Uber, Lyft Teaming with Health Providers to Offer Non-Emergency Medical Rides

Uber and Lyft have announced recently that they are offering a service for  non-emergency health care to provide rides to medical appointments.    Uber Health is similar to the existing Uber service but it works with health providers who can schedule and pay for rides for patients.   Providers can pass the costs onto patients but many are assuming the costs.  Transportation has been identified as a top priority as hospitals are  trying to coordinate care for patients for their non-medical needs when they leave the hospital as well as for other non-emergency trips to providers.  As health systems are trying to reduce emergency room and hospital utilization, they view payments for transportation for routine care as cost effective.

It is estimated that there are 3 million persons who don’t make medical appointments because of a lack of access to affordable transportation.   Uber offers some specific information on its website about the service.  Here is a link to frequently asked questions


Some health care systems in New York’s DSRIP Medicaid transformation program are using transportation platforms to coordinate rides.   Lyft, which is an Uber competitor, is working with a company called Circulation, another online platform for non-emergency medical transportation.   Here’s a link to the press release announcing their collaboration.


Consumer Organizations Urge Public Transparency and Accountability for Acquisition of Fidelis Care; $3.75 Billion in Charitable Health Care Assets at Stake

this is a press release from the following four consumer groups about the proposed sale of Fidelis Health Care to a private company, Centene

Albany, NY – Four leading statewide consumer advocacy groups – Health Care for All New York, Medicaid Matters New York, New Yorkers for Accessible Health Coverage, and Consumers Union – released a joint statement on February 27, expressing concern about the proposed acquisition of the nonprofit Fidelis Care health plan by Centene Corporation, a national for-profit insurance company. Centene has proposed to acquire Fidelis Care’s assets for $3.75 billion, and operate the organization as part of a national for-profit insurance company. Fidelis Care has proposed to convey 100% of the proceeds to a charitable heath care foundation, while New York State is proposing to take up to 90% of the plan’s value as a “public asset” to pay for state health care programs. The advocates call for more specificity from both sides regarding their proposals for what is to be done with the assets, as well as for assurances that quality of care will improve as a result of the transaction.

“There are basically two sides to this transaction,” said Chuck Bell, Programs Director for Consumers Union. “On the one hand, you have a statewide nonprofit health plan that is essentially being privatized, and will in the future operate as part of a national for-profit insurance company under investor control. On the other hand, there is the issue of what happens to the nonprofit Fidelis Care’s charitable assets, which essentially belong to the community, and are held in trust by the Fidelis Care board of directors. We need full public transparency and accountability for both sides of the transaction, so that the public knows what changes in health care are in store, and also the details of what is happening to the $3.75 billion in the proposed asset sale.” “The proposed Centene acquisition of Fidelis Care is not just a technical corporate change that can be quickly rubber stamped,” said Lara Kassel, Coordinator of Medicaid Matters New York. “The asset sale must not be allowed to adversely affect consumers or health care access in New York State, and Fidelis Care’s assets should be protected for the public’s benefit. We urge a thorough review of this application, with public hearings and independent analysis of the impacts on the Medicaid program and the affordability and accessibility of insurance coverage, to ensure that consumer interests are fully protected.”

“New York has been an outlier in the way that it has approached some nonprofit insurance transactions in the past, with massive conversion assets taken by the state in 2002,” said Mark Scherzer, Legislative Counsel to New Yorkers for Accessible Health Coverage. “Other states have placed 100% of the value of their insurance plan assets in charitable foundations, to provide for investment in long-term resources to offset the loss of the nonprofit health plan. New York State needs long-term funding streams for our state health care programs that are robust, renewable and reliable.”

“Fidelis Care’s charitable health care assets should remain dedicated to its mission of expanding quality, affordable health insurance in New York,” said Elisabeth Benjamin of Health Care for All New York. “Consumers would like to see Fidelis and state officials use the assets to: offer coverage to immigrant New Yorkers who are currently ineligible for coverage; develop programs to offer enhanced premium support to shore up the individual market; or other consumer assistance programs designed to help New Yorkers trouble-shoot health coverage and care.”

Critics Rap GOP Family Leave Proposal Which Taps Social Security Early

It’s great that the push for paid family leave is now becoming a national issue.   New York’s paid family leave program is the best in the country right now and should be a model.  New York Senator Kirsten Gillibrand is sponsoring a bill that provides a national paid family leave program that seems closer in financing to our New York program  that became effective on January 1st of this year.  Gillibrand’s bill would assess a small payroll tax to fund the program.

Some Republicans in Congress have developed legislation for a paid family leave program tapping the Social Security system.   Senators Marco Rubio and Mike Lee are developing a proposal that would allow younger workers to tap their Social Security benefits early to take up to 12 weeks off.   This is not an ideal proposal because it would  require a worker’s early benefits deducted or delayed from their retirement benefits.  The proposal has drawn criticism from defenders of Social Security and Democratic leaders.

Ivanka Trump is pushing for paid family leave and the Trump budget pushes it through the unemployment insurance program.

The Wall Street Journal is editorializing this week against the GOP plan saying it opens up a new “entitlement” that will only grow bigger if it is enacted.   They would rather encourage the private sector to do this.   The problem with that is the benefit is only available if you are lucky enough to have an employer which offers it.

There is momentum now for the program at the national level though it seems unlikely this Congress has pass anything new beyond a tax cut.  However, the wisdom of providing a more family friendly workplace is clear and the United States needs to catch up with many other countries which already have leave programs.

