Gotham Gazette http://www.gothamgazette.com/component/tags/tag/1348 Wed, 20 Mar 2019 16:11:53 +0000 Joomla! - Open Source Content Management en-gb webmaster@gothamgazette.com (Webmaster) Coverage Denied No Longer: Expanding Eating Disorder Treatment in New York http://www.gothamgazette.com/130-opinion/8300-coverage-denied-no-longer-expanding-eating-disorder-treatment-in-new-york http://www.gothamgazette.com/130-opinion/8300-coverage-denied-no-longer-expanding-eating-disorder-treatment-in-new-york niley ro am

Assemblymember Nily Rozic, the author


“An eating disorder? I wish I had one of those — I could stand to lose a few pounds.”

Every year, clients, advocates, and professionals visit the New York State Capitol to meet with legislators. When discussing their eating disorder experiences and pushing for legislation to ensure proper insurance coverage, too often they are met with that response and others like it.

These kinds of insensitive quips reveal how little many people know about the danger and severity of eating disorders.

No one intentionally jokes about wanting a life-threatening illness. And the truth that too few people understand is that eating disorders are life-threatening mental illnesses. Not a choice; the disorder is a means of coping and can be attributed to a collection of biological, psychological, social, and genetic factors.

Anorexia and bulimia nervosa are the most common disorders but they are not the only ones. Others recognized by the American Psychiatric Association in the Diagnostic and Statistical Manual include Binge Eating Disorder, Avoidant Restrictive Food Intake Disorder, Other Specified Feeding or Eating Disorder, Pica, and Rumination Disorder. All of these disorders are serious and require medical attention.

People who struggle with an eating disorder are doing precisely that — they are struggling. Part of that pain and stigma comes from their symptoms not being understood as dangerous or serious. Often, symptoms are not taken seriously and they must convince not only their loved ones that they are sick but also insurance providers that approve treatment and coverage.

There remains a troubling gap in insurance coverage. Through Timothy’s Law, eating disorders are ensured coverage but only anorexia and bulimia nervosa are named. Insurance providers use this grey area as reasoning to deny coverage of the other eating disorders.

The story is common: Too many people are turned away due to lack of coverage. Too many people lose their chance of a full recovery because they didn’t meet strict weight requirements to classify as anorexic or didn’t throw up often enough each day to be considered bulimic. Not only is it hard to be approved for coverage, it’s even harder to find a comprehensive care center close to home — there are only three across New York.

It is time that law reflects the most current version of known eating disorders. New York can change the story. Earlier this year, I introduced the Eating Disorders Act (A1619/S3101) that would ensure coverage is provided to all people struggling with eating disorders by codifying all the currently recognized disorders.

The time for awareness is now. The time for change is now.

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New York State Assemblymember Nily Rozic represents parts of Queens. On Twitter @nily.

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Have an op-ed idea or submission for Gotham Gazette? Email opinion@gothamgazette.com

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Coverage Denied No Longer: Expanding Eating Disorder Treatment in New York Sun, 24 Feb 2019 05:00:00 +0000
Creating a Single-Payer Health Care System That Works for All New Yorkers http://www.gothamgazette.com/130-opinion/8273-creating-a-single-payer-health-care-system-that-works-for-all-new-yorkers http://www.gothamgazette.com/130-opinion/8273-creating-a-single-payer-health-care-system-that-works-for-all-new-yorkers health care is a right

(photo: Michael Appleton/Mayor's Office)


In November, New Yorkers voted for a united government in Albany with a resounding directive: fix our broken healthcare system. Those election results are directly linked to the financial strain New Yorkers are facing as they struggle to choose between paying for their medication, premiums, long-term care, and basic needs, such as food or housing.

The high costs of healthcare in our state have devastated hundreds of thousands of New York families by bankrupting those who are underinsured or forcing them to forgo treatment due to the financial burden it usually causes. According to the Campaign for New York Health, approximately 1 million New Yorkers still do not have health insurance; 20,000 New Yorkers have died due to their lack of coverage in the last ten years; and millions more would be bankrupt if faced with a medical emergency under their current health care plan.

The New York Health Act (NYHA) is the only option on the table that would provide comprehensive healthcare coverage to all New Yorkers. It would extend coverage to those that currently have no access while providing quality and comprehensive care to New Yorkers who have been traditionally underinsured.

This year, we are going one step further. We are introducing a version of the NYHA that aims to close an additional gap in our healthcare system by integrating long-term care coverage into the legislation. This shift in policy will address our state’s long-term care crisis and meet the healthcare needs of seniors, people with disabilities, as well as countless family caregivers, who are primarily women, for generations to come.

The benefits of including long-term care in the NYHA will not only be felt by those who will now be able to afford assisted living, nursing home care, or home health care, but it will also have a rippling effect on our economy. In the Northwest Bronx, where we both live and work, thousands of home health aides, care workers, and unpaid caregivers have to withstand low wages, few benefits, and not enough investment in training and retention services. The current system is financially debilitating to families, those who require care, and the workforce that is tasked with administering care, all of whom are predominantly women struggling to provide for their loved ones. For instance, nationally, Latinx family caregivers spend 44% of their annual income providing caregiving services, while African-American family caregivers spend 34% of their income.

A healthcare system that guarantees long-term care coverage would help ease the financial burden of thousands of families across our state while dramatically improving the system for those who receive and provide care. According to a study recently released by the RAND Corporation, even with the addition of long-term care, the NYHA would cost less than what is being spent under the current healthcare system. It is simply the most fiscally responsible step to take.

The majority of New Yorkers have spoken loud and clear. They are demanding a healthcare system that works for them and not for the most powerful corporations. This new version of the NYHA and our new leadership in Albany bring us one-step closer to making healthcare a right and not a privilege for all New Yorkers.

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State Senator Gustavo Rivera is the Senate sponsor of the New York Health Act. Karla Lawrence is a direct care worker specializing in gerontology and long-term care; she is a member of 1199 SEIU and the National Domestic Workers Alliance, and a leader in the New York Caring Majority.

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Have an op-ed idea or submission for Gotham Gazette? Email opinion@gothamgazette.com

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Creating a Single-Payer Health Care System That Works for All New Yorkers Mon, 11 Feb 2019 05:00:00 +0000
A Closer Look at ‘Vital Brooklyn,’ Cuomo’s Plan for ‘One of the Greatest Areas of Need in the Entire State’ http://www.gothamgazette.com/state/8144-a-closer-look-at-vital-brooklyn-cuomo-s-plan-for-one-of-the-greatest-areas-of-need-in-the-entire-state http://www.gothamgazette.com/state/8144-a-closer-look-at-vital-brooklyn-cuomo-s-plan-for-one-of-the-greatest-areas-of-need-in-the-entire-state billion vital bk

Cuomo & Vital Brooklyn (photo: Mike Groll/Governor's Office)


In March of 2017, Governor Andrew Cuomo unveiled what he described as a groundbreaking initiative to “bring health and wellness to one of the most disadvantaged parts of the state.” That place was Central Brooklyn, where roubling health indicators of all types plague residents, from diabetes rates to poverty levels to inadequate access to quality health care.

Cuomo said the plan, named Vital Brooklyn, came with $1.4 billion in state funds to pay for a long list of items across the borough, from playground renovations to job training to resiliency projects — all with the aim of fighting “entrenched pockets of poverty” in a comprehensive way, he said at the time.

“What is the area in this state that has the greatest social need? If you look at unemployment rates, food stamps, physical inactivity, number of murders, one of the greatest areas of need in the entire state is Central Brooklyn. And it’s not even close,” Cuomo said.

Since then, the governor has made nearly a dozen announcements related to Vital Brooklyn, six of them taking place from June to September in the lead-up to this year’s gubernatorial primary in which candidates for statewide offices heavily courted Central Brooklyn voters. At those events, Cuomo emphasized state funding for an oyster reef restoration project ($400,000), 22 community gardens ($3.1 million), fresh food programs ($1.8 million) and a new 407-acre state park to be named after iconic Brooklyn Congressional Rep. Shirley Chisholm — an announcement made eight days before the primary.

