The cost of health care and insurance in this country is outrageous, and it looks like it’s not going to get better in New York.

This is because health coverage for 1.7 million New Yorkers who rely on the Essential Plan (the low-cost state health insurance plan) is under threat, but there is an interesting workaround solution.

I dive in below. I also share how to access free at-home HIV tests, report on a contained outbreak of eye fungus at a clinic in NYC, and provide updates on infectious diseases.

The cuts keep coming: New York health insurance coverage

For 1.7 million New Yorkers, the Essential Plan is the safety net that makes health coverage possible when Medicaid, Medicare, or employer insurance isn’t an option. But new federal policy changes could make that coverage harder to keep.

The “Big Beautiful Bill” includes a major provision that restricts how federal dollars can be used to cover non-citizens. This change is expected to reduce federal funding for New York’s Essential Plan by about $7.5 billion each year.

The rollout has already begun and will continue in a phased approach. Starting in October 2026, federal Medicaid matching funds will no longer cover many legally present non-citizens, including green card holders in the U.S. less than 5 years, refugees, asylees, and trafficking victims (with limited state options remaining for lawfully residing children and pregnant people in states with those options).

This comes just weeks after another hit: the loss of enhanced ACA subsidies—extra financial help that lowered monthly marketplace premiums for many middle- and low-income enrollees. This loss made marketplace coverage more expensive for about 140,000 New Yorkers. (See more about that here in a previous YLE post in January.)

What is the Essential Plan?

To understand what’s at stake, it helps to understand the several ways New Yorkers are covered by health insurance:

1. Employers: they cover about half of New Yorkers.
2. Medicare/Medicaid: funded by both the state and federal government.
3. Health coverage from the marketplace: paid out of pocket and/or subsidized by the federal government.
4. Essential Plan: a New York-specific program that is funded through the federal government.

The Essential Plan (#4 above) is important because it’s designed to fill a gap for people who earn too much for Medicaid but not enough to afford marketplace plans (and who don’t have employer-based coverage). It also includes many lawfully present non-citizen immigrants (about 750,000 in New York), such as permanent residents with green cards and DACA recipients, who may face eligibility barriers in other programs. The $7.5 billion cut puts all of the Essential Plan coverage at risk.

Is there a workaround? Maybe!

To lessen the blow and keep as many people insured as possible, the governor’s office seems to be trying by moving people around in a pretty creative way.

Some of those in the Essential Plan qualify for Medicaid, so the state will cover them (which will cost $3 billion).

But that doesn’t cover everyone.

For those who can’t move to Medicaid, because of income limits or immigration status, the governor is proposing to shift the Essential Plan back to an older funding model, one that isn’t bound by the new federal immigration restrictions. The trade-off? The old model only allows eligibility up to 200% of the federal poverty level (FPL).

The governor’s Essential Plan change proposal (note: it hasn’t passed yet) tightens eligibility. As a result, ~460,000 New Yorkers would lose insurance coverage.

This is a balancing act—one that aims to preserve health care coverage for the greatest number of New Yorkers, despite federal cuts. The move would maintain coverage for about 1.3 million New Yorkers, but leave 460,000 without the Essential Plan.

Here is the problem: The governor’s Essential Plan change proposal requires approval from the federal government (Centers for Medicare & Medicaid Services to be exact). If CMS says no (which I think is likely—I don’t think the same administration that cut funding in the first place would approve a workaround), the entire Essential Plan may be cut. If that’s the case, it would likely result in 1.7 million New Yorkers without coverage.

What you can do

• Get help with applying for insurance coverage if you need it: https://communityhealthadvocates.org/
• Check in on neighbors who may be on Medicaid or need help with renewal forms. The New York State Medicaid Help Line is (800) 541-2831.
• Call your senators and congressional representatives to advocate for the issues that matter to you. (Find their contact information here.) Some apps provide representative info as well as scripts for specific topics.

FYI—Free HIV tests available to New Yorkers

New York State just launched a free HIV self-test giveaway campaign with nearly 2,000 kits available statewide.

