Gotham Gazette http://www.gothamgazette.com/component/tags/tag/1348 Tue, 18 Sep 2018 16:31:28 +0000 Joomla! - Open Source Content Management en-gb webmaster@gothamgazette.com (Webmaster) Extending the Human Right of Health Care to All New Yorkers http://www.gothamgazette.com/?id=7853:extending-the-human-right-of-health-care-to-all-new-yorkers http://www.gothamgazette.com/?id=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.

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

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

]]>
Extending the Human Right of Health Care to All New Yorkers Wed, 08 Aug 2018 04:00:00 +0000
28 Years Later, ADA Non-Compliance Leaves Deaf Patients At Risk http://www.gothamgazette.com/?id=7837:28-years-later-ada-non-compliance-is-leaving-deaf-people-at-risk http://www.gothamgazette.com/?id=7837:28-years-later-ada-non-compliance-is-leaving-deaf-people-at-risk unique uconn today

(photo via UCONN)


Imagine being in so much pain that you call 911. Imagine being transported a great distance by an ambulance, all the while in excruciating pain and scared about what might be going on inside your body. Imagine that when you arrive in the hospital, multiple people poke and prod you without telling you what they are doing and without your being able to tell them what you need.

All too frequently, this is the experience of people who are deaf within the United States medical system, because of a complete disregard for the regulations and guidelines set forth in the Americans with Disabilities Act (ADA), which mandate sign language interpreter services.

When former President George H. W. Bush signed the ADA 28 years ago last week, he said, “Let the shameful wall of exclusion finally come tumbling down.” The ADA requires systemic change in how America accommodates people with disabilities, yet more than a quarter of a century after the law’s enactment, pervasive “walls of exclusion” still exist.

New York Lawyers for the Public Interest (NYLPI) recently settled a complaint on behalf of a deaf person in New York City who was denied access to interpreter services at a hospital. It took over six years to resolve the matter, and the client continued to encounter countless similar experiences virtually every time she attempted to schedule an appointment with and visit a medical professional.

This individual is not alone – primary care doctors, specialists, dentists, mental health providers, nursing homes, rehabilitation facilities, and labs routinely deny interpreter services to people who are deaf. This systemic discrimination in the health care setting is illegal under the ADA and has been illegal for even longer in places like New York City, where there are strong state and city non-discrimination laws at play.

The lack of effective communication access is not unique to New York City. The Syracuse University College of Law Disability Rights Clinic also regularly litigates cases of healthcare providers refusing to offer sign language interpreters in upstate New York.

Although there are resources available in New York to hold medical professionals and other agencies accountable if they do not provide effective communication, these problems remain. The New York City Commission on Human Rights and the New York State Division of Human Rights have the ability to investigate and redress such discrimination, even where the individual wants to proceed anonymously. However, these mechanisms are not enough to prevent countless instances of discrimination against members of the deaf community who seek health care.

So if it is illegal, and there are mechanisms for redress, why does the problem persist?

It’s all about money and attitude. There’s a pervasive disregard in the health care profession for the importance of effective communication access for both provider and patient. As an anti-discrimination law, the ADA was intended to enact societal change. However, laws are often not enough – we need a shift in culture.

When deaf individuals speak out about not receiving interpreter services at medical offices, they are often told it is too expensive and providers are reluctant to pay for communication access. The problem is even more acute for solo practitioners than it is for large hospitals and medical practices with deep pockets. The medical community’s failure to budget and plan for this easily anticipated and legally required expense is unacceptable.

Those who speak out are also told they do not really need an interpreter as they can communicate through other means. This is unacceptable.

To require a person who is deaf and deprived effective communication access to seek change, continue to advocate until the change is made, file a lawsuit if the change is not made, and continue to prosecute the lawsuit until it is resolved, is not a realistic solution for creating a more accessible world. It unfairly places the onus on the deaf individual.

There are already models for how to pay for these services. A few years ago, the Monroe County Bar Association established a fund to help defray up to 50 percent of a member’s interpreter bill. Likewise, Title IV of the ADA, which mandates the establishment of a national telephone relay system enabling deaf people to communicate, is funded through a tiny fee collected from everyone’s telephone bill. For health care providers not affiliated with a large institution, a similar fund should be created.

