Maya Wiley unveils $1B plan to create city-sponsored health insurance
Democratic mayoral candidates Maya Wiley holds a news conference. | Mark Lennihan/AP Photo
[Ed. - NYPAN endorses Maya Wiley, and has for months]
Mayoral candidate Maya Wiley is unveiling a plan Tuesday that would create city-sponsored health insurance for low-income and undocumented New Yorkers — and dismantle a signature 2019 program created by her former boss, Mayor Bill de Blasio, to address the same issue.
While the de Blasio administration looked to provide free care to people, it was based largely on services the public hospital system already provided. Wiley’s plan aims to get more than a third of the city’s 600,000 uninsured residents covered with traditional insurance policies.
“Health care is a human right and insurance matters. Without it, people suffer more and die younger,” Wiley said in a statement. “Under a Maya Wiley administration, costs will no longer be an impediment to accessing good quality health insurance.”
The $1 billion plan, reviewed by POLITICO ahead of its official release, would provide insurance to about 246,000 people who are ineligible for Medicaid, a publicly supported plan like MetroPlus, or those who cannot participate in the state's public exchange. The campaign's policy analysis found that more than 350,000 people are ineligible for health insurance because they are undocumented or cannot afford it, despite working.
But there are some significant "ifs" in the plan.
The proposal assumes 70 percent of New Yorkers who are eligible will sign up. And the plan’s funding model hinges on cooperation from the Biden administration, the state, hospitals and insurers — a fickle coalition even with Democrats controlling the city, state and federal governments.
Wiley’s campaign is banking on the Cuomo administration to underwrite at least $180 million by allocating part of the surplus from the state's Essential Plan for the program. To do so would require the Biden administration to grant a waiver submitted by the state.
“The Essential Plan surplus is already dealt with in federal law, which is why they haven’t used it up until now. That’s why it’s been piling up,” said Bill Hammond, senior fellow for health policy at the conservative think tank, Empire Center. “That’s not going to be easy to get.”
The plan also hinges on the state Legislature passing a bill that reduces the its indigent care surcharge from 9.63 percent to 7.04 percent, the same rate Medicaid and state government employees claim, according to the proposal. The state collects those surcharges from self-funded plans, among other payers, to fund the Indigent Care Pool — money that is distributed to hospitals based on how much free care they provide to the uninsured.
In addition, the Wiley analysis assumes it can grab $160 million in savings from reducing Emergency Medicaid spending, a program that reimburses hospitals for providing care to people who would qualify for Medicaid if they were citizens and eligible. The state and federal government split the bill and reimburse hospitals for that care, and the plan assumes a portion of the state savings would be directed into the program.
New York’s Medicaid per capita expenditure for an adult under 65 without disabilities is $7,091, which is much higher than Wiley’s allocation of $4,228 per person, but Hammond said he thought the plan was still feasible.
“You can quibble with some of their numbers, but they’re in the ballpark, and although they call it ‘health care for all,’ they make no bones about the fact that they’re going to reach a portion of the uninsured,” Hammond said. “Let’s say the states and the feds don’t come up with the money — the city could come up with a billion dollars.”
The proposal also calls for collecting $143 million to $149 million in funding from Correctional Health Services, which treat the incarcerated, and $100 million earmarked for NYC Care.
Wiley, de Blasio's former counsel, would shift $100 million from NYC Health + Hospitals, which runs a program that has connected 60,000 uninsured and undocumented people to existing services at the public hospitals, and use it to bolster her insurance plan.
Although the city subsidizes about one-eighth of the public hospital system’s budget, de Blasio pumped additional money into the program aimed at closing gaps in care. At the time, he described NYC Care as an effort to steer uninsured people to primary care doctors and away from costly, inefficient emergency room visits.
About $80 million of the NYC Care funds paid for primary care doctors, increasing access to specialty and emergency care, and covering the cost of prescription drugs for patients who can’t afford them, according to a budget document obtained by POLITICO through a public records request. The other $20 million is allocated to the customer service end of NYC Care, including a call center and website, additional staff and membership cards, according to the budget document.
Those dollars would instead be part of the funding that pays for the insurance plan, which would give customers more choice in where they receive care.
People insured under Wiley's plan who still want to seek care at NYC Health + Hospitals will not receive care for free; they’ll become part of the system’s revenue stream, as would other insured patients. Patients could also receive services at private hospitals under the state’s charitable care law, which requires hospitals to allocate a certain amount of resources to low-income patients. Those hospitals could also make payments to boost the fund.
Currently, de Blasio's NYC Care can only be used at NYC Health + Hospitals, while Wiley's insurance plan could be accepted at most hospitals. It also aims to bolster privacy protections by minimizing the amount of information a person is required to disclose. Undocumented people may not be inclined to offer up information to the government in exchange for an NYC Care card.
Under Wiley’s proposal, a nonprofit would manage operations and enrollment, and the city would contract with a third-party administrator like Empire BlueCross BlueShield or EmblemHealth to provide coverage at cost.
“NYC pays the two companies more than $7 billion annually for insuring City employees, retirees, and their dependents,” according to the analysis. “In both cases, the City’s business constitutes more than one quarter of their entire insurance portfolio.”
A self-insured plan would allow a Wiley administration to better manage costs and reduce premiums by as much as four percent, according to the Wiley campaign. It compared the plan to an option offered by 32BJ SEIU, which offers low-cost health care coverage to a similar-sized cohort of nearly 200,000 people.
The sliding-scale plan would cap cost-sharing — deductibles, copays and co-insurance — and premiums up to 10 percent of income. People making $75,000 or more would pay no more than $7,500 a year, while those making $50,000 to $74,999 would pay 7 percent, capped at $5,000 a year. Individuals making $25,000 to $49,999 would pay 5 percent and have their costs capped at $2,500. For those who make less than $25,000 a year, they would not pay anything.
“It seems to be the new dogma on the left: that health care should be free,” Hammond said. “This plan’s going to have copays and premiums and deductibles, which makes this more mainstream."