medicaid waiver, which Gov. Andrew Cuomo’s office, as well as New York City Mayor Bill de Blasio, insisted was needed to aid troubled hospitals.

The state had long argued it was due to receive the waiver due to reforms made by Cuomo’s Medciaid redesign.

From the Moody’s report:

“The approval of the waiver is a credit positive for Moody’s-rated hospitals and health systems within the state of New York. The funds will provide an additional source of revenue for hospitals at a time when they are facing reduced reimbursement from Medicare and Medicaid, lower commercial rate increases, and pressure from all payers to drive down costs and reduce avoidable hospital utilization.”

The waiver is most likely to impact safety-net providers that have successfully met a stated cost reduction and process improvement benchmarks under the Delivery System Reform Incentive Payment (DSRIP) program.

DOH: More Than 865K Enrolled In Health Exchange

With the deadline to enroll in a health insurance plan passed, the state Department of Health says 865,487 New Yorkers have enrolled through the state’s health exchange and 1.2 million have completed applications since Oct. 1.

With that pace, New York is on track to meet or exceed the goal of having 1.1 million registered through the exchange by the end of 2016.

“Year one on the Marketplace has been great success, and we’re thrilled that more than 865,000 New Yorkers have enrolled in quality, low-cost insurance,” said Donna Frescatore, executive director of NY State of Health. “Under the leadership of Governor Cuomo, hundreds of thousands of New Yorkers to have the peace of mind and security that come with having quality, affordable health insurance. Going forward, we will continue to help individuals, families and small businesses across the state to access the insurance coverage they need.”

According to the Health Department, 39,000 people registered in the marketplace alone before the end of open enrollment for individuals.

Though Monday was the deadline to enroll for individuals and families, the state’s exchange will allow for additional assistance for those who have taken steps to apply for coverage but are yet to complete the enrollment process.

All applications and enrollments in health plans must be completed by April 15.

Nationally, the Obama administration reported nearly 7 million people enrolled.

DOH: More Than 700K Enrolled In Exchange

The state’s health insurance exchange has enrolled 717,207 in coverage since it was launched since Oct. 1, according to numbers provided by the state Department of Health on Monday.

Meanwhile, more than 1 million New Yorkers have completed applications, the DOH reported.

Despite the glitches in the roll out of the health exchange and Obamcare nationally, New York officials have touted the relative success of the state’s system.

New York was named the winner of the 2014 CBC Prize for Public Service Innovation, an award given by the Citizens Budget Commission.

“New York State has distinguished itself by creating NY State of Health, which has excelled while other state Marketplaces and the federally facilitated Marketplace have faltered,” said CBC President Carol Kellermann. “New York’s initiative provides an extraordinary public service through an innovative use of technology and an impressive array of consumer services.”

Senate lawmakers, however, noted problems with out-of-network costs in the health exchange as well as a lack of Spanish-language options that administration officials pledged would be addressed.

After Botched Sign Ups, Empire Blue Cross Blue Shield To Offer Free Coverage

The thousands of policyholders who experienced issues with enrolling in Empire Blue Cross Blue Shield through the state’s health insurance exchange will receive three weeks of free coverage.

Gov. Andrew Cuomo announced the agreement with the insurance giant Sunday morning, which comes after the state’s top insurance regulator, Department of Financial Services Superintendent Ben Lawsky began a probe into concerns that Empire was mailing ID cards and bills late.

Attorney General Eric Schneiderman had opened an investigation into complaints of Empire’s coverage last month as well.

“Empire did the right thing by working to address these issues and delivering relief to consumers,” Cuomo said in a statement. “We will continue to work vigilantly to ensure that consumers receive the high standards of care and service that they deserve from their insurance companies.”

As part of the agreement struck with the state, the company also pledged to spend $2 million promoting enrollment in the state’s insurance exchange marketplace, the system devised as part of the roll out of the federal Affordable Care Act.

