Testimony: Protecting Health Coverage in the Face of Federal Cuts

Testimony: Protecting Health Coverage in the Face of Federal Cuts

Mia Wagner

Before the NYC Council Committees on Hospitals, General Welfare, Governmental Operations, and State & Federal Legislation

The Community Service Society of New York (CSS) would like to thank the City Council for allowing the public to weigh in on the impact of federal budget cuts on New York City. CSS is an 180-year-old organization that aims to build a more equitable New York for low- and moderate-income individuals, assisting over 130,000 New Yorkers statewide annually in accessing health care. CSS administers the Managed Care Consumer Assistance Program (MCCAP) to help New York City residents navigate the health care system through a network of 21 community-based organizations in all five boroughs. Since 2020, MCCAP has helped over 20,000 New Yorkers save a total of $1 million.

An estimated 730,000 New York City residents are at risk of becoming uninsured due to federal cuts to Medicaid, and at least 225,000 New York City residents will lose Essential Plan coverage next year.^[1] At least 240,000 New Yorkers across the State will experience higher premiums because of the expiration of the enhanced premium tax credits (EPTC) on January 1, 2026. The expiration of EPTCs will hit New York City residents hardest and is estimated to lead to an average monthly premium increase of 38 percent for a couple.

CSS has two recommendations for the city council: (I) consider funding MCCAP to conduct community-based outreach to help New Yorkers navigate coverage transitions and (II) support the State in the transition of the Essential Plan to the 1331 waiver and any efforts to provide coverage to the 225,000 New York City residents that will no longer be eligible for Essential Plan coverage.

1. Funding MCCAP to conduct targeted community-based outreach about the availability of enrollment assistance.

The new federal rules include burdensome documentation requirements that will hamper individuals' and families' ability to enroll in and maintain health coverage. The City can look to lessons from New York's success in mitigating coverage losses during a prior major federal policy reform-the end of the COVID-19 Public Health Emergency.

In 2023, federal COVID-19 Public Health Emergency policies mandating continuous enrollee retention in publicly funded insurance expired. Under these policies, New York's public health insurance enrollment climbed to 9 million people and the State achieved its all-time lowest uninsurance rate.

To secure these coverage gains, New York executed a 14-month multi-pronged effort to retain as many New Yorkers as possible in health coverage, including boosting localized assistor outreach efforts through the philanthropically funded Keep New York Covered (KNYC) project.

As described in CSS's report, We'll Keep You Covered: How Funding Community Based Outreach Reduces Coverage Losses in the Face of Federal Policy Changes, the $2.5 million KNYC project funded CSS (the State's largest Navigator group) to act as a central hub that procured and supported 36 community-based enrollment organizations that:

conducted targeted outreach about the availability of enrollment assistance through over 60 million engagements using a variety of mediums, such as: bus advertisements, postcards, social media, in-person presentations; and
enrolled over 85,000 New Yorkers as a direct result of these outreach efforts.

At a cost of $30 per enrollment, the KNYC project generated a 3,850 percent return on investment. This concerted effort to conduct community-based outreach and marketing was crucial to the goal of protecting the State's enrollment gains, particularly in solidifying the decade-long progress in reducing disparities in uninsurance rates for many racial and ethnic minorities.

The lessons of the KNYC project are particularly trenchant for state policymakers seeking to secure insurance coverage rates in the face of impending federal threats to Medicaid and the Affordable Care Act. CSS urges the city council to consider funding MCCAP to support community-based organizations in conducting targeted outreach about the availability of enrollment assistance to help New Yorkers navigate coverage transitions.

2. Supporting the State in returning the Essential Plan to the Basic Health Program (Section 1331) from the 1332 waiver.

On September 10, 2025, the State initiated the process to unwind its 1332 waiver program that the Biden administration approved to expand Essential Plan coverage to people making up to 250 percent of the federal poverty level. Federal cuts to eligibility have left the Essential Plan with significant funding losses that require the State to return to the Basic Health Program under Section 1331 of the Affordable Care Act.

While this transition will allow the State to minimize coverage losses for New Yorkers with Essential Plan coverage, it will leave approximately 225,000 New York City residents with incomes between 200-250 percent FPL no longer eligible for the Essential Plan and at risk of losing coverage.

CSS urges the city council to submit comments during the 30-day comment period to support the State in its initiative to return to the Section 1331 Basic Health Program. In addition, the city should support the State in any initiatives to provide cost-sharing reductions or subsidies to the 200-250 FPL population to allow access to affordable coverage.

Thank you for the opportunity for the public to weigh in on this matter. Should you have any questions, please do not hesitate to contact Mia Wagner at [email protected].

Notes

[1] NYSOH enrollment data as August 30, 2025 indicates 60 percent of New Yorkers with Essential Plan coverage live in New York City. An estimated 450,000 New Yorkers will lose essential plan eligibility in 2026. NYS DOH data indicates 57.5 percent of New Yorkers with Medicaid coverage live in New York City. An estimated 1.3 million New Yorkers will lose Medicaid coverage due to new eligibility and verification hurdles.

Issues Covered

Access to Health Care

Latest News

Testimony: Protecting Health Coverage in the Face of Federal Cuts

Testimony: Federal Cuts Imperil New York City Housing

Trump's Racist Attack on Black America

More News