In total, the governor’s office says there are 8,800 projects funded under the Vital Brooklyn umbrella, funded by the $1.4 billion (a dollar amount unchanged since spring of 2017, according to the state budget office). However, it’s important to note that those touted by the governor — such as those gardens, farmers markets and state park — make up a small slice of the total funding. The much larger pieces of the pie fall into just two (albeit very big) categories: housing and health care.

In fact, nine out of every 10 dollars spent through Vital Brooklyn fall into the housing and health care columns: $578 million for subsidized housing in rapidly gentrifying areas (for example, a 2,400-unit project just announced in East New York) and $700 million, allocated in 2015, for a new health care system that aims to restructure and revive three of Brooklyn's struggling hospitals.

While some aspects of Vital Brooklyn are quickly taking shape, others will take months or years to materialize. Some officials, including several who have excitedly joined Cuomo at celebratory announcements, are lauding the investments, but critics of the project worry it’s not enough — and take issue with how Vital Brooklyn was rolled out, and how the money is divvied up.

Brooklyn Borough President Eric Adams said in a recent interview that his office wasn’t asked to give input on the project (the state instead took comments from advisory boards convened through the area’s elected state Assembly members) and he feels the funding is too small in scope and dollar amount, even if the governor’s frequent appearances make it appear otherwise.

“We have to have a re-examination of the state allocations and are we doing what’s right by Brooklyn,” he said, particularly in relation to the Bronx, which Adams feels has gotten significantly more financial help from the state; Bronx Borough President Ruben Diaz, Jr. is a close ally of the governor.

Earlier this year, he put it more bluntly earlier in an interview on the Max & Murphy podcast.

“You can’t keep brushing off and rolling out the same billion-dollar project,” he said in May.

When asked to respond to that claim — and whether or not the Vital Brooklyn announcements were made in relation to this year’s primary — Cuomo spokesperson Tyrone Stevens’ comment was brief: “Bogus.”

“This is simple: Our significant new investment in Brooklyn is based on a multi-pronged strategy to uplift communities that have been ignored for too long,” Stevens said in an email. “We’re proud of this effort, and we will not be shy about talking to local residents about the important work we’re doing to make their neighborhoods a better place to live.”

Big Spending: Health Care
Of Vital Brooklyn’s $1.4 billion, fully half is dedicated to a new health care system for Brooklyn. That funding comes from a $700 million capital grant made through the Health Care Facilities Transformation Program included in the 2015-2016 state budget, allocated two years before it was announced as part of Vital Brooklyn.

The funding will go to One Brooklyn Health System (OBHS), a newly formed operator that will combine the management of three previously separate Central Brooklyn hospitals — Kingsbrook Jewish Medical Center in East Flatbush, Interfaith Medical Center in Bedford-Stuyvesant, and Brookdale University Hospital Medical Center serving Brownsville and East New York — into one not-for-profit corporation.

LaRay Brown, previously the president and CEO of Interfaith, is heading up the new venture. She says she’s been pushing for years for the “incredibly impactful” amount of state funding that will support dozens of major projects throughout the new health care system.

Inside the buildings, the $700 million will pay for “boring things, but essential things,” Brown said, like replacing elevators, repairing HVAC systems and updating an outdated fire alarm system.

“I say they’re boring, but they’re critical to providing safe and comfortable patient care,” she said.

The medical centers will get major upgrades to their patient facilities, too. According to Request for Proposal documents from OBHS, Brookdale will build out a new 33-bed intensive care unit, renovate a 40-year-old operating room suite and upgrade all of the facility’s inpatient psychiatric units among others improvements. At Interfaith, the medical center’s emergency room will be upgraded and expanded, inpatient medical units will be renovated and new equipment such as MRI and x-ray machines will be installed. Major medical equipment will be replaced at Kingsbrook, as well, the documents show.

Overall, the idea for the restructuring and redesign is to merge services among the three hospitals in order to form a more streamlined organization — and hopefully, in the end, become more financially stable.

That’s according to state officials from the Public Health and Health Planning Council who approved the creation of OBHS in December of 2016. A report to the council at the time concluded that, operating separately, the hospitals require hundreds of millions of dollars in operating subsidies from the state every year “and are otherwise not financially sustainable.” (According to budget data from a PHHPC report, operating funds given to the three hospitals from the state totaled $169 million in 2015-16, then rose to $245 million in 2016-17 and $250 million in 2017-18.)

“They've come together … in an effort to try to restructure and become more efficient and reduce its dependence on specialty subsidies,” state health department official Charles Abel told the council before it approved the OBHS application.

To achieve those efficiencies, OBHS will reorganize how certain operations run within the three hospitals. For example, Brown said, Kingsbrook will no longer have inpatient medical-surgical beds and, though it will still have an emergency room, patients in need of ongoing acute or complex care will be transferred elsewhere, likely to Brookdale, which Brown said will become the system’s “center of excellence.”

LaRay Brown Brooklyn“As the inpatient acute care role diminishes at Kingsbrook, that role increases at Brookdale,” said Brown (pictured).

But Brown is careful to note the restructuring effort should not be considered a consolidation. Current assessments by OBHS show no material difference between the number of current beds and projected beds in the system, according to OBHS’ Dona Green. In the end, Brown says the quality and quantity of services will expand.

“Because these hospitals are coming together and because of the state’s commitment to invest in these hospitals, the Central Brooklyn community served by these hospitals will get more services, and not less,” Brown said.

That sentiment was echoed by Assemblymember Latrice Walker of District 55 in Brownsville, who has been waiting for years to see this funding come through for the hospital system, particularly at Brookdale, where many of her constituents go for care — and where her own brother died of gunshot wounds when he was 19, she said.

“I’m confident the services will be reinvigorated and enumerated. I don’t think we’re going to lose anything here,” she said. “Quite the contrary — we’re actually gaining.”

By the totality of the health facilities in the works under Vital Brooklyn, that appears to be the case. A chunk of the initiative’s healthcare funding — $210 million in all — is allocated to create 32 new ambulatory care facilities, or community health centers, under the OBHS umbrella. The goal there is to create more medical offices, outpatient surgical facilities and urgent care options with a more long-term goal of reducing unnecessary trips to emergency rooms.

“We need to start moving toward people having primary care physicians so that the emergency room isn’t their doctor office,” Walker said.

Cuomo put it this way when announcing some of the 32 ambulatory care locations in July of this year: “It's not just about a hospital where you go when you're very sick.”

“Prevent the illness in the first place,” he continued. “Have more community-based healthcare systems that are focused on wellness, and health, as opposed to waiting for a person to get sick, and then be in acute need.”

These new ambulatory centers are meant to handle a diverse slate of same-day health services, including diagnostic work, rehabilitation, or even major procedures such as hip replacements, according to Bill Hammond, the Director of Health Policy at the Empire Center think tank.

Ambulatory centers have a lot of benefits, he said. For the patient, it’s generally a more comfortable experience to avoid spending a night at a hospital, and there’s less risk of infection. For hospitals, increasing outpatient services makes a lot of financial sense.

“It’s less expensive,” he said. “Hospitals come with a lot of overhead.”

That idea is in line with a healthcare trend more generally to move patients out of traditional inpatient hospitals and toward ambulatory centers for all kinds of services, from preventative doctor visits all the way up to certain surgeries. The move from “reliance on hospital-based services” to more outpatient services “is a major policy shift,” said Brown of OBHS. And it takes place within the context of years of financial struggle, and at times closure, for many hospitals, particularly those serving low-income communities, as costs have continued to rise.

To combat that, the Vital Brooklyn plan puts a priority on the financial viability of health care projects funded under the plan. Included in guidelines for evaluating applicants to Vital Brooklyn, the state’s website says it will consider “the extent to which the proposed projects further the development of primary care and other outpatient services; the extent to which the proposed projects contribute to the long-term sustainability of the applicant or preservation of essential health services; and the extent to which the proposed projects involve partnerships with community-based health care providers,” among other criteria.

With the funding for the new 32 health facilities, the state hopes to roughly double the number of ambulatory care visits in Central Brooklyn, increasing capacity for 742,000 more visits every year, according to the governor’s office.

