Council Member Rivera, one of the authors (photo: John McCarten/City Council)
Even in an era of relentless attack on health care by the Trump administration and its allies in Congress, New York City is continuing to reap enormous benefits from the Affordable Care Act. This year alone another 80,000 city residents enrolled in health coverage through our state’s Obamacare exchange.
But a huge number are still being left behind: an estimated 962,000 adults in the five boroughs remain uninsured. These New Yorkers -- many of whom are living in poverty -- often receive no health care until their conditions are severe enough to land them in the emergency room.
The trend is not good for those New Yorkers’ health, as they should have access to preventive care, regular check-ups, and other aspects of quality health care. What’s more, the current situation is also dealing a serious financial blow to our struggling public hospital system (known as Health + Hospitals), whose vital mission it is to serve those in need, including the uninsured. For H+H to avoid financial disaster we need to close the health insurance gap in New York City.
H+H serves over a million patients per year in a network of 11 acute care hospitals and dozens of other facilities throughout the five boroughs. These institutions are by far our city’s largest provider of care to Medicaid recipients, mental health patients, and -- critically -- those who are uninsured.
For decades our public hospitals -- Bellevue, Kings County, Harlem, Elmhurst and others -- have been the ultimate safety net for New Yorkers with nowhere else to turn. H+H’s diverse and committed staff, its proximity to low-income communities, and its sliding-scale fees have helped establish it as second-to-none in serving the neediest New Yorkers.
But balancing the books at our public hospitals has never been easy, in part because Medicaid reimbursement rates are so low. The system’s challenges have only gotten worse in recent years as federal and state safety-net funding has shrunk. And now tectonic changes in the health sector have dealt further blows, as care rapidly moves from inpatient to outpatient services.
The result: H+H is confronting a $1.3 billion deficit this year, projected to balloon to $2.1 billion next year.
This financial strain has real implications for patients, compounding long-running problems in the system. The wait time for appointments at H+H can stretch into the months. Many of the system’s buildings are crumbling, with leaking roofs at Harlem Hospital, deteriorated plumbing at Lincoln, obsolete electric systems at Metropolitan, and elevators throughout the system that are so outdated that their replacement parts are no longer sold.
H+H’s new CEO, Dr. Mitchel Katz, has laid out a multi-pronged plan to address this crisis. He has set out to reduce administrative expenses, more effectively bill insurance companies, and retain more paying patients, among other efforts.
But there is another critical strategy needed to save H+H: New York City urgently needs to enroll more people in health insurance.
Our public hospitals treat over 400,000 uninsured patients each year. That represents hundreds of millions of dollars of lost insurance billing for those eligible for coverage. Providing this health care regardless of ability to pay is the moral thing to do. It also affects the health of all New Yorkers by helping us prevent the spread of communicable diseases.
We need to tap health insurance as a way to make this important work financially sustainable. That’s why it’s critical that we dramatically ramp up our outreach and enrollment efforts.
Today, most funding for ACA enrollment is provided by the State, which spends about $12 million per year on a network of community-based organizations in the five boroughs offering health insurance navigation assistance.
Several City agencies also have dedicated teams doing enrollment, but the numbers are small: only about 50 staff at Human Resources Administration (HRA) and 70 at Department of Health and Mental Hygiene (DOHMH).
We need an aggressive, coordinated plan to take this work to the next level. And we need to be on the ground in neighborhoods. Community-based non-profits make ideal partners for this work, because of their cultural competence and because of the trust they so often have earned in low-income communities.
One group of New Yorkers can’t get enrolled no matter how much we spend on outreach: undocumented immigrants. But there’s a win-win possibility for them as well. By investing in a program to provide them access to primary care we can improve health outcomes and prevent the more costly H+H emergency room admissions that would otherwise occur.
A twin effort to enroll more New Yorkers who are eligible for insurance and to fund access to primary care for those who are undocumented would improve the health of our people while going a long way to shore up the finances of our public hospital system.
That would be a giant step forward to the goal of ensuring that each and every New Yorker, regardless of income or immigration status, has access to the affordable, high-quality care they need.
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Mark Levine and Carlina Rivera are members of the New York City Council. Levine chairs the Council’s health committee, Rivera chairs its hospitals committee. On Twitter @MarkLevineNYC and @CarlinaRivera.
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(photo: Benjamin Kanter/Mayoral Photo Office)
New York City’s Department of Finance announced last week that it is moving to reduce the discounts it gives to commercial vehicles through a 15-year-old program that gives companies like Verizon and Fresh Direct a bulk break on parking tickets.
City officials say that the program’s new, higher fees will help reduce congestion by raising the pain for trucks that are double-parked or otherwise blocking traffic, as well as raise revenues by a relatively small amount: $17 million annually. They have sweetened the pill by creating a $120,000-a-year parking czar who supposedly will act as the ticket-payers’ advocate.
But the measure is too little, too late. The problem with the Finance Department’s parking programs -- one is for companies that make short deliveries and another for those with trucks that might stay longer -- is not lack of enforcement; it’s their very existence. New Yorkers should tell their representatives to end, not mend, these inherently unfair, road-clogging, fume-producing programs. A bill pending now in the state Legislature, sponsored in the Assembly by David Weprin (D-Queens), would do that.
Why are the city’s bulk-discount programs for parking tickets so unfair? Aren’t they good for businesses that make deliveries?
Much has changed since Mayor Bloomberg created the programs back in 2003 -- our shopping habits, for one. In the days before massive online shopping, a delivery might be a quick curbside hit by a van. Now, big trucks will park in no-parking zones for hours, as workers unload hand-truck after hand-truck. Traffic crawls around them. Congestion leads to more congestion -- and air pollution, as all kinds of vehicles sit idling.