Access delayed is access denied for members of the deaf community when they seek health care. We need creative funding, changes in attitude, and adherence to the law immediately to address this abhorrent situation.

***
Michael Schwartz, Associate Professor of Law at the Syracuse University College of Law, Director of its Disability Rights Clinic, board member at Tangata Group, and a long-time deaf rights advocate; and Maureen Belluscio, Senior Staff Attorney, Disability Justice Program of New York Lawyers for the Public Interest. On Twitter @NYLPI.

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

]]>
28 Years Later, ADA Non-Compliance Leaves Deaf Patients At Risk Tue, 31 Jul 2018 04:00:00 +0000
To Help New Yorkers Quit Opioids, Expand Access to Medical Marijuana Now http://www.gothamgazette.com/?id=7742:to-help-new-yorkers-quit-opioids-expand-access-to-medical-marijuana-now http://www.gothamgazette.com/?id=7742:to-help-new-yorkers-quit-opioids-expand-access-to-medical-marijuana-now cuomo medical maryjane

Gov. Cuomo at a med mar announcement (photo via the Governor's Office)


As a 67-year-old cancer survivor who suffers from chronic pain as a result of cancer treatments, medical marijuana has allowed me to resume a more normal life free of addictive opioid medications. I hope that lawmakers will now consider expanding the state’s medical marijuana program so that more New Yorkers will have the same access to these important treatments as an alternative to the powerful prescription painkillers that sparked the opioid crisis in our state.

My experience is all too typical of how so many people can easily find themselves reliant on prescription painkillers. Following my retirement from the U.S. Navy and a career in retail management, I was diagnosed with colorectal cancer in December 2015 and underwent chemotherapy, radiation therapy, and abdominal perineal resection surgery the following year. As a result of these treatments, I developed debilitating peripheral neuropathy and chronic lower spine pain and was unable to function normally.

The pain was constant and excruciating. My doctors prescribed oxycodone to manage my pain, and with no other options seemingly available, I was eventually taking Percocet pills every four hours or less.

But after researching New York State’s medical marijuana program, I finally had hope that an alternative to opiates was available to help treat my pain. I contacted my doctor and obtained my medical marijuana card in December 2017. Working closely with my doctor and the pharmacist at the dispensary in my community, we found the medical marijuana products that work best for me.

In just a few months, I was able to quit my oxycodone prescription and now live a more normal life — once again able to enjoy my retirement, children, and grandchildren. While my pain will never completely vanish, medical marijuana helps me manage the symptoms without fear of an opioid addiction that has claimed thousands of lives in New York in recent years. It has also been critical in helping to manage my Post Traumatic Stress Disorder (PTSD), which I developed following service in the Vietnam War.

But while I had a condition that made me eligible for the state’s medical marijuana program — and am fortunate to have a dispensary in my community that could help me quit oxycodone — thousands of New Yorkers still lack adequate access to medical marijuana and remain at the mercy of opioid-based prescriptions to manage their conditions.

Fortunately, there is hope for these patients in need of care. Recently proposed bills in the state Senate and Assembly would greatly expand access to medical marijuana for New Yorkers.  

Senator George Amedore and Assembly Member Richard Gottfried have each introduced bills in their respective chambers that would allow doctors to prescribe medical marijuana to treat opioid addiction or as an alternative for those currently using prescription opiates — which could help prevent an addiction before it starts.

Separately, Assembly Member Gottfried and Senator Diane Savino have both proposed bills that would increase the number of potential dispensaries in New York from 40 to 250 by allowing medical marijuana companies to open up to 25 dispensaries each, bringing access to care for the many communities still in need throughout the state.

While these bills would undoubtedly help thousands of New Yorkers, they remain stuck in their respective committees with just days remaining in the current legislative session. Without action by lawmakers now, patients in need of medical marijuana care will be forced to wait even longer.

My experience is proof that medical marijuana is an important and meaningful alternative to prescription drugs for those suffering from chronic and painful conditions. I hope state lawmakers will support patients like myself by taking immediate action to pass these bills and give more New Yorkers hope for a life free of powerful and addictive opioid-based drugs.