Exactly where all that new health care capacity will be built is unknown; all 32 locations have not yet been finalized. But Cuomo announced plans in July for renovations and the expansion of several existing health care centers, including the Bishop Walker Health Care Center in Prospect Heights, the Pierre Toussaint Health Center in Crown Heights and the Brownsville Multi-Service Center. In addition to those locations, several health care providers including the Bed-Stuy Family Health Center, Community Health Network, and ODA Primary Health Care Network have been chosen by the state to build new health centers in Brooklyn, providing both primary and specialty care.

Some of the 32 new ambulatory health centers will be built within new developments underwritten by the second largest piece of the Vital Brooklyn funding: affordable housing.

Housing on State and Hospital Sites
In all, the state will spend $578 million — or more than 40 percent of the total Vital Brooklyn package — on subsidized housing, with a goal to build 4,000 new units over several years.

The governor has repeatedly linked overall health goals of Vital Brooklyn to housing, particularly in rapidly gentrifying areas such as East New York where speculative buying and building, combined with a 2016 rezoning, has put pressure on poor residents.

“It starts in the home, having the right housing, having the right environment, having the right support. And that's where we're going to start. We need afford affordable housing because out people are being displaced. Gentrification is everywhere,” the governor said at a Vital Brooklyn event earlier this year.

How all those units will be constructed is still up in the air, but details on some of the development sites are beginning to emerge. Late last month, the state announced four winning bids to develop housing on land owned by the three OBHS hospitals or on state-controlled land, including one complex in East New York that’s set to deliver the bulk of the subsidized housing funded under Vital Brooklyn.

On Nov. 29, the state chose Westchester-based L+M Development Partners, Harlem-based construction group Apex Building, and two social services organizations — RiseBoro Community Partnership and Services for the Underserved — to bring a massive, 2,400-unit development to the site of the former Brooklyn Developmental Center, a home for developmentally delayed adults that closed in 2015. The three other chosen projects — two to be built on land owned by Interfaith hospital and another on land owned by Brookdale Hospital — will bring another 328 subsidized units to the borough.

At the same time the state announced those projects, it rolled out another set of request for proposals (RFPs) on eight state-controlled sites around the borough, including several hospital parking lots set to be replaced by new buildings. Proposals for five of the sites are due by February 28, 2019 and the three others are due by April 30, according to the RFP documents.

A majority of the affordable housing will be funded by $568 million allocated through the state’s Homes and Community Renewal agency, with a goal of creating 3,000 units. In addition, the governor said in August $15 million in federal tax credits have been allocated by the state for future housing developments on land controlled by the New York City Housing Authority (NYCHA). In his announcement on that initiative, the governor said he hopes to support the creation of 1,000 units of housing. However, no specific sites for those developments have been announced and will be “reviewed on a rolling basis by HCR as NYCHA makes properties available through its disposition process,” according to a press release.

The need for housing is the number one priority for Brooklyn residents, Borough President Adams said, and he gave credit to Vital Brooklyn for addressing the issue. He also acknowledged the plans would bring much-needed resources — including park space and options for healthy food — to the area. But he thinks it doesn’t go far enough.

“We’re dealing with historical inequities. People who were denied food access before — OK, let’s give them more farmer’s market,” he said. “Those things are great. But if we’re going to invest, let’s be visionaries in our investment.”

He would have liked to see more funding allocated to grandparent housing, which is set aside for grandparents who are the primary caregivers to young children, and even more resources given to the hospital network, he said.

More criticism of the governor’s Vital Brooklyn plan came from the East New York district where the large Brooklyn Developmental Center site is set to be rebuilt under the initiative. The complex will have 100 percent subsidized apartments set aside for a combination of formerly homeless New Yorkers, households earning less than 50 percent of the area median income (AMI) — a federal guideline for determining the cost of affordable housing — and the rest for households earning less than 80 percent of the AMI. Currently for a family of three, 80 percent of AMI equals $62,150 a year.

That may sound like a win in a low-income area like East New York. But with the median household income of East New York at $34,512 per year (according to data from the city’s Housing Preservation and Development agency), the development doesn’t satisfy one of the neighborhood’s longtime leaders.

Assemblymember Charles Barron says his district needs even more low-cost units because only a fraction of its residents are in the 80-percent income range. And, overall, he thinks Vital Brooklyn doesn’t go far enough in a state with a $168 billion budget, and billions more in capital spending.

“You see $600, $700 million and think it’s wonderful and a lot of money,” he said. “That is peanuts.”

In particular, he wants to see more support for the healthcare system.

“It’s simply not enough money for three hospitals,” he said.

In response, Cuomo spokesperson Stevens said in a statement that the Vital Brooklyn investment is “delivering substantial resources and coordinated services to support neighborhoods that have long been neglected.”

“We believe this massive commitment is something to celebrate, not politicize with cheap attacks that are untethered to reality,” he said.

Looking for Results
The governor has often said, for him, Vital Brooklyn is a project that brings his own career full circle, from when he was working on housing in East New York as a young man, to now. In speaking about it, he says he has wanted to help turn Brooklyn around for years.

Cuomo Brooklyn“I never lost the inspiration, and the hope, and the optimism, of what you can do when you do it right,” he said in a speech on the project in April, nearly half-way through his eighth year in office. “For me, this is something special. This is something that is long overdue. It's an investment in people who desperately have needed help, and have been ignored for too long.”

But it may take quite a while to see all of the Vital Brooklyn projects come to life. Some of the smaller pieces of the puzzle, like a pilot program for youth-run food markets and construction on new playgrounds, are beginning this year and next, the governor has said. For the larger, more complicated parts, however, it could take years; for example, some of the first units of housing are estimated to come online in 2021 and others — like the East New York project — is not slated for completion until 2026, the governor’s office said.

The health center restructuring, too, will takes years to finish. When it’s finally complete, it remains to be seen whether the largest part of Vital Brooklyn — the $700 million in health care capital funding — will make a substantive difference to financially shore up the three Central Brooklyn hospitals.

Hammond of the Empire Center said if the plan is a good one that reconfigures the facilities’ operations significantly, it “could put them in a different position to succeed,” though he was hesitant to say whether he believes the restructuring will prove successful long-term.

But the health funding is not peanuts, as Barron said, nor is it a groundbreaking amount, as one may think from the governor’s announcements. The reality is somewhere in the middle.

“The state routinely spends billions and billions of dollars on health care all over the state,” both in discretionary grants and capital allocations, Hammond said. “On any given day, you could go to a different community and announce a very large-sounding dollar amount…and it would be absolutely routine.”

However, on a per-resident basis, Brooklyn is getting more than the average — while falling far below the state’s most generous allocations. Hammond found the state spent $190 per resident in capital health care spending in the last five years in New York State. In Kings County, the per-resident breakdown equaled $264 per resident, which is “significantly more than the state average,” he said. But that figure is dwarfed by another capital grant also given in 2015 to a hospital system in Oneida County, where spending totaled $1,297 per resident.

For all those funding plans, however, the dollars have not yet started to flow, according to Brown of OBHS. Before that happens, several bureaucratic steps must take place, including complying with transparency regulations approved by the state comptroller’s office. She hopes that will be complete in the new year.

“Everyone is endeavouring to get [approval]…by early 2019,” she said, while emphasizing it’s hard to make an exact estimate, as she and her team are figuring out the complexities of the project as they go along.

“We’re all entering a new journey here,” she said.

***
by Rachel Holliday Smith for Gotham Gazette
@rachelholliday
@GothamGazette

All photos via the Governor's Office on flickr.

