Cuomo: Executive Order An Option for Health Exchange
By Dan Levy WNYT March 25, 2012
ALBANY – The deadline for the state budget is April First. On Saturday night Governor Cuomo said there are still big issues on the table that could determine whether or not there’s an on-time budget for the second straight year.
“What’s most important to me is that I get a good budget,” the governor told reporters. “Not necessarily an on-time budget but a good budget.”
Of course what constitutes a good budget is the subject of daily and constant debate at the State Capitol. What the governor said on Saturday is that significant progress has been made and he doesn’t see any roadblocks to an on-time budget, however…
“If there is a roadblock, if there is a point of irreconcilable differences where the legislature says, “I can’t do this”, and I say, “I can’t live without this”, then I would go to extenders.
If that were to happen, the governor believes he’d be in a better bargaining position. He’s also determined to make sure there are no new taxes and he wants the $132 billion spending plan to remain within a 2% spending cap.
The governor is also a strong proponent of a health insurance exchange, although if that can’t get done in the context of a budget, he feels there are other options.
“I’m seeking legislation,” Cuomo points out, “Senate Republicans may not be willing to pass it in the budget. If they’re not willing to pass it in the budget, one of the options I’m considering is to do it by executive order.”
The governor made those comments to reporters after addressing the Somos El Futuro Spring Conference, put on by the Legislature’s Puerto Rican and Black Caucus, taking advantage of that setting to announce a big change in his administration by nominating longtime Assemblyman Peter Rivera (D – Bronx) to become the state’s new labor commissioner.
Cuomo says Rivera is well qualified to harness the energy and the skills of new immigrants and train them to that they can join New York’s work force to help stimulate the economy.
Cuomo Flexible on Health Exchange
Governor Suggests He Could Use Other Mechanisms to Establish a Health Insurance Exchange in Accordance with 2010 Law
By Jimmy Vielkind Albany Times Union March 25, 2012
ALBANY – Establishing a health insurance exchange for the Empire State has cropped up as a flash point in the debate over this year’s state budget, officials said, but Gov. Andrew Cuomo suggested this weekend that he is willing to drop it from this year’s spending plan.
The exchange is required under the 2010 federal health care overhaul – sometimes referred to as “Obamacare” – to allow uninsured individuals or small businesses a place to shop for coverage. If the state doesn’t act, federal authorities will establish an exchange.
“I’m working very hard to make it part of the budget,” Cuomo told reporters after a speech Saturday. “The Senate is resistant to putting it in the budget. I said there are a number of options to accomplish setting up a health exchange.”
One of those is the use of an executive order, Cuomo said, though he acknowledged it would be subordinate to legislative action. The exchange is currently envisioned as being run by a separate public authority, which would take federal money to perform several needed studies and then begin full operation by 2014.
An executive order could only apply to state agencies, which might be less nimble in their execution – and less preferable to insurers. Hence the push.
“It appears the major stumbling block to a budget agreement,” said Blair Horner, a vice president for advocacy at the American Cancer Society’s New York chapter. “It’s the only issue I know of where the Senate leadership and the governor are at loggerheads, and in Albany, nothing gets done until everything gets done.”
Assembly Majority Leader Ron Canestrari, D-Cohoes, noted his chamber passed legislation setting up an exchange in June 2011. He said there was an agreed-upon bill that Senate Republicans walked away from after some members of their 32-member conference complained about supporting a plan that the national GOP has opposed as a central plank.
They have an issue with ‘Obamacare,’ or something, but there’s a lot of money at stake,” said Canestrari.
Still, he and other legislative sources indicated there was no stalemate, but slow, grinding progress. Key staffers worked through the weekend, and many remained at the Capitol Sunday evening.
“We don’t believe there are any obstacles to a fiscally responsible budget that is on-time, if not early,” said Scott Reif, a spokesman for Senate Republicans who were resisting the exchange.
There was still no announced agreement over changes to a $250 million pot of education funding that Cuomo had hoped to dole out as competitive grants; legislators, amid lobbying from school districts and teachers unions, reduced it.
There also was no resolved version of language Cuomo proposed that would give him flexibility to move money between agencies after the budget was adopted, for “efficiencies,” he explained. Legislators felt the request infringed on their constitutional obligations.
The plan through the weekend had been to print at least some budget bills before midnight Sunday, which would allow them to age the required three days before possible action Wednesday.
A budget must be passed by March 31. Without final agreements Monday, Cuomo would be forced to issue “messages of necessity,” which can waive the required waiting period, to gain the political win of an on-time budget. Such messages were used earlier this month to pass a pensions restructuring bill, and have been criticized by good-government advocates.
“There’s still optimism and feeling that it’s happening, but it’s still not all nailed down in print yet,” Canestrari said.
Lawmakers Seeking Freer Hand for Medicaid Docs
By Fred Mogul WNYC News March 25, 2012
State legislators want doctors to be able to prescribe drugs for Medicaid patients with less oversight from the private plans that oversee prescription drug coverage.
Doctors had a freer hand with their prescription pads until last year, when New York turned to commercial companies to manage patients’ prescription drugs, as part of a large movement to reduce Medicaid spending. The state, however, gave those companies – prescription benefits managers or PBM’s – a veto of sorts over doctors on the right to “prior authorization” of prescriptions.
But now, less than a year later, the state Senate, with backing from some key Assembly members, would eliminate the companies’ right to prior approval. The budget provision may or may not survive negotiations with Governor Andrew Cuomo’s staff, but consumer and physician advocates are pushing hard to restore the “prescriber prevails” process.
“Already, physicians feel that the medication approval processes in New York cost them unnecessary time and money as they seek to assure that their patients have access to the medications they prescribe,” said Dr. Neil Nepola, a Staten Island family doctor and president of the New York State Academy of Family Physicians, during budget hearings.
New York expects to get $100 million in Medicaid drug savings from using the PBM’s. As with other forms of managed care, the promise is not only to save money but improve patient care.
“We’re concerned about the patient’s safety,” said Paul Macielak, president of the New York State Health Plan Association. “There is only a very limited number of physician prescriptions that require a prior authorization – a review of whether for that drug and that patient, whether it’s the appropriate dose, the appropriate drug, whether there’s contraindications, whether there’s possible fraud or abuse issues.”
Macielak said PBM’s are mainly focusing on painkillers and certain psychiatric medications. He says of the 3.5 million prescription requests in January, managed care companies made about 30,000 initial denials – less than 1 percent – and most of those were eventually reconciled. He gave as an example a PBM that flagged a prescription of a strong anti-psychotic prescribed to a 7 year old. The drug is not recommended for children.
Macielak also said it could be difficult for the state to achieve its projected savings if PBM’s can’t use prior authorization to deter doctors from over-prescribing. He added that private insurance companies have this mechanism, so there’s no reason Medicaid shouldn’t.
“The program has only just been implemented, and we’re still going through the transition, and we think it’s too soon to undo the program to go back to the ‘good ol ways’ of doing things,” he said.
Assembly Health Committee Chairman Richard Gottfried opposed the switch to PBM’s in 2011 and thinks softening their authority now is a step in the right direction.
“It’s pretty hard to argue that PBM’s are looking out for the patient,” Gottfried said. “They are a business making a profit for stockholders. They are not a professional practicing health care.”