***
Garry Croney is a resident of Newburgh.

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

]]>
To Help New Yorkers Quit Opioids, Expand Access to Medical Marijuana Now Fri, 15 Jun 2018 04:00:00 +0000
Expanding Health Insurance Enrollment Will Help Heal New Yorkers and Our Public Hospitals http://www.gothamgazette.com/?id=7672:expanding-health-insurance-enrollment-will-help-heal-new-yorkers-and-our-public-hospitals http://www.gothamgazette.com/?id=7672:expanding-health-insurance-enrollment-will-help-heal-new-yorkers-and-our-public-hospitals Carlina Rivera City Council

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.

***
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.

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

]]>
Expanding Health Insurance Enrollment Will Help Heal New Yorkers and Our Public Hospitals Mon, 14 May 2018 04:00:00 +0000
What's The [Data] Point? 176,000, with Patrick Orecki http://www.gothamgazette.com/?id=7668:whats-the-data-point-176-000-with-patrick-orecki http://www.gothamgazette.com/?id=7668:whats-the-data-point-176-000-with-patrick-orecki whats the data point


What's The [Data] Point? Episode 40 -- 176,000, with Patrick Orecki [You can download What's The [Data] Point? wherever you get your podcasts, including on iTunes]

patrick orecki wtpd

176,000 is the number of New Yorkers statewide currently enrolled in Medicaid health homes, a key component of the Cuomo administration's Medicaid redesign efforts that have helped rein in costs and a program that provides care coordination services for Medicaid enrollees with complex health care needs to link these individuals to a full spectrum of health care providers and other social supports.

Patrick Orecki, CBC’s research associate specializing in the state budget and health policy issues, joins the podcast to break down the significance of health homes, what the program is doing well, challenges it has faced, and where it should go next.

Listen to the conversation and let us know what you think: Ben Max of GG (@TweetBenMax), Maria Doulis of CBC (@MariaDoulis). Listen below or download wherever you get your podcasts!

***
by Ben Max, Gotham Gazette
     

Read more by this writer.

]]>
What's The [Data] Point? 176,000, with Patrick Orecki Fri, 11 May 2018 04:00:00 +0000
Expanding Immigrant Access to Health Care in New York http://www.gothamgazette.com/?id=7520:expanding-immigrant-access-to-health-care-in-new-york http://www.gothamgazette.com/?id=7520:expanding-immigrant-access-to-health-care-in-new-york Statue of Liberty

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


In January of 2017, after living in this country for 17 years, I was able to access health insurance for the first time in my life. I became eligible as a new graduate studentl at NYU, which had a Student Health Insurance Plan—and, because in New York, DACA (Deferred Action for Childhood Arrivals) recipients were eligible for health insurance.

Now, when I am ill or in need of a checkup, uncertainty and stress are no longer part of the equation. When I feel sick, I no longer need to try to force my body into thinking I’m not sick or treat myself with Tylenol or Theraflu. Instead, I can see a doctor, get the prescription I need, and recover quickly.

Having access to high-quality health care in the past year has lifted an enormous burden from my shoulders. I used to feel anxious and scared every time I started to catch a cold. Now, each time I find myself at the Student Health Center since then, I feel gratitude and relief.

But now, as President Donald Trump’s attacks on immigrants escalate, health care access is in jeopardy again for Dreamers like me, as well as immigrants with Temporary Protected Status (TPS).

New York has long led the way in providing more expansive health care access than the federal government and most states. In Florida, where I went to college, I could not get health insurance. Earlier this year, Dreamers in New York received good news when Governor Cuomo announced that income-eligible DACA beneficiaries would continue to be eligible for state-funded Medicaid. This was an important step forward for the immigrant community and for health care for all in New York.

But the governor’s announcement does not mean that all Dreamers and immigrants will have access to health care. We need further action to ensure that all Dreamers and TPS holders have access to health insurance.

For immigrant youth like me, and young people across the state more generally, the solution is to pass legislation to increase the upper age limit of the Child Health Plus (CHP) Program from 19 to 29.

CHP was founded on the fundamental truth that health care is a human right. The program honors this principle by providing comprehensive health care services to uninsured young people not eligible for Medicaid or Marketplace coverage. For a mere .5% of the state’s annual budget, Governor Cuomo and the Legislature could expand CHP in this way to increase access to nearly 100,000 more young adults who would be newly eligible for high-quality coverage, since they have been aging out of CHP when they turn 19.

Additionally, with Trump acting to terminate TPS for countries like El Salvador and Haiti, hundreds of thousands of current TPS holders are at risk of losing legal status. In New York, this will put tens of thousands more in jeopardy of losing access to health care, in addition to potentially facing deportation.

