I recently started a new job, and with a new job comes new health insurance. With new health insurance comes all the usual questions: does my primary care physician take it, what about other doctors I may be seeing? Can I still get my prescriptions or continue the treatment course I was on? Some apply to me, some don’t, but everyone who has switched jobs knows the annoyances that come with switching health insurance. Just when you get used to one, you’re getting screwed by another. For some families, the bigger worry is not switching cards but confronting a state-run Medicaid program whose rules can upend a doctor’s orders.

As someone who used to do health policy at a conservative think tank, I understand the realities of health insurance. In New York, those realities run through a centralized Medicaid pharmacy program and a Drug Utilization Review (DUR) Board that decide how high-cost drugs are handled.

New Yorkers are dealing with the maze of it all right now. The barrier is not necessarily a doctor, but a calendar, a committee and the words “statistically insignificant."

The New York healthcare system has taken away the patient’s voice. You might be able to pick your plan, or at least the tier, but your employer chooses the company, and you’re stuck with it…unless you switch jobs or they switch insurance companies.

There is no shopping around inside New York Medicaid. One program, and one board, set rules for everyone – it’s “one-size-fits-all,” whether it “fits” or not. No one is advocating for patient rights.

Here’s how the process in New York “works”: The state marks a drug as high-cost. Prior approval follows. Families wait while paperwork moves through the mill. It gets denied, or even worse, returned for a minor regulatory detail.

I don’t begrudge health insurance companies for prioritizing making money; it’s why those companies exist. My problem comes when the state has monopoly power over individuals and overrule anything and everything that harms its bottom line.

Nothing illustrates this better than prescription drugs. I know “Big PhRMA” is a convenient boogeyman and an easy target. A couple of years ago, I was without health insurance and had to take a prescription for digestion. It rang up as $1000. I prioritized my health over the high cost.

Not everyone is fortunate enough to afford a financial “hit” like that, either occasionally or regularly.

Consider the families who suffer under New York law as the commissioner targets expensive medicines for rebates and then refers them to the DUR Board.

Imagine having a life-threatening issue and being told by your government, “No, you are not statistically significant enough to justify this cost. You are not worth the 20 cents each New Yorker would have to pay.” What do you do? In New York, the answer is wait for notices, agendas, public comment, executive sessions, and final determinations. Disease doesn’t pause for that.

I recently wrote about Elevidys, a gene therapy for the treatment of Duchenne muscular dystrophy - a horrible illness that impacts children and can rob them of their ability to walk. The FDA approved this drug for patients four-years-old and older. Yet, a major insurance company called Centene won’t cover it and New York State is threatening not to cover it. 

 There are countless examples of treatments that doctors believe are best for their patients being overruled by faceless bureaucrats. There needs to be a better way. New York needs to align its Medicaid rules with FDA labels and treating physicians. Patients first. Delay is not a health policy. When the state adds delay the harm spreads because that business model is applied to the whole population.

The “appeals processes” available are just thinly-veiled flaming hoops for doctors and patients to jump through. New York’s process is heavy, and getting through it feels like running in deep mud. Meetings, comments, executive sessions, cost-benefit analyses, final determinations, the list goes on. Families cannot wait while muscles deteriorate and daily lives shrink. 

We need a patient-centered model in health care. In New York, that means a Medicaid that respects FDA decisions and treating physicians and putting patients first and does what is best for them, not the bottom line. 

Derek Hunter is the host of the Derek Hunter Show on WMAL in Washington, DC, and has a free daily podcast (subscribe!) and author of the book, Outrage, INC., which exposes how liberals use fear and hatred to manipulate the masses, and host of the weekly “Week in F*cking Review” podcast where the news is spoken about the way it deserves to be. Follow him on Twitter at @DerekAHunter.

Editor’s Note: The Schumer Shutdown is here. Rather than put the American people first, Chuck Schumer and the radical Democrats forced a government shutdown for healthcare for illegals. They own this.

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