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A Closer Look at ‘Vital Brooklyn,’ Cuomo’s Plan for ‘One of the Greatest Areas of Need in the Entire State’ Thu, 13 Dec 2018 05:00:00 +0000
Max & Murphy Podcast: Will Single-Payer Health Care Come to New York? http://www.gothamgazette.com/state/8139-max-murphy-podcast-will-single-payer-health-care-come-to-new-york http://www.gothamgazette.com/state/8139-max-murphy-podcast-will-single-payer-health-care-come-to-new-york mxm logo

Ben Max, left, of Gotham Gazette, and Jarrett Murphy, right, of City Limits


December 12, 2018 - Max & Murphy Podcast: Will Single-Payer Health Care Come to New York?

wbai dec12 400One of the most hotly-debated issues in state government is whether New York should or will move ahead with the New York Health Act, which would institute single-payer health care. State Senator Gustavo Rivera, a Bronx Democrat, is the Senate sponsor of the bill and will soon be part of the Democratic majority in the Senate, as well as the health committee chair. He joined the show to discuss the broader priorities of the Senate Democrats and the prospects for the New York Health Act when his party has full control of state government come January.

Then, Bill Hammond, director of health policy at the Empire Center, joined the show to dissect the New York Health Act and a variety of ways in which he thinks it is problematic legislation, as well as the political terrain ahead for it.

Listen to the conversation and let us know what you think -- we're on Twitter @TweetBenMax and @JarrettMurphy. You can listen to the show through the embedded audio below or download the episode wherever you get your podcasts, under "Max & Murphy," and listen to Max & Murphy live on Wednesdays at 5 p.m. on WBAI radio, 99.5FM or wbai.org

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by Ben Max, Gotham Gazette
     

Read more by this writer.

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Max & Murphy Podcast: Will Single-Payer Health Care Come to New York? Wed, 12 Dec 2018 05:00:00 +0000
With Full Democratic Control, Sponsors of New York Single-Payer Health Care Hopeful About 2019 http://www.gothamgazette.com/state/8066-with-full-democratic-control-sponsors-of-new-york-single-payer-health-care-hopeful-about-2019 http://www.gothamgazette.com/state/8066-with-full-democratic-control-sponsors-of-new-york-single-payer-health-care-hopeful-about-2019 Cuomo health care

Gov. Cuomo (photo: Kevin Coughlin/Governor's Office)


This is part of AGENDA 2019, a joint Gotham Gazette-City Limits project
Find the rest of the series here

Though Governor Andrew Cuomo has not expressed support for instituting a single-payer health care system in New York, his fellow Democrats campaigned on the issue as they flipped control of the state Senate, landing all of state government into Democratic hands and providing a significant boost of optimism to the lead sponsors of the New York Health Act, which would create a government-administered single-payer health care system.

The bill has passed the Democrat-dominated state Assembly several times and all the members of Senate Democratic conference signed on as co-sponsors at the end of last legislative session in a unified show of support for the program heading into the election season.

Cuomo has said he supports a Medicare for all-type system at the federal level, but cast doubts on the cost and complexity of doing it in New York, and since their resounding wins on Election Day, the incoming leaders of the Democratic Senate majority have indicated that the massive undertaking of single-payer is not at the top of the agenda.

Still, with Democratic control of the Senate and the Assembly by wide margins, single-payer healthcare could be passed as early as the 2019 session, according to Assemblymember Richard Gottfried, chair of the Assembly Health Committee and lead sponsor of the New York Health Act.

“It was clear in the country and New York that healthcare was the number one issue on voters’ minds,” Gottfried said, before pointing to his legislation. “A solid majority of the new state Senate has either been a cosigner, voted for it in the Assembly, or campaigned on it. So I think we’re on track to get it passed in the Assembly and state Senate.”

The New York Health Act would replace health insurance companies with New York state government as the payer of healthcare costs for all New Yorkers. It has been passed in the Assembly four years running but has yet to be voted on in the Senate, where Republicans have held control. All of the other 30 Democratic senators joined lead sponsor Senator Gustavo Rivera of the Bronx to co-sponsor the legislation, though the Senate Democratic conference is seeing significant turnover due to primary wins by insurgent challengers. But, those challengers have in general been even more vocally supportive of single-payer health care than their more moderate predecessors. These facts give Gottfried confidence that the New York Health Act will pass during the 2019 session, which begins in January.

But the bill still faces an uphill battle, in part because of the massive changes it would institute, and the fact that though it might reduce overall individual and business healthcare costs after implementation, for the state to run the system it would require raising taxes significantly, something many Democrats have promised not to do and Cuomo is vehemently opposed to. It would also drastically impact the state’s private and public hospitals, the health insurance industry, and more. Some of the changes would of course be beneficial to New Yorkers, but the undertaking is complex and the New York Health Act as currently written leaves a lot of detail undetermined, including funding.

The governor has repeatedly opposed single-payer healthcare at the state level, suggesting that it would be more rational and financially feasible if administered by the federal government. Cuomo questioned in the past how a single-payer system could be put in place without doubling the tax burden, and cited California’s and Vermont’s debates over single-payer — which both ended when supporters were not able to answer one question: where would the funding come from? — as paragons of the impracticality of state-level single-payer.

Gottfried, a Manhattan Democrat, is confident that with his fellow lead sponsor Senator Rivera, who is likely to be the Senate health committee chair come January, and other legislators, he will be able to sway Cuomo to support the legislation.

“He’s obviously not on board yet, but he and his staff are very open to working with the Legislature on the issue,” Gottfried said. “I’m convinced we can satisfy their concerns.”

And after a recent study by RAND Corporation concluded that the New York Health Act would result in a reduction of administrative costs, provide all New Yorkers with healthcare, and reduce healthcare costs for most, Gottfried says the financing of the bill will not be a problem.

“New Yorkers are all going to have to think about what they will do with the hundreds of thousands of dollars that will end up in their pockets, and that’s a nice problem to have,” Gottfried said.

The study has a caveat, however, stating in its conclusion that “the estimated effects depend heavily on the assumptions about provider payments, administrative costs and drug prices.” Politico highlighted these assumptions as well as the likely tax increases that have largely been brushed aside by Democrats supporting the legislation. Wealthy people leaving the state, companies restructuring, the cost of hospital expenses rising at a faster rate or the Trump administration not issuing a federal waiver to redirect all healthcare-related funds to the new state entity are all possible events that could result in RAND’s conclusion falling apart.

For it to work, while health care costs drop, taxes would undoubtedly increase significantly for many New Yorkers. As cited by Politico, “a household reporting $150,000 in income would see its state tax rate increase from 6.45 percent in 2017 to 18.3 percent,” under one model scenario. Additionally, those who receive Medicaid or fall under the state’s Essential Plan, which subsidizes health insurance for low-income New Yorkers, have less to gain from the expansion. According to RAND, though, 1.2 million New Yorkers would gain health coverage.

It is likely that funds for New York single-payer health care would partially come from a new payroll tax, which RAND projects to fall largely on employers. However, RAND suggests the health act payroll tax would cost less for businesses already contributing toward employee health insurance and the Medicare payroll tax, estimating decreases in employer costs fairly quickly.

Concerns about businesses and high-income individuals leaving the state persist, with a tax atmosphere in New York that many, including Cuomo, acknowledge is already burdensome and became more so for many taxpayers, especially top earners, under the new federal tax code.

Senator Rivera, aware that cost is the primary argument against single-payer health care, repeatedly emphasized the need to work towards a version of the bill that would reduce the financial strain.

“I will continue working diligently with Assembly Member Gottfried, Senate Majority Leader Stewart-Cousins and the Senate Democratic Conference to make the New York Health Act a bill that is not only fiscally responsible, but that provides comprehensive coverage to all New Yorkers,” Rivera wrote in an email to Gotham Gazette.

The bill and its potential ramifications have been studied closely by Bill Hammond, director of health policy at The Empire Center, a think tank. "Regardless of which party controls the state Senate, the New York Health Act remains a wildly unrealistic idea," Hammond said by email. "It means putting New York's entire health-care system — representing one-fifth of the economy — in the hands of the same state government that struggles to run the subways. It requires massive, draconian tax hikes, enough to roughly triple total state revenues."

"Plus, a true single-payer plan would need federal waivers that the Trump administration has vowed to block," Hammond continued, also noting a political angle -- that if Democrats spend great sums of money and political capital on a health care overhaul of this magnitude, what will they ignore, like fighting climate change or improving mass transit.

