Fund Decries Hospital’s Refusal to End Anti-Worker, Sky-High Pricing Structure, Takes Necessary Steps to Protect Affordable Care Access for Participants
New York, NY, June 3, 2021 – The 32BJ Health Fund, which provides affordable health coverage for members of the city’s largest union and their families, announced today that NewYork-Presbyterian will no longer be an in-network provider as of January 1, 2022.
“Our fight is not with NewYork-Presbyterian’s doctors, nurses, or support staff, who deliver top-tier care and save lives daily – especially over the past year,” said Kyle Bragg, 32BJ SEIU president and 32BJ Health Fund chair. “Our issue is with the accountants and executives who manage the system and charge prices for standard procedures that are higher than other hospitals in the metro area. We will not stop fighting until we reach a workable solution that protects workers’ long-term ability to access affordable, quality care.”
The Fund provides benefits to almost 100,000 essential building workers and their families, for a total of 190,000 people. The Fund is committed to providing participants with access to high-quality care at an affordable price. NewYork-Presbyterian charges prices that are above-market rates compared to other area hospitals.
The Fund is a self-insured health plan, which means the cost of high-priced care is directly paid from the accumulated funds contributed on behalf of workers. The Fund has no profits or shareholders and has no interest other than providing workers with the highest quality health care they can afford. When more dollars are spent to cover the cost of high-priced hospitals, it means less money available for workers for wage increases and other benefits.
Empire BlueCross Blue Shield, the Fund’s third-party administrator, has not negotiated a contract renewal with NewYork-Presbyterian that reins in costs for Fund participants and would enable them to keep more of their hard-earned money while allowing for broader access to affordable care.
The key factors that led to the Fund’s decision to terminate its relationship with NewYork-Presbyterian include:
- High Prices
The prices paid by the 32BJ Health Fund to NewYork-Presbyterian are more than three and a half times – 358% – the price that Medicare pays for the same care at the same hospitals.
The Fund analyzed the costs paid by the Fund for routine procedures performed at New-York-Presbyterian and other hospitals and outpatient facilities and found a significant difference in costs for the following procedures:
- End of Critical Services
The contract between Empire and NewYork-Presbyterian would force the Fund to end the innovative programs it currently offers participants, including a cutting-edge maternity care program with several NYC hospitals and its lauded joint replacement and bariatric surgery programs with $0 copays.
- Threat to Accessing Affordable Care
The Fund is self-insured and uses Empire to provide its network, authorize medical care, and pay claims. Those claims are entirely paid with Fund dollars, while Empire receives a flat administrative fee. Every dollar the Fund spends on higher-priced healthcare is a dollar it is unable to use to make other kinds of care more available and affordable.
Bragg noted that while the 32BJ Health Fund is taking this unprecedented step to protect participants’ ability to access affordable care in the long term, the impact of steadily rising hospital costs is both far-reaching and significant.
“NewYork-Presbyterian’s secretive contracting practices and out-of-control care prices not only impact 32BJ Health Fund participants but also millions of other New Yorkers who rely on the hospital system for care,” Bragg said. “At a time when workers – especially those who are members of Black and brown communities – have been disproportionately impacted by the coronavirus pandemic and a full economic comeback is years away, the city can ill afford these escalating costs.”
For more information on the 32BJ Health Fund, visit https://www.32bjfunds.org/.