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Check out the recently released fact sheet from the NY State of Health with great information about health insurance options for student visa holders.

This resource outlines how student visa holders may be eligible for Qualified Health Plans (QHPs), Child Health Plus (CHP), and the Essential Plan (EP). The fact sheet also tells you how your health benefits may impact eligibility for a Student visa.

 Last Updated: July 31, 2017

Last week, the Senate took a series of steps in attempt to move forward with repealing parts of the Affordable Care Act (ACA). On 7/25/17, they voted to start debating new iterations of the American Health Care Act (AHCA), which passed the House in May. The original vote to begin debating was tied at 50-50, but Vice President Pence casted the tie-breaking "yes" vote to move forward with the process. This vote initiated 20 legislative hours of debate, during which votes occurred on two key bills:

• Better Care Reconciliation Act (BCRA): Leading up to this week, there were a few versions of the BCRA (also known as "repeal and replace" bills), which contained much of the same language as the AHCA, but had some key changes that set them apart from each other and the House bill. On the evening of 7/25/17, the Senate voted on a version of the BCRA that included amendments from Senators Cruz and Portman. The Cruz provision was particularly controversial, as it would have allowed insurers to offer less comprehensive plans off the exchange that would not be subject to many ACA regulations. This may have made it much more difficult for less healthy individuals to obtain coverage.

  • Result: The bill failed 43-57.

    • BCRA Links: bill text; section-by-section summary of BCRA (without Cruz Amendment); section-by-section summary of Cruz Amendment
      

• Obamacare Repeal Reconciliation Act (ORRA): This bill is very similar to the 2015 Budget Reconciliation Act (often called the "repeal and delay" bill), which passed both Houses of Congress roughly a year and a half ago, but was vetoed by President Obama. On 7/26/17, the Senate voted on the ORRA, which would have repealed parts of the ACA, but delayed many of the changes for a few years.

  • Result: The bill failed 45-55.

    • ORRA Links: bill text; section-by-section summary.

On the evening of 7/27/17 after the 20 hours of legislative debate, a process called the vote-a-rama began. At this time, the Senate voted on multiple amendments and then took a final vote on the following bill:

• Health Care Freedom Act (also known as the "skinny repeal"): This bill would have repealed the individual mandate, loosened restrictions on Health Savings Accounts and 1332 waivers, and defunded entities that cover certain abortions (including Planned Parenthood), among other provisions. The final vote of this process occurred in the early morning of 7/28/17.
  • Result: The bill failed 49-51.
    • Skinny Repeal links: bill text; section-by-section summary

Looking Forward

This past week represents a major defeat for the Republican leadership in their efforts to repeal and replace the ACA, as the Senate failed to pass any sort of bill. It is still unclear at this point if and when the Senate will renew their efforts; Senate Majority Leader Mitch McConnell (R-KY) has already put health care reform back on the calendar for future consideration, but the Republican leadership has yet to formulate a repeal bill with enough support to pass the Senate. At this point, the ACA remains the law of the land.

Last Updated: July 10, 2017

In many areas of our health care and coverage systems, States have the authority and flexibility to implement policies and programs that cater to their specific populations. As we track the potential changes that may be forthcoming in the new Senate repeal bill, also called the Better Care Reconciliation Act (BCRA), we are also keeping a close eye on changes at the state level.

Below are a few recent key developments in New York (NY):

Executive Order 167

In an attempt to maintain a stable insurance market in NY, Governor Cuomo issued an executive order that disincentivizes insurers from exiting the Individual Marketplace. Effective immediately, most insurers that withdraw their qualified health plans (QHPs) from the Marketplace will face significant restrictions in their other lines of business. Specifically, insurers that withdraw from offering QHPs may not:

• Offer plans in Medicaid, Child Health Plus (CHP), or the Essential Plan, or
• Enter into any new contracts or extend existing contracts with most State entities, unless authorized through a special determination

As this executive order aims to maintain the number of choices available for QHPs in the Individual Market, we will keep an eye on impacts relating to choice of plans over the next enrollment period.

Regulations on access to contraceptive and abortion services

The Affordable Care Act (ACA) requires insurers to cover at least one form of each FDA-approved category of contraception with no cost-sharing. Recently, NY officially adopted a regulation to ensure that this requirement will remain in place for NY, regardless of whether or not it is repealed at the federal level. Additionally, this regulation goes beyond what is required at the federal level by also requiring insurers to cover an initial 3-month supply of contraceptives and up to 12 months of supplies after the initial prescription. This regulation will take effect on August 27, 2017.

NY also finalized another regulation, which will require insurance policies that provide hospital, surgical or medical expense coverage to include coverage for medically necessary abortions without cost-sharing. The regulation also clarifies criteria that qualify certain religious employers to opt out of this requirement, but requires those employers to issue a separate rider (with no premium) that provides coverage for medically necessary abortions. This regulation will take effect on August 21, 2017.

