OPINION: Gov. Cuomo, Make Insurance Pay Its Fair Share

June 30, 2021 | ACTS in Albany

Times Union
by Steve Sanders

If there is such a thing as a “no brainer” for the Governor, then mandating insurance coverage and more clinical help for very young children with disabilities would surely be it.

These services are embodied in the state’s Early Intervention Program which was created back in the 1990’s to serve toddlers from birth to age three. Like programs for Pre K special education and public school, such services are free to parents whose children are diagnosed with a disability. It is paid for by commercial insurance or Medicaid for those families with coverage. For families without insurance the state and counties share the cost and reimburse the service providers.

Sounds like an ideal construct. Children get help to remediate their problems as toddlers saving the state and local governments $hundreds of millions in avoided and more complex costs later on. And 70,000 parents don’t have to worry about how to access and pay for their children’s needed help. What could go wrong?

Enter the lobbyists for private insurance companies. Their job is to protect their clients from paying their fair share of the cost of Early Intervention for the families who they insure.

These companies have evaded their responsibility since the inception of the Early Intervention Program. They are very good at collecting their premiums but not so good at paying for necessary services billed to them. Sound familiar? They find creative ways to deny nearly 85% of such claims year after year.

The result is that of the $700M annual cost, insurance only pays about $13M which amounts to a minuscule 2%. Whatever claims insurance rejects, the state and counties must pay the difference to the tune of tens of millions of dollars in added costs every year. Ultimately New York taxpayers foot the bill.

This year the Legislature said “enough already” and passed a bill REQUIRING commercial insurance to cover Early Intervention costs, as was always intended. The measure calls for insurance to reimburse about 50% of what is billed to them. Government insurance in the form of Medicaid historically has paid about 70% of claims submitted to it while commercial insurance approves only 15%.

Insisting that the insurance industry finally pay their fair share would allow providers to avoid the futile but expensive and time consuming efforts to pry loose payments from those recalcitrant companies and enable them to focus on clinical help for at risk kids while also saving the state and local governments $millions each year.

A “no brainer” right? No, not when offending the deep pocketed insurance industry.

This sensible and necessary legislation now awaits the Governor’s decision to approve or veto the bill. The Insurance lobby can be counted on to strenuously oppose this reform using all their resources to convince the Governor that the State and Counties should continue to subsidize them as they deny payment for legitimate claims.

How will this end? Sad to say, but sometimes the Governor’s desk is where good public policy ideas go to die in service to the special interests of well-heeled industries

-Mr. Sanders, a resident of Troy, is Executive Director of Agencies for Children’s Therapy Services. He was an Assemblyman for 28 years.