New York State must take measures to ensure that TPS holders maintain their health coverage regardless of the reckless—and, frankly, racist—policies from Washington. First, the State must pass legislation to ensure TPS recipients remain eligible for Medicaid, even if they are stripped of their protection. Second, New York should create a state-funded Essential Plan for all New Yorkers who earn up to 200% of the federal poverty level, regardless of immigration status. This plan would be of particular urgency for immigrants who will be losing their TPS and thus, their current health insurance.

These policies offer a clear path for New York to lead on immigrant health care access. That’s why immigrant-led organizations like Make the Road New York (MRNY), which has included the policies as part of their statewide Respect and Dignity for All Platform, and the Coverage for All Coalition are lobbying legislators and the governor to adopt them. In fact, more than 500 MRNY members will be rallying and talking to legislators in Albany today -- Tuesday, March 6 -- about this issue as a central part of their 2018 agenda.

Day in, and day out, immigrants build this country. We are the ones who cook your food, care for your kids, stock your shelves, pick your vegetables, mow your lawn, and clean your house. We graduate in the top percentile of our classes, pay for our own education, serve our communities, and make lasting contributions to the beautiful tapestry of American culture. 

Like all Americans, and all New Yorkers, we deserve access to health care—not as a privilege, but as a right.

New York has led the way before on health care access and standing up for immigrants. This legislative session, it’s time for Governor Cuomo and the Legislature to renew that commitment by adopting further measures to protect immigrants like me.

The Trump administration doesn’t want immigrants like me to have access to health care. We need New York to have our backs.

***
Lucas Lopes is a Master of Public Administration student at NYU’s Robert F. Wagner Graduate School of Public Service.

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

]]>
Expanding Immigrant Access to Health Care in New York Mon, 05 Mar 2018 05:00:00 +0000
Under New Leadership and Oversight, City’s Hospital System in Spotlight http://www.gothamgazette.com/?id=7515:under-new-leadership-and-oversight-city-s-hospital-system-in-spotlight http://www.gothamgazette.com/?id=7515:under-new-leadership-and-oversight-city-s-hospital-system-in-spotlight Carlina Rivera hospitals hearing

Council Member Carlina Rivera (photo: @NYCCouncil)


The new CEO of the city’s beleaguered Health + Hospitals (H+H) public hospital system, Dr. Mitchell Katz, testified in front of the City Council’s new hospitals committee, and its chair, Carlina Rivera, for the first time on Wednesday, discussing the progress of the “One New York” plan to 'transform' and improve the system.

H+H is a public-private corporation that manages the city’s 11 public hospitals, health centers, and municipal healthcare provider, MetroPlus.

“Its mission is to provide quality, comprehensive health services to all New Yorkers, regardless of their ability to pay,” Rivera said. “In effect, Health + Hospitals is the default system of care for Medicaid patients, the uninsured, and other vulnerable populations, and is integral to our system of safety net hospitals.” Rivera noted that approximately 70% of H+H patients are uninsured or on Medicaid.

H+H has faced numerous fiscal challenges over the past few years. When the original One New York report was released in 2016, its intention was to reduce an anticipated budget deficit of $1.8 billion in fiscal year 2020, which begins July 1, 2019.

Last fiscal year, the de Blasio administration provided $1.8 billion in city aid to H+H as its interim leadership also took measures to overhaul its operations and finances, before Katz was brought in from Los Angeles to accelerate that work. (That was an increase from $607 million in fiscal year 2011, according to the Citizens Budget Commission.)

A recent fiscal scare originating in the federal government concerned the potential defunding of the Disproportionate Share Hospital program, which provides additional funding for hospitals that see a disproportionate number of low income patients, who may be uninsured and/or on Medicaid. The threat of cuts, which has loomed since 2014 but has become especially acute since President Donald Trump took office, was averted for the immediate future with a recent two-year extension of funding in the latest federal stopgap measure passed in February. When the cuts take effect, federal and state funding is expected to drop by approximately $800 million.

Meanwhile, after H+H announced plans to file a lawsuit against New York state government for failing to provide $380 million in funding, Governor Andrew Cuomo relented, giving H+H $360 million of the $380 million H+H claimed it was owed in October. Cuomo had initially suggested that the city tap into its reserves to provide the funding.

