Frequently Asked Questions about New York Health

December 13, 2014


Q: Doesn’t the ACA fix health care?

A: The Affordable Care Act is making insurance available to more people, and has led to 900,000 New Yorkers getting coverage that they otherwise wouldn’t have had. But many health plans have narrow restricted provider networks, rising premiums, high deductibles and co-payments that shift a large part of the cost to the individual. The marketplace is so complicated because the system requires an income assessment to see who is eligible for financial assistance, and then requires people to select from multiple plans and “tier levels.” Employers continue to shift more of the cost of coverage to their workers, or drop coverage entirely, a long-running trend before the new law.

The basic flaw of the ACA is that it leaves insurance companies in charge – with high premiums, high deductibles, and co-pays; too much control over which doctors or hospitals we can go to and what care they can provide; and high administrative costs and profits.

Q: Won’t New York Health be just like every other health plan, only bigger and more powerful?

A: Not at all. By law, it will not be limiting who you can go to for care and will not be dictating health care decisions. Financial barriers won’t limit your ability to get care when you need it. Because wealthy and well-connected New Yorkers will be in the same plan with the rest of us, you can be sure it will be a better plan – better for patients and for health care providers.

Q: Won’t this be a huge new tax increase?

A: Our total price tag will go way down, because we won’t be paying for inefficient insurance company middlemen. We won’t be paying for premiums, deductibles, copays, and out-of-network charges. Property taxes will go down because local governments won’t pay for Medicaid and health care for their employees will be cheaper. The bottom line is New Yorkers will have more money in our pockets and better health care for our families.

Q: Can I buy private insurance?

A: Under this proposal, private insurance that duplicates benefits offered under New York Health could not be offered to New York residents. But a private market will remain for coverage of benefits that might be outside the NY Health program, like cosmetic surgery. •

Q: Is long-term care covered?

A: Long-term care (e.g., home health care, nursing homes) will be covered, but the specifics are to be developed later.

Q: What about retiree health benefits?

A: Most retirees will simply be covered by New York Health, plus Medicare. A plan will be developed to deal with retirees who move out of state.

Q: What if a person moves out of state?

A: New York Health covers New York residents.

Q: What if a person is temporarily out of state and needs care?

A: New York Health will pay for health care while a New York resident is temporarily out of state and needs health care there. It will also pay if there are special reasons why someone needs health care from an out-of-state provider.

Q: How will this affect union health plans?

A: New York Health will be at least as comprehensive as any employer- or union sponsored coverage, with no deductibles, co-pays or limited networks. Instead of negotiating for health benefits, unions will be able to put all their efforts into negotiating for higher wages and other issues. Unions that have negotiated low or zero worker contributions to a health plan will negotiate the same arrangement for the worker share of the payroll assessment. Union-sponsored clinics will be able to continue serving union members – and anyone else – and be paid by New York Health.

Q: How much will doctors and hospitals get paid?

A: New York Health will set up payment systems (hopefully moving away from the fee-for-service model that just rewards volume, not value) and levels of payment. Health care providers will be allowed to form organizations that will collectively negotiate with the plan over payment and other issues. The most important guarantee that payments will be adequate is that all New Yorkers – rich and poor alike – will be in the same publicly-accountable plan.

Q: What doctors and hospitals will I be able to use?

A: There will be no restricted network of providers. Every health care provider in the state will be able to participate, and patients can go to whichever provider they choose. •

Q: Will doctors and hospitals be required to participate?

A: No. However, there would be no other insurance coverage to pay a non-participating provider.

Q: Will doctors and hospitals be able to charge more than New York Health will pay for specific services?

A: No. If a provider is paid by New York Health, the patient may not be charged more (no “balance billing”).

Q: How much will we have to pay for New York Health coverage?

A: The average family will pay a lot less than we do now. The total cost of coverage will go down because we won’t be paying for insurance company overhead and profit that eat up 20-30% of the health care dollar. Basing payments on the ability to pay means less of a burden on most households and most employers – especially small businesses and start-ups. Most of us will have more money in our pockets.