• If you live in New York outside NYC, you can take the eligibility survey to see if you can get a free at-home kit mailed to you.
• If you live in NYC, request a free kit through an agency listed on the NYC Health Map and (click “HIV Testing”).

Free testing helps people get care earlier and prevents transmission:

• Antiretroviral therapy treatment (ART) can make HIV undetectable—meaning it can’t be passed through sex (undetectable = untransmittable).
• Pre-exposure prophylaxis (PrEP), medication that can be taken before sex, injection drug use, or other potential HIV exposures, can prevent HIV.
• Post-exposure prophylaxis (PEP) can reduce risk if started within 72 hours of potential exposure. (Visit the New York State PrEP website for more info.)

These treatments and medications are truly remarkable for HIV prevention and treatment, but early testing, diagnosis, and access to care are essential.

Good news: An eye fungus outbreak stopped in its tracks

This week, disease detectives at the NYC Department of Health published an investigation that underscores the critical importance of infection prevention in health care settings. In December 2024, three people developed serious fungal eye infections after elective laser eye surgery at a single NYC ophthalmology clinic. All three had vision loss, and one required a corneal transplant.

The clinic reported the trend after noticing that three of 11 patients (27%) who underwent surgery over a two-week period developed eye infections. After testing, Purpureocillium lilacinum, an environmental mold that rarely infects healthy people but can be dangerous to the eyes, was found to be the culprit.

After an investigation, there were many things that went wrong at this clinic:

• Incomplete sterilization logs.
• No EPA-registered disinfectants for work surfaces.
• Expired eye medications.
• Notably, cool-mist humidifiers in the procedure room. (CDC specifically warns against cool-mist humidifiers in health care settings because they can aerosolize mold spores.)

A single definitive “smoking gun” source wasn’t confirmed, but fungal DNA was detected in the tubing of one surgical device.

The good news was that after the clinic paused surgeries, fixed infection control problems, and resumed operations in January 2025, no new cases occurred. This is a solid example of how fast action and cooperation can stop an outbreak.

What this means for you: If you’re considering LASIK or similar procedures, ask your clinic about infection prevention practices: how they sterilize instruments, whether they use EPA-registered disinfectants, whether they check medication expiration dates, and if cool-mist humidifiers are used near procedure rooms. If you’ve had recent eye surgery and develop pain, vision changes, or discharge, seek care immediately—eye infections require fast treatment to prevent permanent damage or vision loss.

Infectious disease “weather report”

Measles: NYC reported the first measles case of the year—an unvaccinated infant with a history of international travel. Contact tracing by the health department is underway, and people who may have been exposed are being notified.

Measles is of increasing concern in the U.S., including in New York. (See YLE National’s updates.) Last year there were 48 cases in New York, including 20 in NYC.

The most important thing to do is check the MMR status for everyone in your household, and get vaccinated if eligible and not fully vaccinated, especially if you will be traveling internationally or to any U.S. region with a measles outbreak. Two doses are about 97% effective at preventing measles.

Flu: Cases increased slightly in NYC, but ED visits and hospitalizations continue to fall. With severe indicators continuing to decline, this small increase in cases isn’t a big concern.

RSV: RSV cases went up while ED visits slightly decreased, a sign that activity is still elevated but that severe infections are going down. If you’re an older adult or have small children, it’s still worth continuing to take precautions like masking in indoor crowded spaces.

Covid: ED visits and hospitalizations for Covid slightly increased, but overall remain low compared to previous winters.

Bottom line

Health coverage for up to 1.7 million New Yorkers is on the line, and the state’s workaround would still leave hundreds of thousands uninsured. If you or someone you know is affected, now is the time to plan: get enrollment help, watch for renewal paperwork, and talk to your representatives about your concerns.

Love,

Your NY Epi

Dr. Marisa Donnelly, PhD, is an epidemiologist, science communicator, and public health expert. This newsletter exists to translate complex public health data into actionable insights, empowering New Yorkers to make informed and evidence-based health decisions.