"It was easy to cast a symbolic yes vote for a single-payer bill that had no chance of passing," Hammond said. "Now that that it might actually happen, supporters are going to be forced to confront the practical realities. Then, hopefully, they’ll focus on helping the 6% of New Yorkers who still lack insurance, rather than disrupting coverage for those who already have it."

agenda19v2 aRivera acknowledged that moving to single-payer would not satisfy everyone, especially those who benefit from the current system, and that there are negotiations to come that will likely adjust the bill to make it more palatable to holdouts.

“The biggest challenge will be to reach a consensus among stakeholders that the NY Health Act is feasible [and] fiscally responsible,” Rivera wrote.

Citing “healthcare practitioners, prescription drug companies, healthcare providers, employers, unions and New Yorkers,” as the various groups involved, Rivera also mentioned courting Cuomo as an important step to take in the coming legislative session.

“Our main priority for the next legislative session is to continue shaping the bill so that it is feasible, affordable, that the Governor is willing to sign, and that primarily, provides quality healthcare for everybody,” Rivera wrote. “During the next legislative session, we will focus on making the necessary amendments to the bill so that it truly reflects the different healthcare needs affecting all New Yorkers.”

For now, it is very difficult to imagine Cuomo coming on board, especially given the pains he’s taken to keep state spending increases at around 2 percent per year and to lower taxes. Asked about single-payer health care during a Thursday appearance on The Capitol Pressroom with host Susan Arbetter, Cuomo painted it as unrealistic given budget constraints. He said Democrats are generally in agreement on the concept, but legislators will have to deal with reality in working with him on a state budget next year, while he also said he thinks it's much more workable on the federal level. “Single-payer health plan, for example," Cuomo said, "conceptually I think it’s the right way to go in. I believe it’s more feasible financially on the national level. No state has been able to finance the transition costs.”

A variety of factors, including the challenge of getting Cuomo’s support and not wanting to come into power quickly pursuing something as revolutionary as single-payer health care, may be why the likely next Senate majority leader, Andrea Stewart-Cousins, and her likely deputy, Senator Michael Gianaris, have not highlighted it as top priorities for the coming session.

Assemblymember Gottfried noted that state Senators’ public approval of the bill gives him no reason not to “take them at their word,” and said he expects the legislation to move through the Legislature. He knows that private health insurers are certain to vehemently oppose the continued push.

“The insurance industry will be fiercely lobbying against the bill and they have a lot of money, going up against their lobbying will take a lot of work,” Gottfried said. “but I’m convinced with so many senators on the record in support of the bill, we will prevail.”

This is part of AGENDA 2019, a joint Gotham Gazette-City Limits project
Find the rest of the series here

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by Victor Porcelli, Gotham Gazette

Read more by this writer.

This article has been updated with Cuomo's comments from 11/15/18 on The Capitol Pressroom.

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With Full Democratic Control, Sponsors of New York Single-Payer Health Care Hopeful About 2019 Tue, 13 Nov 2018 05:00:00 +0000
Democrats in Swing Districts Run On, Not From, Single-Payer Health Care http://www.gothamgazette.com/state/7995-despite-lack-of-support-from-cuomo-democrats-in-swing-districts-run-on-not-from-single-payer-health-care http://www.gothamgazette.com/state/7995-despite-lack-of-support-from-cuomo-democrats-in-swing-districts-run-on-not-from-single-payer-health-care andrewcuomo affor

Gov. Cuomo & Long Island Democratic Senate candidates (photo: @andrewcuomo)


Since the Affordable Care Act has failed to tame the beast that is America’s private health insurance system, and a new presidential administration is actively hostile to even that modest attempt at near-universal coverage, activists and many Democrats in New York have recently come to embrace a way forward. Single-payer, state-government-administered health care coverage has become something of a rallying cry for progressive activists in New York even as Governor Andrew Cuomo has argued it’s a program better-suited for the federal government to tackle.

While often thought of as a politically risky issue to embrace outside of solidly progressive areas, candidates in swing districts across the state are carrying the torch for single-payer and calling it a morally correct thing to do that will also save the state money. And with criticism of the proposal from Republicans, the issue has become a flashpoint in the battle for control of the New York State Senate, the GOP’s only source of power at the state level and the key for Democrats hoping to enact a long list of progressive goals.

The New York Health Act, the proposed law that would set up single-payer health insurance in New York, has gained momentum in the state Senate after years as an Assembly-focused effort. Every Democrat in the upper chamber of the state Legislature, where the party is in the minority by one seat, signed on to the bill last session.

The push saw added attention as Democratic gubernatorial candidate Cynthia Nixon made passing the bill a centerpiece of her campaign, although unlike on other issues like legalizing marijuana, Nixon didn’t appear to push Cuomo left on healthcare. But while Nixon and New York City Democrats -- the lead sponsors of the NYHA are Manhattan Assembly Member Dick Gottfried and Bronx Senator Gustavo Rivera -- have received the most attention for their embrace of the plan, Democratic state Senate candidates in the Hudson Valley and Long Island are also running on the passage of the bill despite the risk that an embrace of big government socialism could be a liability in their swing districts.

Conventional wisdom about the relative conservatism in many areas outside of New York City, and Cuomo’s own reluctance to embrace statewide single-payer (during his debate with Nixon he said it is a good idea “in theory,” but that it would double the state’s tax burden and he supports single-payer at the federal level), would suggest that Democrats in tight races would avoid the New York Health Act. Prominent Cuomo-led events where he’s endorsed suburban Democrats haven’t included mention the bill at all, instead focusing on issues like the continuation of the two percent property tax cap, the passage of the Reproductive Health Act and a “red flag” gun control law, and funding an effort to fight the MS-13 gang.

As Cuomo avoided the issue, Senate Majority Leader John Flanagan brought up the specter of socialism and high taxes in an op-ed column arguing for the GOP’s continued control of the state Senate. “The Democrat Conference vows to enact single payer health care, and so do all the candidates they are running. Medicaid for All would double the state’s budget while taking away Medicare from our seniors. You cannot support a cap on spending and a permanent cap on property taxes, while supporting budget-doubling policies like socialized medicine.”

But for some suburban Democrats, single-payer is as much of a winning issue as any other. “There's definite support [for the New York Health Act],” said candidate Pete Harckham, running to unseat Republican Terrence Murphy in the Senate’s 40th District, in the Hudson Valley. “People are tired of fighting with insurance companies, hospitals are tired of fighting with insurance companies, doctors are tired of fighting with insurance companies. So I think there's a very high appetite for the discussion and the dialogue with the New York Health Act as the starting place.”

Jen Metzger, running against Ann Rabbit in the 42nd District for the retiring Senator John Bonancic’s Hudson Valley seat, also said that she’s heard support for the bill out on the trail. “I come right out and say I'm a supporter of the New York Health Act and no one has said yet that it's a terrible idea or a scary idea,” Metzger told Gotham Gazette. “People understand that this system is not working and that major change is needed.”

“We've got to put every option on the table, because we're coming to a breaking point,” John Mannion, running against Bob Antonacci in the race to replace retiring Senator John DeFrancisco in western New York’s 50th District, told Gotham Gazette.

Both Metzger and Harckham don’t hedge their support either; each candidate told Gotham Gazette that they view healthcare as a human right and believe in a single-payer insurance system. It’s a view that’s become common enough among Democrats that Andrew Gounardes, running against state Senator Marty Golden in a relatively conservative district in southern Brooklyn, said, “frankly I don’t think it’s out of the mainstream to talk about universal health care in the year 2018,” during a previous interview with Gotham Gazette. Cuomo has also endorsed Gounardes, at a rally in Brooklyn where there was no mention of single-payer healthcare.

Support for the bill, even in districts currently held by Republicans, may not be as much of a liability in a wave year for the candidates who’ve expressed their support for it. The 40th and 50th Districts went for Hillary Clinton in 2016 by more than 5 points each, though the 42nd District went for Donald Trump by 5 points.

Gounardes and his primary opponent Ross Barkan were hardly the only New York City Democrats banging the drum for the New York Health Act this primary season. It was one of a slew of issues that challengers to the former members of the Senate’s Independent Democratic Conference (IDC) regularly used to explain how the incumbents had not represented progressive values while forming a power-sharing agreement with the Republican conference.