The parking scofflaws also adversely affect safety for motorists, cyclists, and pedestrians, especially disabled people who must negotiate round the trucks and who depend on unfettered access to parking.
The programs also hurt the little guy. The average citizen does not get to enroll in the programs; we have to fight infractions in hearings or hire agents (like my firm) to do it for us. And higher fees for tickets also will hurt the smaller firms in the program, forcing them to spend more time in court.
The biggest losers may be the taxpayers. The city estimates that it settled almost half of the 3 million tickets incurred by businesses in the programs -- revenues that could have added up to $100 million to city coffers annually. When the city zeroes out tickets through the programs, it also expunges a $15 surcharge on all tickets mandated by the state, which funds anti-drunk driving education, help for indigent defendants, and domestic-violence programs. That deprives the government of another $45 million or so annually.
For all these reasons, these outdated programs amount to corporate welfare we can ill-afford, and they breed cynicism about our traffic laws. Why do some get their fines reduced as part of the cost of doing business, while everyday people pay full freight, so to speak?
Tell your representatives that the meter has run out on these programs.
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Glen Bolofsky is the CEO of parkingticket.com, a nationwide, web-based service that disputes parking fines.
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(photo via Facebook: @HowieHawkinsForGovernorPolitician)
That didn’t take long. On Saturday, April 13 the Working Families Party endorsed Democrat Cynthia Nixon for New York Governor. By the following Tuesday, the WFP said they didn’t really mean it.
“We will not be a spoiler,” said Bill Lipton, the WFP’s political director, indicating that the WFP will take Nixon off its ballot line if she loses the Democratic primary against Governor Andrew Cuomo. Perhaps the WFP will offer Cuomo their ballot line for a third time if he wins the Democratic primary – if he will take it.
I feel for rank-and-file WFP progressives. It’s an abusive relationship. They got double-crossed by Cuomo in 2014 when they endorsed him. This year they got strong-armed by Cuomo when they didn’t.
I would like to reassure WFP progressives that, whatever happens in the Democratic primary, the Green Party gubernatorial ticket will offer a progressive alternative in the November 6 general election.
Only three parties – Democratic, Republican, and Green – created their ballot lines by running their own candidates. The other five ballot-qualified parties got the 50,000 votes for governor needed for a ballot line by cross-endorsing the Democrat or Republican. These so-called “fusion” parties function like political clubs inside the major parties, not independent parties.
When the WFP endorsed Cuomo over Zephyr Teachout in 2014, Cuomo’s double-cross began immediately. He backed away the next day from promises he made to get the endorsement in his so-called hostage video to the WFP convention. At the Celebrate Israel Parade the morning after, Cuomo told reporters, “It’s very simple at these political conventions: you either win or you lose. Uh, and I won…At the end of the day I won the endorsement, and that’s what’s really relevant.”
On that morning after, Cuomo broke his promise of the night before to allow municipalities to raise the minimum wage. Asked about his promise to help Democrats take control of the State Senate, Cuomo said, “This is about electing people who support an agenda. I also will oppose Democrats who have opposed things that we have tried to pass."
Over the next nearly four years, Cuomo spent none of his political capital to pressure the Independent Democratic Conference to break its governing coalition with Senate Republicans. Cuomo used the Senate to deflect blame for his failure to enact so much of what he had promised the WFP, including full funding of public schools, the Dream Act, abortion-rights protections, government ethics reform, and public campaign financing. Cuomo played the WFP and took their votes for granted.
So this year the WFP was right to endorse a progressive challenger. Cuomo’s response, according to WFP leaders, was a power play to pull the unions out of the WFP and threaten to cut union and state funding for WFP-affiliated community organizations.
Then there are the scores of WFP-endorsed “Working Families Democrats,” as this nominal third party refers to them, who are running for the State Senate and Assembly. No doubt these Democrats feel pressure from the Democratic machine, and particularly the big Democratic donors who back Cuomo, to endorse Cuomo...or else.
Such are the contradictions of fusion balloting. It would be confusing for the WFP to run Nixon against Cuomo in November when it is also supporting Democrats whose ticket would be headed by Cuomo. Organizing working people to vote for the corporate-sponsored Democrats is like organizing workers into a company union run by the bosses.
The Green Party takes a different approach. We organize working people and progressives into a party that is independent of the Democrats’ corporate donor swamp of real estate barons, Wall Street bankers, media and movie moguls, military contractors, and big pharma and insurance. Our political independence forces Democrats to compete for progressive voters instead of taking them for granted. The Green vote gives us political leverage. We try to win, but we don’t have to win the office to make a difference.
The 184,419 votes for 5% in the general election that the Green gubernatorial ticket received in 2014 reinforced the 192,210 votes that Zephyr Teachout got in the Democratic primary. Cuomo, who had wanted to run up his vote for a presidential run, received a smaller percentage than he had in 2010. Seeking those votes to his left after that election, Cuomo adopted a number of Green demands, from the fracking ban and paid family leave to partial implementation of the $15 minimum wage and tuition-free public college.
Greens will demand more this year, including single-payer health care, fully-funded public schools, a stop to fracked-gas infrastructure, 100% clean energy by 2030, and public campaign finance. And we will still be on the ballot in November.
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Howie Hawkins, a recently retired Teamster from Syracuse, was the Green Party candidate for Governor of New York in 2010 and 2014 and is seeking its nomination again this year. On Twitter @HowieHawkins.
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