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New York’s underinsured now have greater access to preventive health care at the city’s hospitals because of a new state law standardizing financial aid policies and forcing hospitals to tell patients about that financial aid upfront.

City public health advocates think the law, which took effect Jan. 1, is such a radical departure from past practices, and such a benefit to poor New Yorkers, that nearly a dozen community groups joined the New York Immigration Coalition (NYIC) last week for a press conference to publicize the changes.

“A lot of people have been avoiding health care because they fear the medical debt that would come along with it,” said Adam Gurvitch, NYIC director of health advocacy. Holding an event to announce the law’s implementation was important, because the health care system will change only “if people get the word” about what their rights are, Gurvitch said.

So what does the new public health law actually say? First, it establishes a sliding scale to spell out how hospitals should bill the underinsured – those with no medical insurance, with little insurance, or without the means to make co-pays.

“As the patient’s income gets lower, the hospital discount gets steeper,” explained Gurvitch. And those discounts are no longer just disparate policies at different hospitals, but now a single policy dictated by the new law.

For example, for patients with income between 101% and 150% of the federal poverty level, which is $9,800 for a single person, the hospital now is allowed to bill only on a sliding fee schedule, and to bill no more than one-fifth of what it would pay an insurer.

For patients with incomes at or below 100% of the federal poverty level, the hospital is limited to collecting a “nominal payment amount.” That small fee has yet to be set by New York State Department of Health.

A second notable provision of the new law is that it requires hospitals to inform patients about the availability of this financial aid. In particular, general hospitals with 24-hour emergency rooms are required to tell patients they have the option of financial aid when patients register for treatment, as well as in all bills and statements sent to patients.

The upshot of all of these new hospital guidelines is that New Yorkers lacking medical insurance will face less of a financial burden and, public health advocates say, can feel more comfortable seeking out routine medical care.

Until now, the advocates say, hospitals have been able to charge patients without health insurance high rates – even higher than what they charge patients with Medicaid or a private insurance plan. This has led to uninsured patients seeking out non-emergency care in the emergency room, or waiting out medical problems until emergency treatment is the only option.

Advocates such as Gurvitch say that hospitals have erected barriers for uninsured patients in other ways, such as by requiring upfront payments for non-emergency treatment. By contrast, the new law “really opens the door for non-emergency care” to the underinsured, he said.

The pre-January system at New York City’s hospitals also has led to medical debt for the New Yorkers who can least afford it. At Thursday’s press conference, Urban Justice Center legal staffer Annie Lai said, “We don’t think any family should have to go into financial ruin because of something that was medically necessary.”

Advocates such as Lai believe the new system will make it easier for uninsured patients to pay their medical bills, reducing the impact of medical care on their finances and, in turn, encouraging more of them to seek out preventive care. According to Gurvitch, the law covers all hospital services, such as treatments for asthma, diabetes and mental health.

In a statement, the Greater New York Hospital Association, which represents nearly 300 public and private hospitals in the metro area, backed the new rules. GNYHA “and its member hospitals support this legislation … As all requirements in the bill are minimum requirements, nothing prohibits hospitals from providing more ‘charity care’ to more people … hospitals have long been deeply committed to caring for the poor and uninsured 24 hours a day, seven days a week, regardless of their ability to pay.”

The law, which was signed last year by former Gov. George Pataki as part of the state budget, is more than three years in the making, Gurvitch said. He said the cause of financial assistance to the underinsured was championed by Assemblymember Pete Grannis (D-Manhattan) and City Council Speaker Christine Quinn, in addition to numerous groups, such as the Legal Aid Society and NYIC.

While the law applies to both public and private hospitals, it is directed more toward private ones, says Judy Wessler, director of the Manhattan-based Commission on the Public’s Health System. That’s because the Health and Hospitals Corporation, the public hospital system in New York City, already is successful in handling uninsured patients, she said.

Implementation of the new law is “in its infancy stage,” said Wessler, with the state Department of Health still figuring out some of the details of the law, such as what the nominal fee will be for the poorest of the uninsured.

– Rachel Nielsen

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