It is unclear how many consumers were impacted by the problems surrounding Empire’s enrollment.

The Department of Health reported last week that 657,000 New Yorkers have completed applications for insurance while nearly 381,000 have formally enrolled for coverage.

Shah Makes Case For Medicaid Waiver

New York needs the federal government to approve a $10 billion Medicaid waiver from the federal government or hospitals across the state could close.

That was the message from Department of Health Commissioner Nirav Shah after Gov. Andrew Cuomo on Tuesday gave his budget presentation for the 2014-15 fiscal year.

The waiver is key, since Cuomo is counting on that waiver in order to keep state spending at a 1.7 percent increase and fund his property tax rebate proposal.

Essentially, the administration is trying to seek permission from the federal government to take the waiver to reinvest it in savings taken from growth estimates taken from recommendations of the Medicaid Redesign Team.

The talk from Shah — it is not common for department heads to speak at the budget presentation — is the most direct to date from a state official on the need for the waiver, which the state applied for a year and a half ago.

“To transform failing hospitals, expand primary care and get the right mix of community based services, the federal government needs to approve the $10 billion federal Medicaid waiver we submitted 18 months ago,” Shah said.

The DOH commissioner said the most dire consequences could be in Brooklyn, where three hospitals are at risk of closing.

“The reality is this: If the federal government continues to delay our waiver hospitals in Brooklyn and statewide will close very soon,” Shah Said. “It’s a simple fact: the unreasonable delay is endangering New York’s entire health care system, not just for hospitals in Brooklyn, but throughout the state.”

Medicaid spending in his year’s budget — with federal, state and local spending combined — is projected to reach $58 billion.

DOH: Nearly 100K Sign Up For Exchange Since Dec. 24

There are now 587,486 New Yorkers who have completed applications to enroll in the state health insurance exchange marketplace, according to the state Department of Health.

Since the exchange went on line Oct. 1, 328,796 have enrolled for coverage in the exchange.

Since Dec. 24, there have been 98,172 who have been enrolled, according to health department officials.

“Activity on the NY State of Health site remains high, as close to 100,000 New Yorkers enrolled for quality, low-cost health insurance since December 24,” Donna Frescatore, executive director of NY State of Health, said in a statement. “We are very pleased with our overall results to date as well, with almost 330,000 enrolled, and more than 587,000 people have completed applications since the October 1 launch of the Marketplace.”

Frescatore touted the number of enrolled in the health exchange marketplace at a Senate hearing earlier this month.

Republican lawmakers, however, questioned the burden the federal health care law was placing on businesses and the availability of out-of-network care.

Health Department Details Enrollment In Exchange

The state Department of Health on Monday released an 11-page report detailing statistical enrollment information for the health care exchange.

The report breaks down enrollment by demographic and by private health care plan.

Broadly, there are 230,624 people enrolled through Dec. 24, with 168,999 enrolled in private insurance plans.

Those enrolled under the Medicaid program, which was expanded by the federal health care, acount for 61,625.

The data represents those who enrolled from Oct. 1 through Dec. 24 in order to qualify for coverage beginning Jan. 1.

“The results show strong activity throughout the state and across many important measures such as age, plan activity, newly insured, types of plan options chosen, and others,” Donna Frescatore, executive director of NY State of Health, said. “From October 1 to December 24, more than 230,000 New Yorkers enrolled in quality, low-cost coverage through the NY State of Health marketplace. We are on track to meet, if not exceed our goal of 1.1 million by the end of 2016.”

Around the state, 37 percent of those enrolled live in New York City, while 21 percent live on Long Island. The Capital Region and the mid-Hudson Valley is conflated into one region, with 20 percent of enrollees coming from those areas.

The Senate held a hearing earlier in the day on the implementation of the health care measure and the issues with exchange, including out-of-network coverage.

December 2013 Enrollment Report_Jan 13 2014 by Nick Reisman