Ex-Cuomo aide pushes health exchange tweak

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Richard Bamberger. (AP Photo/Mike Groll)
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A former top aide to Governor Andrew Cuomo is spearheading a media campaign to require insurers to offer out-of-network benefits as part of their health exchange plans next year.

Richard Bamberger, who was Cuomo’s communications director, is working on behalf of the Patient Protection Coalition (P.P.C.), a newly formed advocacy group that appears to be making headway in Albany.

Insurance executives said they were shocked last week when state health officials reversed course and discussed requiring insurers to offer out-of-network coverage for all exchange plans.

The requirement would fundamentally alter New York's exchange, which is among the most successful of the state run marketplaces, and could cripple newly formed insurance companies, drive doctors out of networks and increase premiums on the state’s exchange by as much as 30 percent.

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"The Patient Protection Coalition would be more aptly named the provider protection coalition as it is more interested in protecting specialists' income than making health insurance affordable to consumers," said Leslie Moran, spokeswoman for the New York Health Plan Association.

Doctors, legislators and some patient advocacy groups, however, have criticized the state’s exchange for not including out-of-network benefits, arguing that it limits patients' choices and denies them an affordable option for seeing any doctor they want.

Bamberger is running the media campaign for M Public Affairs, the consulting firm he joined when he left the Cuomo Administration in 2012.

The P.P.C. created a Facebook page on January 30th this year, and registered a website, Chooseyourdoctorny.com, just last month.

Bamberger says he isn't doing any lobbying for the group (he's prohibited by state ethics laws from doing so) but said the new advocacy group has retained its own lobbying firm, Bogdan, Lasky & Frazier LLC.

The advocacy group includes medical specialists, including a specialty medical clinic that is also a longtime client of the firm. One surgeons’ group affiliated with the P.P.C., the Midtown Surgery Center, is paying the lobbying firm $7,500 a month to lobby the Legislature and governor’s office about out-of-network benefits requirements and other health-related issues.

Bogdan, Lasky and Frazier has lobbying contracts with several other medical groups, including a $4,500 contract with The Society of New York Office Based Surgery Facilities, a $65,000 annual contract with the New York State Association of Nurse Anesthetists, Inc. and a $6,500 monthly contract with the New York Providers’ Alliance.

"What we’re trying to do is make patients fully aware of what their options are,” said Mark Reiner, a clinical professor of surgery at Mt. Sinai who is affiliated with the coalition. “We want the patients to be able to choose the physician of their choice, wherever that person may be."
Patients can already see any doctor they want but have to pay far more if their physician isn't contracted with their insurer. That often makes it unaffordable so requiring out-of-network benefits would help many consumers shopping on the exchange, provided they could afford policies with higher premiums.

Doctors would also benefit from the rule change because many specialists, such as surgeons, anesthesiologists and radiologists, remain outside of health insurance networks, allowing them to charge higher rates.

Until recently, health officials were resisting calls to require out-of-network benefits on exchange plans, citing the high costs. Donna Frescatore, executive director of the state's health exchange, said in January that she did not believe there was a problem of network adequacy.

“New Yorkers from across the State have told us directly they would like the option to purchase coverage that includes both adequate provider networks and out-of-network coverage," said Bill Schwarz, the Health Department's Director of Public Affairs, in an emailed statement. "For that reason, this issue is being examined.”

UPDATE: After this article was published, health department spokesman Bill Schwarz emailed the following, unsolicited statement: “New Yorkers from across the State have told us directly they would like the option to purchase coverage that includes both adequate provider networks and out-of-network coverage. For that reason, this issue is being examined. The Department of Health has never been contacted by Mr. Bamberger, or his firm, nor was it aware they were working on this issue. To suggest otherwise would be both untrue and irresponsible.”

For the record, this article contains no such suggestion (apart, maybe, from the above statement). Bamberger's work on the issue is not disputed by Bamberger or anyone else contacted for this article, which does not in any way address the idea of contact between Bamberger and the department. The article states that Bamberger is handling media relations for a client which, according to Bamberger, has hired an outside lobbying firm to handle that aspect of the campaign.