Last Updated: June 13, 2017

The NY State Department of Financial Services recently enacted emergency regulations which clarify that the State will continue to implement protections against discrimination in the health insurance marketplace and maintain the ACA's essential health benefits.

Background: The Affordable Care Act (ACA) requires all non-exempt health insurance policies to include coverage for ten categories of essential health benefits. As passed in the House in May 2017, the American Healthcare Act (AHCA) would give States flexibility to determine the benefits that are considered "essential."

In addition, the ACA also doesn't allow health insurers to charge higher premiums to individuals with pre-existing conditions. The House version of the AHCA would allow States to opt out of this requirement in some circumstances.

New York's Essential Benefit and Non-discrimination Standards: First, the regulations clarify that, regardless of any potential changes to the ACA, New York State's 10 essential health benefits listed below will remain in place:

1. Ambulatory patient services (ex: office visits, dialysis, chemotherapy)
2. Emergency services, such as emergency room, urgent care and ambulance services
3. Hospitalization (ex: preadmission testing, inpatient services, hospital, skilled nursing, and hospice care)
4. Maternity and newborn care (ex: delivery, prenatal and postnatal care, breastfeeding education and equipment)
5. Mental health and substance use disorder services (ex: behavioral health treatment, screening diagnosis and treatment for certain disorders)
6. Prescription drugs, such as coverage for generic, brand name and specialty drugs
7. Rehabilitive and habilitive services and devices
8. Laboratory services, such as diagnostic testing
9. Preventive and wellness services and chronic disease management
10. Pediatric services, including oral and vision care

Second, the regulations state that insurers may "not discriminate … based on race, color, creed, national origin, sex, age, marital status, disability, or preexisting condition." This means that insurers in New York are not allowed to charge someone higher premiums based on any of those factors. New York's long-standing requirement for community rating for insurance policies, which prohibits discrimination in pricing of policies for any of the above reasons, goes beyond the requirements of the ACA.

Looking Ahead: The Senate has not yet released their version of the AHCA and it's still not clear what provisions will be included in the final bill. While some aspects of the House bill would be mandatory for States, many parts of the bill would give States flexibility to respond to new provisions in a way that makes the most sense for their populations. We will continue to update this site with New York's responses as they occur. As of now, this emergency regulation clarifies that New York will continue to protect against discrimination and maintain the 10 essential health benefits.

Last Updated: May 15, 2017

Health Savings Accounts are tax-exempt accounts that people can use to help pay for medical expenses. To qualify for an HSA, you must:

• Be covered under a high-deductible health plan (HDHP)
• Have no other health coverage (with some exceptions)
• Not be enrolled in Medicare
• Not be claimed as a dependent on someone else's tax return

The IRS sets the maximum annual amount that people are allowed to contribute to an HSA and deduct from Federal taxes. In 2018, this amount will increase by $50 for people with self-only coverage and will increase $150 for people with family coverage.

The IRS also sets the definition for what qualifies as an HDHP – the chart below shows how this will change for calendar year 2018.

Last Updated: May 05, 2017

On May 4, the AHCA passed the House of Representatives by a very small margin (217-213 votes). While this represents a major step in the GOP's plan to repeal and replace parts of the Affordable Care Act, the bill still needs to proceed through several more steps before it becomes a law.

What's Next?

The AHCA now moves to the Senate, where another version of the bill will be drafted. At this early stage, we don't know which provisions of the House's bill will make it into the Senate version and which provisions will be cut. We do know, however, that the Senate has stricter rules on the types of provisions that can be included in a budget reconciliation bill (see the January 17th post below for more details on this process).

After the Senate drafts their version of the AHCA, they will vote on it – a simple majority will allow the bill to move to the next step in the process. If the House and Senate versions of the bill are different, a committee may then have to create another bill that compromises the two versions. Once the compromised version is complete, each house would again have to vote and pass the new bill in order for it move on to the next phase. Once the bill passes Congress, it requires the President's signature before it becomes a law.

Overall, yesterday's passage of the AHCA in the House is a significant step towards passing the AHCA, but there is still a long way to go before we know if and how the bill will change our healthcare system. Until then, the Affordable Care Act is still the law of the land, so it is important to get coverage now!

Be sure to check back soon for updates as this process develops.

Last Updated: May 04, 2017

Health and Human Services (HHS) recently finalized a Federal Rule that will change the health insurance marketplace in several ways. Below are some highlights:

Open Enrollment Periods

• Prior to this rule, annual Open Enrollment Periods have spanned from November 1st – January 31st
• The Market Stabilization Rule cuts this period in half. The Open Enrollment Period to get coverage in 2018 will span from November 1, 2017 – December 15, 2017
  - New York State has the option to extend this shorter Open Enrollment Period, but it's unclear if and how long it may be extended.
• Takeaway: Plan to renew your health insurance plan before December 15, 2017 to ensure you have coverage for next year.

