Did you hear the sound of the wind picking up this morning? It was not the wind, but a collective sigh of relief from New Yorker’s with preexisting conditions.
Governor Andrew M. Cuomo is not waiting to see what the future holds for the ACA, better known as Obama Care. In a pre-emptive move against the federal government’s decision to repeal the ACA and install the American Health Care Act, he signed an emergency order to keep the essential protections in place that were covered by Obama Care. If Congress passes the AHCA, it would allow states to “opt out” of the essential coverage and charge premiums based on preexisting conditions.
Cuomo mandates that health insurance carriers do not discriminate against New Yorker’s with preexisting conditions, age, or gender. These actions will also ensure that each New York resident has coverage for what is referred to as “essential coverage.” These protections will cover individual policies, small group policies, and marketplace policies.
In addition to the essential health coverage listed below, regulations were finalized to ensure that commercial insurers provide contraceptive drugs and devices without co-pays, coinsurance, or deductibles. They also state that all medically necessary abortion services are covered by commercial insurers without co-pays, coinsurance, or deductibles.
10 Categories of Essential Health Care (please note, this is not an all-inclusive list)
- Ambulatory patient services (office visits, radiology, chemotherapy, abortion services, hospice, diabetic, etc)
- Emergency Services & Urgent Care
- Hospitalization, pre-admission testing, inpatient surgical services, skilled nursing
- Maternity and newborn care
- Mental health, substance abuse services, behavioral health, autism screening and treatment
- Prescription Drugs
- Rehabilitative services and devices
- Laboratory services
- Preventive and wellness services
- Pediatric services, including oral and vision care
For an insurer that wishes to offer policies to the individual and group market in New York State, they must abide by these rules and protections in order to maintain their license in New York. For those insurers that wish to withdraw from offering these plans in the State Health Marketplace, they will be banned from future participation with programs such as Medicaid, Child Health Plus, and the Essential Plan. These heavily subsidized programs are generally a profit center for the insurance companies. Exclusion of these plans would likely hurt their bottom line, therefore acting as an incentive to not pull out of the marketplace. In addition to not being able to participate in these subsidized programs, an insurer that wishes to pull out of the marketplace will be banned from contracting with any other State Agency.
“We will not stand idly by as ultra-conservatives in Washington try to roll back the progress we have made to expand access quality, affordable health care, putting our most vulnerable New Yorker’s at risk,” Cuomo said.
New York has historically been at the forefront of patient protections prior to the ACA compared to other places around the nation. As a state that is heavily democratic, Cuomo’s move doesn’t come as a surprise. Some of the protections in the order he signed this morning have already existed in New York. However, this sends a signal that New York will protect own, regardless of what happens in Congress.