Jessica Ramos promoted single-payer on her website, Alessandra Biaggi explained her support for it using her own father’s Parkinson’s Disease as an example of how the current healthcare system was failing, and Zellnor Myrie promoted a recently-released RAND Corporation study that suggested the New York Health Act would save the state money over time -- all three of them defeated former IDC members in the primary.

Even John Brooks, a Long Island Democrat running a tough re-election campaign for his seat on Long Island states on his website that he supports the New York Health Act, and has called affordable health insurance “a right, not a privilege.” Harckham though, said that the bill has appeal outside of the city because “the economic and the healthcare hardship is the same in the suburbs as it is in the city.”

Just under 5 percent of New Yorkers lack health insurance, according to a recent report by Comptroller Tom DiNapoli, and 7 million New Yorkers are receiving Medicaid, the federal program administered by the state with localities. Beyond the rhetoric of health insurance as a right and not a privilege, these Democratic candidates are also insisting the move to a single-payer system would actually save taxpayers and businesses money in the long run. “Shifting to a single-payer system would actually reduce property taxes, because it would reduce the cost of local taxes and government costs from how they pay for their employees' health insurance,” Metzger, a member of the Rosendale Town Council, told Gotham Gazette.

This is of course disputed by state Senate Republicans, who have cast the possible change to a single-payer system as a big government takeover of the healthcare sector. “You can’t hold the line on taxes and spending when you’re calling for creation of a new government-run health care system that would double the size of the state budget and cost taxpayers hundreds of billions of dollars more than they already pay,” Senate GOP spokesperson Scott Reif said in response to a Democratic pledge -- signed by Cuomo and Long Island Democratic Senate candidates -- that included a promise to keep property taxes low, but made no mention of single-payer health care.

The RAND Corporation study concluded the change to a single-payer system in New York could (if certain assumptions were made true) save the state money in the long run, as even the bill’s primary sponsor in the Assembly, Gottfried, has said, that payroll and other taxes would need to increase to pay for the new system. The New York Health Act legislation itself doesn’t provide an exact way to pay for the single-payer system, instead authorizing a commission to figure out how to fund the plan should the bill pass. But Mannion posited that it’s not as if health insurance costs are affordable or helpful at the moment.

“I spoke to someone, a small business owner in my district, who said the entire health insurance premium he paid was $300,000 for his employees six years ago, and this year alone it increased by $300,000,” Mannion said, in response to a question on whether he’s prepared to explain tax increases necessary for a single-payer system.

Still, some Democrats are wary to discuss their views on the issue, even if they list it as an issue they’re running on. Jim Gaughran, running against Republican Senator Carl Marcellino in Long Island’s 5th District, called healthcare a right and not a privilege on his website, but did not respond to a request for comment, even after he was reached on his cell phone and promised a return call that did not materialize. The same situation came up with candidates Karen Smythe, whose website calls for universal single-payer, and Pat Strong, who said she would pass the New York Health Act. In the case of Assembly Member James Skoufis, running to represent the 39th Senate District, he’s already voted for the bill more than once in his time in the Assembly, but doesn’t list is as one of his main issues on his campaign website. Skoufis released a campaign ad touting his a fight with insurance companies on behalf of a constituent, but his campaign did not respond to multiple requests for comment on whether or not he would support the New York Health Act in the Senate the way he did in the Assembly.

The candidates who spoke to Gotham Gazette did insist that even if they won and Democrats capture a majority in the state Senate, voters shouldn’t expect an immediate passage of the bill in the first budget session.

“During the gubernatorial primary, Cynthia Nixon said ‘Oh just pass [the bill] and pay for it,’ but that's not how you pass and craft legislation,” Harckham said, referring to when Nixon told the Daily News editorial board “Pass it and then figure out how to fund it” when its members asked her about the New York Health Act. “My starting point is New York Health, and let's sit down with the experts. The Assembly has passed this version, so it's pretty far along, but that doesn't mean the Senate can't alter it,” she continued. “Let's do our due diligence, with the goal of providing universal single-payer coverage for all New Yorkers.”

Harckham did say, though, that he felt “two years of legislative time” is long enough to debate and pass a bill, which he called a first-term priority on his website (state legislative terms are two years long).

“The Assembly bill has to be revamped, and we have get it right,” Mannion said. A spokesperson for Mannion later told Gotham Gazette that “getting it right” meant that Mannion believed “a transition from the current system to universal coverage as per the bill would likely require a transitional period in which purchasing into a Medicare-for-all like system would be a possible step, including offering that option on the NY State of Health exchange website.” That website is currently where New Yorkers can purchase health insurance plans under the Affordable Care Act.

And even though the governor has said he prefers single-payer on a federal level, Metzger said there might be hope of convincing him to embrace the New York Health Act by playing to his love of New York being first. “I think we can show that [single-payer] can be done, I think there's a lot of value in demonstration value,” Metzger said. “It's been these academic debates in this country for a long time. If anyone can do it, I think New York can do it.”

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by Dave Colon, Gotham Gazette
     

Read more by this writer.

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Democrats in Swing Districts Run On, Not From, Single-Payer Health Care Mon, 15 Oct 2018 04:00:00 +0000
State of Latino Health: Dismal, and Invisible http://www.gothamgazette.com/130-opinion/7988-state-of-latino-health-dismal-and-invisible http://www.gothamgazette.com/130-opinion/7988-state-of-latino-health-dismal-and-invisible Gotham Health Center

(photo via NYC Mayor's Office)


Latinos make up nearly a third of New York City’s eight million residents. But even though we are a large part of New York’s present and a rising population that’s crucial to the city’s future, we are completely invisible.

We are invisible in large part because we are different. And because of those joined factors, our health care is in a state of crisis. Compared to our fellow New York neighbors, we lack access to quality, culturally competent care, and we face a shortage of high-quality family care options. In fact, we sometimes encounter unique barriers that make us even more susceptible to illnesses than our neighbors and tend to experience worse health outcomes.

After decades of efforts to bring health care to underserved Latinos across the city, we set out to answer crucial questions: Why do great disparities in health care remain? And why do our families lack the health care services they need?

Why are Latinos far less healthy than our neighbors?

In a new report put out by my organization, a nonprofit network of over 2,000 providers who treat over 650,000 patients largely from lower income immigrant communities, we talked to hundreds of Latino doctors and patients across New York City to compile a first-ever poll.

We hope it spurs a movement.

We set out to bring to light health disparities and the cultural, economic, and institutional barriers that diminish access to even basic health care services -- leading to devastating health outcomes for many in our communities.

So what did we learn about the state of Latino health in New York City in 2018?

First, we learned that there is a wide gap between Latino patients and their physicians over what constitutes good health. While a majority of Latinos think they are healthy, their doctors disagree by vast margins. And only one-third of Latino patients think they are not receiving the care they need while two-thirds of doctors think Latinos experience persistent barriers to care.

Second, transportation and child care pose major barriers to health care access in Latino communities. Language is another major issue: in the Bronx, home to the city’s largest Latino population, only 10% of doctors speak Spanish, compared to 60% of residents. In fact, immigrants interviewed stated that language barriers kept them from telling their health care providers all of their symptoms – leading to unnecessary emergency room visits, avoidable crises, and uncontrolled chronic conditions.

Finally, too many health problems are going untreated in the Latino community. Smoking, asthma, obesity, diabetes, and hypertension are prevalent problems but health education has not kept up and health education materials are often not available in Spanish. In addition, mental health and substance abuse challenges are stigmatized and remain taboo to discuss, going undertreated or even untreated.

In short, our report showed us that we have much more work to do to lift up and improve health outcomes in the Latino community, but we can make progress if we are willing to put in the work.

Together, by prioritizing community engagement, we can build and scale a sustainable architecture of innovation to confront and solve these problems. We can and must develop and sustain strong community, public health, and health care strategies to improve access to quality, culturally competent, and much needed care.

Additionally, we also need a serious investment in health education on the part of policy-makers to address not only these conditions but also the lack of health education resources offered. And language matters. Understanding these nuanced, culture-specific disparities will help us build a system that combines high quality with more effective care that reduces costs for patients, institutions, cities, states, and the federal government.

