After Criticism, Home Care Employer Will Look for Better Health Insurance

tens of thousands of New Yorkers have been forced to pay for health insurance that doesn’t cover basic medical care.

New York’s popular state-funded home care program for the elderly and disabled was taken over that month by the company Public Partnerships, LLC, which automatically enrolled all of its new employees in the New York City area in a bare-bones health plan that is funded through deductions from their salaries but doesn’t cover many essential services, like hospital stays or specialist doctors.

5 Key Takeaways From Our Investigation Into Health Insurer Leading Edge Administrators

Sam Mellins

The arrangement has frustrated many home care workers, most of whom already have health insurance through other jobs or social programs like Medicaid. Some of those workers could lose their current insurance as a result of the new plan; for most, it will be a second plan they’re paying for but don’t need.

“I have a full time job and I’ll be getting insurance through that,” said Sophie-Anais Renois, who cares for her grandmother in Nassau County. “I don’t need to have another piece of insurance. It would just be better to have those dollars put into our salary.”

Last week, PPL signaled that change may be on the way. At a hearing in New York City, PPL’s vice president of government relations, Patty Byrnes, told state lawmakers that the company is seeking to offer a new and improved health insurance plan around the end of the year.

The announcement was in response to a question from state Senator Chris Ryan, who asked Byrnes whether she thinks the insurance that PPL offers is “adequate.”

“It is what we were able to provide,” Byrnes responded. “We are in the process of talking to brokers about what we can do to provide better services.”

Byrnes said that the company is exploring options for a better plan for this year’s open enrollment period, the annual window to switch health insurance that lasts from November 1 to January 15. A PPL spokesperson declined to provide further details in response to questions from New York Focus.

State Senator Kristen Gonzalez, who serves on the chamber’s health committee and attended the hearing, said that she plans to monitor whether PPL follows through.

“This is the only thing that PPL agreed needs to change, so let’s see if they actually change it,” she said.

‘I Thought I Was In-Network’: The Insurance Scheme That Could Leave New Yorkers With Mountains of Debt

Sam Mellins

One obstacle to upgrading workers’ health insurance is that the company managing the plan, Leading Edge Administrators, has a record that includes canceling patients’ insurance, revoking previously granted approval for medical procedures, and failing to pay doctors. PPL’s contract with Leading Edge will last at least a year, according to state Senator Gustavo Rivera, who chairs the health committee, potentially making it difficult to improve the plan this fall.

A bigger barrier could be finances. The current plan is paid for by deducting 40 cents per hour from workers’ paychecks, adding up to some $80 million annually, according to one estimate. This deduction is mandatory: Workers are not permitted to opt out of it, even if they have other insurance. But even so, the sum adds up to far less than the $9,000 per employee required to offer standard health insurance in New York.

“There is no possible way for PPL to offer useful health insurance” unless it dramatically increases the amount of money it is spending on coverage, said Michael Kinnucan, health policy director at the think tank Fiscal Policy Institute. “The best they could do is move from a complete scam fake plan to a very bad normal plan.”

And in that case, workers would get better value by just buying insurance from the public marketplace, since the federal government heavily subsidizes those plans for low-income workers, Kinnucan argued.

Ilana Berger of New York Caring Majority, an advocacy group for patients and workers that has opposed the transition, suggested that rather than tinkering with the plan, PPL should end its relationship with Leading Edge and offer workers extra pay instead of a subpar health plan.

“People are pissed. They want the cash and they want to be able to make their own choices,” she said.