Tellingly, Katz, who assumed his current role after leading the Los Angeles County Health Agency for seven years and turning a $250 million budget deficit into a $560 million budget surplus, did not focus his City Council testimony on short-term revenue streams coming from Albany and Washington but rather on what he assesses are deficient practices within H+H operations and bureaucracy that are hindering its ability to collect revenue to its full potential.

Katz outlined a seven-point plan to increase revenues without cutting vital services. It includes cutting administrative expenses, which Katz said has begun recently by eliminating outside consultants from the system to the tune of $16 million in savings, and investing in new “revenue generating positions” such as primary care doctors, pharmacists, and nurse practitioners instead of solely ER doctors, a goal Katz outlined at the beginning of his term.

Hiring more people will also cut down on wait times, Katz said, in response to Rivera bringing up the issue. Katz described waits for appointments as “hugely variable.”

“One of the things that I found distressing was at Bellevue, is that the wait for behavioral assessments for a kid is currently months,” Katz said. “Which, frankly, has nothing to do with money, because kids are fully insured.”

But perhaps the more significant stabilization schemes, which were the focus of more attention at the hearing, relate to reforming H+H’s billing processes and bringing more insured patients into the system. Because H+H has a reputation as the hospital network that serves the indigent, many insured people do not use municipal hospital services. As a result, Katz said there is a substantial amount of bureaucratic waste within the system due to poor administrative skills on the part of system workers, who normally work with people who are either uninsured or on Medicaid.

This point was hammered by Council Member Antonio Reynoso, who recently became a father and described his experience as an individual with private insurance at Woodhull Hospital, an H+H hospital “across the street” from his district. Reynoso effusively praised Woodhull’s maternity ward and other services, but chastised billing procedures as inefficient.

Katz agreed that H+H needs to develop better billing procedures, including diagnostically coding bills correctly, checking insurance cards, checking prior authorization, and better communication with insurance companies. He cited a skilled nursing facility that spends roughly $21 million on drugs but only has revenues of $5 million.

“That’s impossible,” Katz said, “because we’re talking about skilled nursing facilities where there are almost no uninsured patients.” Katz claimed that the $21 million was a fair market value for the drugs but that the significant revenue shortfall had its roots in poor billing practices.

The situation at the skilled nursing facility is only the tip of the iceberg. In response to a question from Rivera, H+H Chief Financial Officer Plachikkat Anantharam stated that H+H lost between $130 million and $290 million in 2017 as a result of chronic underbilling.

Further, Katz said that H+H should not be referring patients out of the system and into the private market. Via MetroPlus insurance, H+H by proxy essentially pays private hospital operators to provide care, resulting in a significant amount of lost revenue.

Katz also stated that H+H needs to begin offering services that are “well reimbursed.” He illustrated this point by comparing behavioral health, for which H+H is the largest provider in the city and which is “poorly reimbursed,” and angioplasties, a heart procedure that is well reimbursed by insurance companies, but is rarely performed by H+H, and only at Bellevue Hospital.

Katz also wants, as part of his plan, to “convert uninsured people who qualify for insurance to be insured,” whether through Medicaid or MetroPlus, the government sponsored health insurance provider wholly owned by H+H that insures around a half-million New Yorkers and is offered on the Affordable Care Act exchange. Katz identified 250,000 people in the city who are uninsured but qualify for insurance coverage, out of a total of 667,000 uninsured people in the city.

“250,000. Let’s agree we won’t get 250,000,” Katz said, in reference to not being able to insure every eligible uninsured New Yorker. “That’s a lot of people. But if you got 100,000 of the 250,000 that we believe are currently getting our services and are insurable, that would be huge.”

Regardless, the Council members and Katz acknowledged that signing up tens of thousands of people for insurance is easier said than done. Council Member Mark Levine, chair of the Council’s health committee, asked whether it was possible to enroll patients who walk into a facility on the spot, and why this hadn’t been done in the past.

“Is that another cultural challenge you have to overcome,” he asked. “Is that a resource issue? Or am I making it seem simpler than it really is?”

“No, Council Member, I think you’re right, and accurate. It’s both of those things,” Katz responded.