The Latino community is growing faster in New York than in Nevada or California. Over the next few years, through intervention, innovation, and integration, we will use the findings of this report to partner with the state and city to better deliver culturally-competent care and build a stronger, healthier Latino community in New York.

The need is urgent, the path forward clear – now it’s time for action.

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Dr. Ramon Tallaj is the founder and chairman of SOMOS Community Care.

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Have an op-ed idea or submission for Gotham Gazette? Email opinion@gothamgazette.com

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State of Latino Health: Dismal, and Invisible Wed, 10 Oct 2018 04:00:00 +0000
With Fake Clinics Proliferating, New Yorkers Should Know Their Reproductive Health Care Rights http://www.gothamgazette.com/130-opinion/7951-with-fake-clinics-proliferating-new-yorkers-should-know-their-reproductive-health-care-rights http://www.gothamgazette.com/130-opinion/7951-with-fake-clinics-proliferating-new-yorkers-should-know-their-reproductive-health-care-rights letitia james andrea miller

Letitia James and Andrea Miller, the authors


When visiting a health care provider, most patients trust that they’ll get a reasonably high standard of medical care and assume that their medical providers will keep their information confidential, and are not actively trying to deceive them. But around the country, 2,700 fake women’s health centers – which sometimes call themselves “crisis pregnancy centers” – are lying to women and giving false information in order to prevent women from having abortions. One hundred of them are here in New York State.

It is imperative that any New York woman or teen who is pregnant, or thinks she might be, can get accurate health care information and knows her rights, including the right to have an abortion.

That’s why the National Institute for Reproductive Health (NIRH) and New York City Public Advocate Letitia James have just released “Know Your Rights,” a public awareness and education brochure, so pregnant New Yorkers, those who might be pregnant, and their families and loved ones, can access accurate information about pregnancy and abortion, regardless of whether a woman chooses to continue her pregnancy or not.

Fake clinics actively trick and lure women into their centers. They set up shop near legitimate health care providers and brand themselves with words like “women’s choices” or “pregnancy resources” to suggest they provide all-options counseling and care to help women and teens make fully informed decisions; they advertise free pregnancy tests and ultrasounds. Inside, these clinics can look and feel like a real doctor’s office — staff wear white coats or medical scrubs, and pamphlets about pregnancy and ultrasound machines are located in exam rooms. The staff will often lie to women, either telling them that they are farther along in their pregnancy than they really are, and that it is too late for an abortion or that it is earlier in pregnancy than they really are, and they should wait before making any decisions.

Fake clinics are often part of national anti-abortion networks, and they target women from low-income communities, communities of color, and immigrant communities. Alarmingly, fake clinics outnumber real abortion providers by as much as four-to-one nationwide.

New York City saw the dangers these fake clinics posed and passed Local Law 17 in 2011, which took effect in 2016, requiring them to disclose that they don’t have a licensed medical provider on site and to keep client information confidential. Unfortunately, many fake clinics fail to comply with this law.

In light of the federal government’s continued attempts to undermine access to abortion and the current Supreme Court’s indifference to the harms posed by fake clinics, New York must work twice as hard to protect our residents’ right to accurate medical information and abortion care. We must retain our reputation as a state that protects and supports women and girls.

NIRH and Public Advocate James are committed to protecting the reproductive health and rights of all New York women. "Know Your Rights," available at the NIRH website, the public advocate website, and in hard copy around the city, provides a list of legitimate health care providers that offer prenatal care and abortion, and information regarding privacy rights.

New York City residents deserve nothing less.

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Letitia James is New York City Public Advocate. Andrea Miller is President of the National Institute for Reproductive Health (NIRH). On Twitter @TishJames and @AMillerNIRH.

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Have an op-ed idea or submission for Gotham Gazette? Email opinion@gothamgazette.com

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With Fake Clinics Proliferating, New Yorkers Should Know Their Reproductive Health Care Rights Sun, 23 Sep 2018 04:00:00 +0000
As Broader Debate Intensifies, New York Nonprofits Consider Throwing Weight Behind Single-Payer http://www.gothamgazette.com/state/7944-as-broader-debate-intensifies-new-york-nonprofits-consider-throwing-weight-behind-single-payer http://www.gothamgazette.com/state/7944-as-broader-debate-intensifies-new-york-nonprofits-consider-throwing-weight-behind-single-payer gottfried org 2

Assemblymember Gottfried (photo: Dickgottfried.org)


Wendy Stark is ready to press the reset button on health care. The executive director of Callen-Lorde Community Health Center, based in Lower Manhattan, Stark is hopeful that an overhaul may be on the horizon in New York through controversial legislation gaining increasing attention as this fall’s elections determine the upcoming balance of power in state government, from the governor’s office through the state Legislature.

The New York Health Act -- which has increasingly strong chances of passing the state Legislature but does not have the support of Democratic Governor Andrew Cuomo, who is favored to win a third term -- would set the stage for New York to toss out the current health insurance system in favor of a single taxpayer-funded, government-administered health care program for everyone.

As the bill has been the subject of more debate in recent months, partially stemming from gubernatorial candidate Cynthia Nixon’s support for it, powerful lobbyist groups representing insurers, hospitals, and businesses have been vocal about their opposition. The Business Council of New York State took to Fox & Friends to denounce the legislation, while others have written op-eds in local publications. Republicans running for office, including gubernatorial nominee Marc Molinaro, are warning New Yorkers about a potential government takeover of health care.

But as the leader of a health care provider that serves mostly low-income members of the LGBT community through its clinics in Manhattan and the Bronx and employs more than 350 people, Stark has a very different take. She says in addition to allowing her organization to save on employee benefits and administrative costs -- a projection generally backed up by the RAND Corp.’s recently-published analysis of the New York Health Act -- a single-payer system would cut down on the red tape patients have to deal with.

“So many of the barriers to care people experience are rooted in the economics of health care,” Stark said. “We don’t believe health care can make adequate improvements without changing the foundational economics of how it works and is paid for.”

Under the proposed single-payer system, insurance premiums, deductibles and copays would all go out the window, and patients could visit any health care provider without having to worry about whether they were in their insurance network. Meanwhile, taxes would go up, with the wealthiest New Yorkers paying a greater portion of their income and employers paying a certain amount per employee. Under the sample tax model proposed by the RAND Corp., the state would have to collect an estimated $139 billion in new taxes in 2022 to pay for the single-payer system. Still, RAND projected that overall spending on health care would go down -- barring a few caveats that that could stand in the way of the system being successful.

Callen-Lorde is one of 10 community-based health centers and 183 total nonprofit groups statewide that have publicly endorsed the campaign supporting the New York Health Act (in addition to a variety of mostly small for-profit businesses). But while it may seem like a natural fit, the bill still has a ways to go to become a widespread legislative priority for the large contingent of community-based organizations that help connect immigrants, people with behavioral health problems and housing insecurity, formerly incarcerated individuals, and members of other marginalized groups to needed health care and social services.

Many nonprofit health centers and other organizations, including those in the human services sector -- which employ a growing workforce and have formed coalitions to represent their interests in Albany and Washington, D.C. -- are still examining the implications of the New York Health Act before issuing full-throated endorsements. Others are directing their limited resources to what they see as more pressing policy and funding concerns.

But that may change as the policy conversation develops. Groups like the Federation of Protestant Welfare Agencies, FPWA, which represents 170 human-services and faith-based organizations, are hoping to help move things along.

“We believe the New York Health Act would strengthen nonprofits both for the communities they serve as well as their employees, and make the system more tenable long-term,” said Winn Periyasamy, policy analyst at FPWA.

FPWA, along with the Coalition for Asian American Children and Families and the New York Immigration Coalition, hosted a forum on single-payer for nonprofit representatives on the Lower East Side last month, where they heard about the New York Health Act directly from its lead sponsors in the Legislature, Assemblymember Richard Gottfried and Senator Gustavo Rivera, both Democrats who represent parts of New York City in their respective legislative houses.