Special Enrollment Periods (SEPs)

• Certain life circumstances qualify individuals and their families to enroll outside the open enrollment period through SEPs. This allows consumers to obtain or adjust their health insurance to address major changes in their life circumstances.
• The Market Stabilization Rule places several restrictions on SEPs including restrictions on changing metal-levels and stricter rules on SEPs for marriage and permanent moves.
• Takeaway: Even with the new restrictions, there are still a variety of SEPs available for people who experience life-changing circumstances. When enrolling through an SEP, ask your enrollment assistor what options you have.

Past-due premiums

• This final rule will allow health insurance issuers to deny coverage to individuals who fail to pay past-due premiums in the year before they apply for coverage.
  - This only applies if someone fails to pay their premiums and wants to re-enroll in coverage with the same insurer (or group of insurers). If someone applies
  for coverage through a new insurer, the new insurer is not permitted to deny coverage for any reason.

The Market Stabilization Rule also made changes to the following topics:

• Actuarial Value Variation
• Essential Community Providers
• Network Adequacy Review

Read an in-depth analysis of the Market Stabilization Rule

Last Updated: March 28, 2017

On Friday 3/24/2017, the American Healthcare Act (AHCA) was pulled from the floor of the House before members could vote on the bill. As we have described in recent posts, this bill represented the new administration's first legislative attempt to repeal and replace parts the Affordable Care Act (ACA). Despite efforts from the White House and Congress, Friday's actions indicated that there was not enough support to pass the bill, and that the leadership will now shift their focus to issues other than healthcare.

In a press conference Friday evening, House Speaker Paul Ryan stated that the ACA is the law of the land, and will remain that way for the foreseeable future. Even though Friday symbolized a milestone setback in the efforts to repeal and replace the ACA, it's important to remember that changes can still be made to the implementation of the ACA and to our healthcare system via rules, regulations, and executive orders.

We will continue to update our website with new developments as they occur.

Last Updated: March 17, 2017

On March 6, the American Healthcare Act (AHCA) of 2017 was introduced in Congress. Sponsored by House Speaker Paul Ryan, this bill represents the first wave of legislation in the Republican leadership's attempt to repeal and replace many components of the Affordable Care Act (ACA). This bill also seeks to make several changes to the financing and operation of the Medicaid program. As of today, the bill has moved past three committees in the House and will likely be reviewed by the Rules Committee within the next week. The overall timeline is still uncertain, but many of the bill's advocates hope to see a vote in the House within the next few weeks. If the AHCA passes the House, the bill will go through a similar process in the Senate and ultimately require a signature from the President.

The bill text has two parts, as it was delegated to the Energy and Commerce and Ways and Means Committees in each branch of Congress. You can use the highlighted links to read the full text and section-by-section summary for the Energy and Commerce part the bill and the full text and section-by section summary for the Ways and Means part of the bill.

If the American Healthcare Act of 2017 becomes a law, there will be many changes to our healthcare system. The bill would immediately repeal the individual and employer mandates and make changes to Medicaid, premium tax credits and cost sharing subsidies, healthcare financing and a variety of other provisions of the ACA. It's important to note that despite these changes, many key aspects of the ACA will remain unchanged including pre-existing condition protections, allowing dependents up to age 26 to remain on their parents/guardians' coverage, essential health benefit requirements for Qualified Health Plans, and the ban on annual and lifetime limits.

The following links can help you gain a richer understanding of the components of the AHCA:

• Kaiser Family Foundation: Summary of the American Healthcare Act
• The New York Times: New York Times: The Parts of Obamacare Republicans Will Keep, Change or Discard
• Healthcare for All New Yorkers: What Does ACA "Repeal and Replace" mean? How would it work?

Be sure to check back soon for updates as this process develops.

Last Updated: January 17, 2017

As the new federal administration gets set to govern, the conversation about potentially repealing the Affordable Care Act (ACA) and the impact for New York is heating up. Those who favor repealing the ACA may try to get rid of parts of the law through a process called, "budget reconciliation," which involves a procedure where the House of Representatives and the Senate have to agree on changes to legislation that involve federal spending, revenues, and the debt limit. During the week of January 9^th, 2017 the first step to this process began – a budget resolution passed the Senate and the House of Representatives with instructions for committees in Congress to draft and submit legislation for a new budget reconciliation bill by January 27, 2017.

It's important to note that many changes under this budget reconciliation process may not happen right away. The most recent attempt to change the ACA with this process was proposed through a budget reconciliation bill passed by Congress in 2015 and vetoed by President Obama. This bill would have phased out most key programs and benefits established by the ACA over two years.

On January 4th, 2017 Governor Cuomo issued a press release reporting the potential impacts of a repeal of the ACA, based upon the State's analysis of the 2015 budget reconciliation bill. The press release revealed that repealing the ACA would put 1,609,209 NYC residents at risk of losing coverage and result in a total loss of $433,294,428 in annual funding for NYC. Keep in mind that change is not happening overnight – it's very unlikely that you will lose coverage or benefits in 2017 if you enroll before January 31st.

Be sure to check back soon for updates about potential ACA repeal.