Q: What part of the assessment will my employer pay?

A: Employers pay at least 80% of the assessment on payroll, and employees up to 20%. Employers can agree to pay all or part of the employee’s share (e.g., through collective bargaining).

Q: My employer now pays the whole premium for my coverage. Will I now have to pay 20% of the payment?

A: Employers can pay all or part of the employee’s share, just as they can now for premiums. It will be easier to bargain to get them to do that, since the total cost will be less than it is now.

Q: What if I am self-employed or a sole proprietor?

A: You will pay the entire contribution, just as you now pay your whole insurance premium.

Q: What about Workers Compensation costs and benefits?

A: Right now, the bill does not change Workers Comp. But the New York Health plan will develop a proposal to move work-related health care costs into New York Health, and consider whether there should be an experience-rating charge to employers to encourage workplace safety. •

Q: I have a good health plan. Why would I want to trade it for New York Health?

A: New York Health will save families thousands of dollars in premiums, deductibles, co-pays, and out-of-network charges, and provide better and more comprehensive coverage.

Q: Is universal health insurance “socialized medicine”?

A: No. New York Health would not tell your doctor or hospital how to care for you, and they would not be working for the government. That would be “socialized medicine.”  New York Health just pays the bills. Like Medicare, which is public health coverage but is not “socialized medicine.”

Q: Won’t this result in rationing and long waits like in Canada?

A: No. In the U.S., the current system rations health care. People who can’t afford care (if your coverage has a high deductible, or you’re uninsured, or the provider you want to use is out of network) often have to delay care or go without it. Every year in America, tens of thousands go bankrupt or get sicker or die as a result. In traditionalMedicare – a single-payer system – there is no rationing or delaying care.  There is no rationing of health care under Canada’s single-payer system. At times, there have been delays in getting some services in Canada, but not because their health plan doesn’t provide excellent coverage. It’s because of management issues in their delivery system, largely because it’s hard to maintain high-volume hospitals in a country with a small population spread out over huge distances.

Q: Who will run the health care system?

A: Under New York Health, patients and their health care providers will be in charge.  Today, our health care is largely controlled by our insurance companies, which tell us who we can go to for care and what services they will pay for. There will be none of  that in New York Health. There will be no limited provider networks. You choose your doctor or hospital. You and your health care providers make the health care decisions.  New York Health just pays the bill.

Q: Wouldn’t it be better to have a national system? Why should New York be doing this?

A: It would be great to have truly universal coverage in every state. But we can’t wait for Washington. A progressive state like New York can and should take the lead. The states have long been the “laboratories of democracy.” Given the current makeup of Congress, it’s unlikely that any major national health care legislation will be enacted in the near future. •


3 Responses to “Frequently Asked Questions about New York Health”

  1. Ron Curtis on December 13th, 2014 6:32 pm

    Not sure we gain efficiency by shifting administrative functions (currently performed by insurance carriers) to the public sector. We do cut executive costs and carrier profits.

  2. bharrisonspny on December 14th, 2014 3:10 am

    What is the basis of your conclusion? Would you please sight your source?



  3. Ricardo Valdes on December 14th, 2014 5:22 am

    This FAQ states:

    “The most important guarantee that payments will be adequate is that all New Yorkers – rich and poor alike – will be in the same publicly-accountable plan.”

    Given that the rich and poor now have the exact same health plan, why would anyone want to go to Bellevue downtown, when they can now go to Lenox Hill hospital on the Upper East Side? If someone is buying a plane ticket, and is told that first class and coach seats cost the same amount – which seat do you think they are going to choose?

    This FAQ states:
    “New York Health would not tell your doctor or hospital how to care for you,”

    “You and your health care providers make the health care decisions. New York Health just pays the bill.”

    This is not believable. What is believable is, “prior authorization is required”, sorry – denied. If the above is true, then doctors and hospitals can just order whatever they want, with no restrictions, and “New York Health just pays the bill.” ha ha ha – I did read somewhere on this site that “medically necessary” treatments are covered. “Medically necessary” is a term that means someone else besides the doctor and hospital decides what is necessary.