New Yorkers in favor of a single-payer health system will know they’re winning, Rivera told the audience, when sinister images of him and Gottfried start appearing in insurance-industry funded attack ads.

“I can’t wait for that gritty video, I can’t wait for it!” said Rivera, of the Bronx, exuding confidence that the debate over the state’s single-payer bill is on its way to reaching a fever pitch.

The New York Health Act passed the Assembly the last four years in a row, but was thwarted each time by the Republican-controlled Senate. Now the bill--which was already only one sponsor short of a majority in the Senate in the last session--is among a slew of progressive measures that have been infused with new hope following the dissolution of the Independent Democratic Conference, which allowed Senate Democrats to caucus with Republicans.

“This is real,” Gottfried insisted at the forum. “This is not a dream. And you and your people are really crucial to making sure it gets done.”

Those in attendance were particularly interested in how the bill would affect undocumented New Yorkers, who are generally not eligible for health insurance now but would be under the single-payer system. Undocumented New Yorkers currently often use public hospitals at great expense, having eschewed preventative care due to their documentation status and lack of insurance. Dr. Mitchell Katz, chief executive of the cash-strapped NYC Health + Hospitals system, praised the Assembly on Twitter for passing the New York Health Act in June.

Attendees at the event also talked about the need to properly translate materials on single-payer into the languages of the communities they serve.

“We’re reaching into our Asian-American communities,” said Anita Gundanna, co-executive director of the Coalition for Asian American Children and Families. “A lot of people had never heard of the [single-payer] proposal before or thought through the impact of it, so for us the very beginning step is to expose our communities to what’s going on and how it might impact them.”

CACF and other groups serving Asian-Pacific Americans advocate for health care initiatives through Project CHARGE, the Coalition for Health Access to Reach Greater Equity. Gundanna said there’s a need to get more buy-in from individual organizations before single-payer can become an official part of the coalition’s policy agenda.

“We have to be strategic and patient,” she said. “We can’t move without having our coalition behind us.”

On the bright side, Gundanna pointed out, the nonprofit sector had to increase its capacity to share information about health policy a few years ago in order to help people understand and get insured through the federal Affordable Care Act, also known as Obamacare.

But more recently everyone has been on the defensive, using their resources to try to preserve the ACA and prevent a wide array of federal policies from taking effect. Lately, many organizations are preoccupied with changes the Trump administration is considering to the Public Charge Rule, which people in the social-services sector say are already discouraging some immigrants from using public benefits, including subsidized health insurance, for fear it could be used as a strike against them later.

Gundanna said she wants to present nonprofits with proactive solutions like single-payer but acknowledges that everyone must consider, “How many resources are there to explore these quote-unquote ideal options in this quote-unquote ideal world?”

Asked about the New York Health Act, the Community Healthcare Association of New York State, which spent much of 2017 and early 2018 consumed by a battle to secure endangered federal funding for its members, said in a statement, “CHCANYS supports innovations in health policy that improve access to high-quality health care for everyone. We continue to study the options for expanding coverage to all New Yorkers and are closely monitoring the current political discourse.”

Meanwhile, the Human Services Council, whose advocacy focuses on improving the government contracts its member organizations rely on for funding, is not likely to take a position on the New York Health Act, said Allison Sesso, the coalition’s executive director.

“Doing stuff on this is not why we exist and could eat up resources,” said Sesso, although she added, “I think this conversation is really important and I’m glad it’s being elevated.”

As advocates for the New York Health Act work to make the case that it’s worth the time and effort for would-be proponents to support the bill, they are also faced with the uphill battle of getting the governor on their side. A year ago, before the bill stood much of a chance of passing both houses of the state Legislature, Cuomo signaled some slight openness to the idea of implementing a single-payer system in New York. Asked about it again during his debate with Nixon, before he beat her in the gubernatorial primary this month, Cuomo came out against the idea. He said he thought it could work at the federal level but would be too costly an endeavor for the state to embark on alone.

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by Caroline Lewis for Gotham Gazette. On Twitter @clewisreports and @GothamGazette.

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As Broader Debate Intensifies, New York Nonprofits Consider Throwing Weight Behind Single-Payer Thu, 20 Sep 2018 04:00:00 +0000
Extending the Human Right of Health Care to All New Yorkers http://www.gothamgazette.com/130-opinion/7853-extending-the-human-right-of-health-care-to-all-new-yorkers http://www.gothamgazette.com/130-opinion/7853-extending-the-human-right-of-health-care-to-all-new-yorkers c johnson brooklyn credit

Speaker Johnson, the author, visits a health care facility (photo via John McCarten)


Health care for all is a human right. This means no one should be denied care based on their ability to pay.

The World Health Organization recognized this fundamental truth 70 years ago, most countries around the world have been putting it into action for decades now, and doctors and nurses live it out professionally every day.

Truly achieving this moral imperative means we need a universal health care system supported by taxes and administered by one provider. Not only is this the right thing to do, it’s also more practical and less expensive than the status quo.

A recent study conducted by the RAND Corporation shows that single-payer is likely to save our state health care system $15 billion by 2031 compared to our current system. Other estimates project savings of up to $45 billion.

For these reasons I introduced a resolution Wednesday urging our state government to approve a law that would lay the foundation for single-payer healthcare in the Empire State. The proposal would create the New York Health program, which, if fully implemented, would result in 90 percent of New Yorkers spending less on health care than they currently do.

The plan would help save New Yorkers money by cutting administrative costs and simplifying the present system. Approximately one million New Yorkers are without any health insurance and have essentially been priced out of the market, which is another practical reason why I support this legislation. Also, you, the patient, would pay no premiums, deductibles or co-payments when visiting a doctor under the new system.

According to the RAND study, New Yorkers could spend half as much money out of their own pockets under the New York Health program than they do within the current system. In fact, according to a relatively conservative scenario, New Yorkers with an annual household compensation of less than $105,300 would save about $2,800 per person every year. Other estimates project even greater savings.

Single-payer is traditionally viewed as a progressive cause, but it has earned support from conservative quarters too. RAND, which was originally founded to provide research to the armed forces, isn’t exactly a progressive endeavor.

It is also worth noting that New York is a relatively wealthy state. Our economy is the third largest in the nation, behind California and Texas. And with a gross domestic product of $1.56 trillion, our economy is comparable to Canada’s, which has a $1.65 trillion GDP.

That kind of prosperity is an advantage few states – and few countries, for that matter – enjoy, and it’s one we should leverage so as many New Yorkers as possible have access to good health care. Failing to do so would be an abdication of our responsibility as elected representatives.

The current landscape is complicated and there are a lot of moving parts, but complexity shouldn’t be the enemy of what is right.

President Trump’s administration has signaled it would oppose single-payer plans from state governments seeking to bring sanity to their respective health care landscapes, so it is unlikely his administration will grant New York the federal waivers needed for a single-payer system to be fully implemented here.

However, even without a waiver, the state could still ramp up the program on a partial basis and, in the process, save money for current Medicare and Medicaid recipients through improved, wrap-around coverage. It would also lay the framework for full implementation of the plan under a new president.

Critics on the other side of this debate have also argued that adequate health care shouldn’t be considered a right – that it is a finite resource and can’t be placed in the same category as voting or free speech.

I disagree.

Many human rights we now take for granted in the United States weren’t considered rights at all during various periods of history. But eventually we evolved to see them as such.

The right to vote, freedom of speech, the right to assemble – these are now encoded into our nation’s DNA, but over the course of world history this wasn’t always the case.

Even today, not everyone on earth has the right to vote. Many Americans didn’t have that right immediately after our nation was founded.

But we’ve made progress – often that progress comes too slowly, but there is no progress until we take the first steps forward.

Adopting single-payer healthcare in New York State would be an enormous step in the right direction. This is why I am standing with my colleagues in state government who support it, and I hope you will too.

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Corey Johnson is the Speaker of the New York City Council and represents the Council’s 3rd District, in Manhattan. On Twitter @NYCSpeakerCoJo.

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Extending the Human Right of Health Care to All New Yorkers Wed, 08 Aug 2018 04:00:00 +0000