Scroll Top

Coalition Opposes Hospital-Backed “Pay and Pursue” Proposal


Coalition Warns Proposal Will Increase Health Care Cost for New Yorkers

A broad group of organizations representing employers, unions, brokers, and health plans today sent Governor Cuomo a letter opposing a hospital-backed effort to enact “pay and pursue” legislation as part of the FY21-22 state budget. The groups said the proposal, which would require that hospital claims be paid before hospitals submit information needed to determine whether the service or treatment was medically necessary, would essentially upend the financing system of the health care system and significantly increase the cost of health care coverage.

Noting that it would create a new, lengthy and costly negotiation process requiring each medical necessity claim denial to be reviewed and negotiated by health plans and hospitals, the letter says the pay and pursue construct would ultimately result in higher health care costs for consumers, employers, union benefit funds and the state.

Representatives from leading labor and business organizations outlined their concerns with the proposal:

“This proposal will result in higher hospital costs that will eventually be borne by our members and ordinary New Yorkers,” said UFT President Michael Mulgrew. “Giving hospitals free reign to ‘get paid first and explain later’ is a recipe for trouble.”

“This pay and pursue proposal would drive up costs for New York employers and their employees,” said Lev Ginsburg, Esq., Senior Director of Government Affairs of the Business Council of New York State. “With businesses struggling to keep their doors open, now is not the time to compound the pandemic’s economic damage by adding to their health care costs.

“New York’s health care costs already are among the nation’s highest,” said Sara Rothstein, Director of the 32BJ Health Fund. “This proposal does nothing to improve the quality or value of health care for patients and merely shifts more costs onto union benefit funds and working people.”

Calling the proposal one-sided, the groups urged the Governor to reject the hospitals’ push for pay and pursue legislation in the final FY21-22 state budget.