Union kicks off statewide combat in opposition to secret medical insurance contracts

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ALBANY — When the 32BJ union well being fund crunched the numbers on how a lot its members have been paying for colonoscopies, knee replacements and child deliveries, it was shocked to study they have been paying 358 p.c extra at New York Presbyterian hospital than these on Medicare insurance policies.

Sara Rothstein is the director of the 32BJ well being fund, which supplies medical insurance for 190,000 members and members of the family of the Service Staff Worldwide Union, Native 32BJ. Rothstein mentioned the well being fund analyzed prices for its members for a few of the commonest surgical procedures, discovering that prices have been exorbitantly inflated.

“That was form of the 1st step. We realized from the info that there was an issue,” she mentioned.

That drawback, the well being fund got here to imagine, was anti-competitive language included within the secret contract agreements between New York Presbyterian and Empire Blue Cross Blue Defend, the insurance coverage firm that acts as an administrative intermediary in 32BJ’s coverage. The 32BJ well being fund final week eliminated New York Presbyterian from its protection community, a big step in opposition to one of the vital prestigious hospitals within the metropolis.

New York Presbyterian didn’t instantly reply to an emailed request for remark Sunday. 

As a result of the confidential contracts between insurance coverage corporations and hospitals are simply that — confidential — it is unattainable to know the way widespread the apply is of including anti-competitive language to drive up costs, so 32BJ’s findings might be an early indicator of a broader drawback. However Rothstein and union management have come to imagine that the well being fund’s expertise with New York Presbyterian might be a canary within the coal mine. 

“What we’re looking for to do in Albany is to ban the contract clauses that give hospitals an unfair negotiating benefit,” Rothstein mentioned, which impacts extra than simply 32BJ, but in addition different unions, non-public companies and public staff. She famous that Empire Bluecross Blue Defend — 32BJ’s insurance coverage administrator — can be the insurer of public staff for each town and state. 

So the union is now pushing the Hospital Fairness and Accountability Regulation, or HEAL Act. The invoice was unveiled in a New York Metropolis press convention Sunday afternoon.

Due to the confidential offers, it is unknown precisely how pervasive the anticompetitive language within the contracts is, Rothstein mentioned, “however one of the simplest ways to inform that they don’t (have it) is to cross the laws we’re proposing.”

With lower than per week remaining within the 2021 Legislative Session, advocates say the invoice’s unveiling is simply the beginning of an extended combat to get the invoice handed into legislation that’s more likely to prolong into subsequent 12 months’s session. 

“Contracts could be very sophisticated, however let me make this straightforward: That is about who has the ability, and it isn’t you proper now. It isn’t the employee, it isn’t the union. It’s the hospital and the insurance coverage firm,” Assemblywoman Catalina Cruz, a Queens Democrat, mentioned on the occasion. 

The invoice would convey elevated accountability into the negotiations between hospitals and the insurance coverage middlemen, with the aim of ending what advocates say are anti-competitive practices that drive up costs and guarantee much less companies can be found general. The aim of the invoice could be summed up with these pasted on an indication on the press convention: “It shouldn’t value an arm and a leg to repair an arm and a leg.” 

“The issue is uncontrolled hospital pricing by hospital techniques which can be offering companies to New Yorkers, and clearly I’m speaking on behalf of my members, we’re laden with these excessive hospital prices,” mentioned Kyle Bragg, the union president. “We don’t know the way they’ve arrived at these costs. As they negotiate these contracts with the third celebration suppliers, with Blue Cross, we’ve no inclusion in that course of. We’re not represented within the bargaining.”

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