Nearly 2 million New Yorkers could lose their low-cost Essential Plan health insurance.

Nearly 2 million people use New York State's Essential Plan, a public health insurance program. These people face an uncertain future due to massive federal budget cuts. Governor Kathy Hochul has announced that she is working on measures to protect the program. AMNY tells in more detail.

Federal funding cuts to the Essential Plan total $7,5 billion, more than half the program's annual budget.

Such cuts threaten the continued existence of Action.

"Access to affordable, quality health care is vital for New York families," Hochul said.

"While Washington cuts and destabilizes the healthcare system, New York will continue to invest in patients, providers, and safety nets. We want to ensure healthcare remains accessible across the state," she said.

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Authorities estimate that around 450,000 people could lose their lives. coating Essential Plan already in July.

Proposal to lower the income threshold

State officials said they were "considering options" for the people.

In September, Hochul instructed the Department of Health to submit an application to the Centers for Medicare & Medicaid Services to return the Essential Plan to the Basic Health Program. She said this would preserve coverage for 1,3 million New Yorkers, for whom the no-premium plan is vital.

The governor proposes lowering the income threshold for participation in the program from 250% to 200% of the federal poverty level. This requires approval from federal agencies.

What is Essential Plan

The Essential Plan is not Medicaid. However, it is a government health insurance program. It provides low-income adults with coverage without monthly premiums.

The program is designed for New York residents who do not qualify for Medicaid or Child Health Plus.

The Essential Plan has become a lifeline for working families and low-income people.

However, the program's reliance on federal funding streams makes it vulnerable.

While Hochul and the Department of Health seek solutions, time is limited for patients.

Some human rights groups warn that funding cuts could negatively impact access to health care.

Concerns of medical centers

Metro Community Health Centers CEO Michelle Quigley said her centers serve patients with intellectual and developmental disabilities, their families, and the local community.

Most patients receive Medicaid. Many will be required to re-certify for assistance under HR1, better known as "The Big Beautiful Bill."

"Their condition doesn't change," Quigley said.

She added that most Medicaid patients at Metro Community Health Centers have "severe disabilities" and complex needs.

Diagnoses include cerebral palsy, Down syndrome, and genetic disorders.
We are also talking about other mental and physical illnesses.

The centers also provide primary healthcare to their families. Many of them use the Essential Plan.

“While most of our patients are eligible for Medicaid and don’t necessarily need the Essential Plan, their families, their caregivers, the people who work to support them are eligible for the Essential Plan,” Quigley emphasized.

"By providing caregivers access to the Essential Plan, we ensure that Medicaid patients have caregivers," she explained.

"The consequences could be catastrophic," Quigley added. "Who will care for my patients if there's no one to care for them at home?"

Potential consequences for patients

According to Quigley, maintaining the Essential Plan is crucial. Metro serves approximately 8,000 patients, approximately 20% of whom use the Essential Plan.

Without the program, many patients will not be able to receive basic and primary health care.

As a federally qualified community health center, Metro is required to accept all patients, regardless of their ability to pay. The center also offers a sliding fee scale.

According to her, community centers ultimately reduce costs for both patients and communities. They provide preventative care and prevent unnecessary and costly emergency room visits.

Housing Works President Matthew Bernardo noted that emergency departments are facing an influx of patients as coverage is cut.

"For people living with HIV, the Essential Plan ensures continuity of treatment and viral load suppression," he said.

"When coverage is cut, treatment is interrupted, people drop out of treatment, and reenter the system in more severe condition, often through emergency rooms. This doesn't save money. It shifts costs to Medicaid. And it weakens the support system New York relies on," Bernardo added.

Criticism of the program

Some healthcare industry experts are skeptical of the Essential Plan, at least in its current form. This is not the original version created under the Affordable Care Act of 2014.

Mario Soliman, a pharmacist at VineRx pharmacy on Staten Island, said the program has advantages, including hospitalization coverage. However, for many residents, it has become financially burdensome. People pay hundreds of dollars a month in copays and prescription costs.

"You don't pay a fee to the state, but you pay through prescriptions and visits," he said.

"It used to be more accessible. Now the program doesn't really help people, but it does allow them to stay insured. If you end up in the hospital, it can be a lifesaver," Soliman added.

Quigley reiterated the importance of healthcare.

"Preserving and strengthening Medicaid and Essential Plan coverage in New York City isn't just smart public health policy. It's fiscally responsible community-based health care delivery," she said.