Cuomo Payroll Tax Swap Plan Could Lower Social Security, Pension Benefits

Governor Cuomo has indicated his desire to help state taxpayers losing the federal income tax deductibility of all their state and local tax payments above $10,000.  While the intent is good to get around the discriminatory federal tax law signed in December, the details are proving to be problematic.   His office is working on a plan to turn the state income tax to a state payroll tax which would be deductible under current federal law.   His plan is set to be proposed to the Legislature in the coming weeks.   It is all a very complicated plan but we are hearing some of the aspects of it which may negatively impact pensions and Social Security.

The payroll tax plan would  result in wages being lowered as employers used the reduced wages to fund the payroll tax deposited for the workers.  If a person’s gross pay is less, then they would pay less in Social Security and Medicare taxes but they would also have less annual earnings to count toward pension and Social Security benefits.  Due to the structure of Social Security,  most people, especially those who are lower income, get a lot more in retirement benefits than they contribute.

It is debatable whether it is worth making this change in the payroll tax because most people other than those with the highest incomes are not going to be effected by the federal limit on state tax deductibility.   The Governor’s plan could negatively impact  most taxpayers regarding retirement benefits while the tax swap of using the payroll tax would benefit those who have high state income taxes and property taxes.  It seems like a bad swap unless it can be constructed in a way that only effects those high income earners which seems burdensome and unlikely.

The change in the gross income would also impact eligibility for a variety of other benefits and services.



Anthem Health Charges Patient $12,596 for Emergency Room Visit

You can read all my blog posts at http://www.generationsofnewyork.com

Here’s a new health care insurance outrage:

The news website Vox.com reports that, after announcing a new policy that will reject “inappropriate” emergency room visits, Anthem Health rejected a claim from a woman in Kentucky who went to the emergency room thinking she had appendicitis.  It turned out she had ovarian cysts. Anthem is trying to cut ER visits and initially refused to pay after reviewing her emergency room visit.  The company rolled out the change in policy and sent letters to its subscribers in four states – Missouri, Kentucky, Indiana and Georgia. –

There is usually no way for a patient to know  what the cause is when they have sudden severe pain.  The Anthem decisions on emergency room visits are made after the fact when they can look at the entire record and see what the patient was eventually treated for.   There is a fairly frequent possibility of patients having these denials of coverage happen.   For example, people thinking they are having a heart attack  offer are only experiencing  severe heartburn.  Should they not be cautious and go to the emergency room anymore?

This issue is just another example of insurance companies putting more importance on cutting costs than providing coverage that they have been paid for.   It seems that the company should have a referral hotline  or another way for a patient to know until after the fact whether the visit will be paid for.  It seems that public education and urging people to go to urgent care or other clinics needs to be the appropriate method to reduce emergency room visits.

The Anthem decision brought an outcry and an initial appeal from the patient that was denied.  Suddenly after the media got a hold of the case, Anthem changed its tune and reversed itself, apologizing for an problems the patient had.

Here’s the link to the full Vox.com story



Hospitals Joining to Produce Some Generic Drugs to Lower Prices and Increase Supplies

Earlier this month, a news report detailed how a group of hospitals plans to work together to form a new nonprofit that will produce generic drugs.  The hospitals are fed up with shortages of key drugs and price increases and they have decided to take matters in their own hands and provide some competition to drug manufacturers.  The hospitals feel if they work together and form a buying pool they can develop enough business to be successful and force price competition.

Drug companies are pushing the envelope with their price increases.  I recently had a call from a relative who was upset about the price of a heart drug she had been prescribed which was going to cost her $446 every two months.  She wanted my help getting the drug from Canada where it is about less than half that price.    Pharmacists report that there are shortages of long established drugs like Atenolol which regulates the heart.

President Trump at  a ceremony for the new head of the Department of Health and Human Services, Dr. Azar, a former drug company executive says he wants him to work on lowering drug prices.  So far, Trump has been all talk on this front and has done nothing except what the drug companies want him to do.   He campaigned as if he was the consumer’s friend on this issue but has ignored it.    It’s clear the market rules do not work with prescription drugs for the benefit of consumers.

Meanwhile, the drug companies keep moaning they need all this money to develop drugs  – at the same time as they have become one of the largest campaign contributors to members of Congress.  They keep pushing to stop Medicare from negotiating drug prices and of course, don’t want drugs that are negotiated at cheaper prices in others countries coming into the United States.

Apple IPHONE Health App Will Allow Doctors, Hospitals to Send Medical Records and Information

Apple has already introduced a Health app on its IPHONE that has information for healthy living and allows users to enter some patient information.  The current cellphone Health app which has a white background and a red heart has four major categories of information:  Activity, Mindfulness, Nutrition, and Sleep. 

Apple has bigger plans though and it has been revealed that the next update to its IPHONE software coming in a few months will have a way for doctors and health providers to upload your latest health records right to the Health app on the cellphone.  There is already a place for the user or patient to enter their own date regarding health records, body measurements and other vital information.   So these places on the app will presumably be there to receive data from health providers.  Of course, patients would have to give permission for the information to be sent to their cellphones.  The information is currently available on patient “portals” or websites that hospitals and doctors have set up for patients to access their information.  The cellphone app would make the information much more accessible.

Health providers are trying to share data with patients to encourage them to have more information to take greater control of their health care.  And, health consumer organizations are promoting “health literacy” to assist patients including older persons to have more information about chronic health conditions including what prescription drugs they are taking.

Those of  us working in health and aging services can play a vital role in community education and assisting patients, especially older patients have to use the Health app.