“I think another part of that is that there’s no -- right now, we haven’t constructed a system to make it that that’s the easiest choice for the person, right, to be able to enroll in insurance,” he continued. “We’ve kind of made it easier to pay $10, which might be the same copay that they would pay if they had insurance. But the difference between what our system and city would receive is huge.”

Katz cited his experience in Los Angeles as evidence that the public hospitals system could be stabilized without attrition, or mass firings in other terms. Indeed, as Citizens Budget Commission noted in its analysis, "Lessons from La La Land," previewing Katz's takeover at H+H, "The good news was all on the revenue side."

“When I started in Los Angeles, there was also a deficit. It was $226 million, which at the time seemed to me like a lot of money, before I came to New York City,” Katz said, eliciting laughter from the audience of healthcare advocates and professionals in the Council’s Committee room. “But when I left, not only did we have a surplus, but we had added 1,500 public sector jobs. So one thing I do know is that you have to take financial problems seriously, but you can grow out of financial problems sometimes more easily than you can shrink out of financial problems.”

Reynoso was particularly fond of that line. “Grow out of a financial problem, that’s a great way to put it,” he said.

***
by Ben Brachfeld, Gotham Gazette

Read more by this writer.

]]>
Under New Leadership and Oversight, City’s Hospital System in Spotlight Sun, 04 Mar 2018 05:00:00 +0000
What's The [Data] Point? $72.4 Billion, with Charles Brecher http://www.gothamgazette.com/?id=7464:what-s-the-data-point-72-4-billion-with-charles-brecher http://www.gothamgazette.com/?id=7464:what-s-the-data-point-72-4-billion-with-charles-brecher whats the data point


What's The [Data] Point? Episode 30 -- $72.4 Billion, with Charles Brecher [You can download What's The [Data] Point? wherever you get your podcasts, including on iTunes]

wtdp w cbrecher 120

Health care policy and health care funding are among the most pressing issues facing the country, state, and city. Chuck Brecher is an expert on those and related topics, having been research director at Citizens Budget Commission for more than 30 years and now health policy advisor for CBC. Brecher joined the podcast to discuss recent news out of Washington, D.C. that is important to New York, as well as a variety of health care related issues facing New York State and City.

Listen to the conversation and let us know what you think: Ben Max of GG (@TweetBenMax), Maria Doulis of CBC (@MariaDoulis) and guest Charles Brecher. Listen below or download wherever you get your podcasts!

***
by Ben Max, Gotham Gazette
     

Read more by this writer.

]]>
What's The [Data] Point? $72.4 Billion, with Charles Brecher Thu, 08 Feb 2018 05:00:00 +0000
Community Health Centers, Essential But At Risk, Must Be Funded Now http://www.gothamgazette.com/?id=7459:community-health-centers-essential-but-at-risk-must-be-funded-now http://www.gothamgazette.com/?id=7459:community-health-centers-essential-but-at-risk-must-be-funded-now doctors and nurses hearts

Doctors and nurses (photo via @NYCHealthSystem)


It is no secret that a war is here – a war on immigrants, on LGBTQ people, and communities of color, on the 99%, and more. Health, a part of politics that affects all facets of life, has suffered a brutal onslaught. While some of 2017’s greatest grassroots successes were in defeating Affordable Care Act repeal efforts, recent federal tax overhauls and budget proposals threaten to further strain a healthcare system millions have come to rely on.

Lost in the conversation have been critical federal health programs like the Community Health Center Fund. Introduced as part of the original Affordable Care Act legislation in 2010, the Community Health Center Fund has come to represent 70% of federal grant funding for the nation’s community health centers.

Community health centers reaffirm the fundamental right to health for all. They provide health care for low costs regardless of age, ability to pay, insurance access, or immigration status. Community health centers are culturally responsive neighborhood clinics families rely on, not just for primary care but also for specialized services like dental, vision, and behavioral health. Without the full funding they and the communities they serve have come to depend upon, these centers may not be able to serve their patients to their full ability.

The Community Health Center Fund was renewed for two years in 2015 as part of the funding renewal for the Children’s Health Insurance Program (CHIP) – and in September, these programs and others expired. The last continuing resolution to address this issue, signed by President Trump on December 22, included short-term renewal funding of CHIP, community health centers, and other vital health programs. However, this resolution provided only a portion of the funds these programs need to operate at full strength, and only through March, thus jeopardizing their long-term sustainability.

While the latest continuing resolution reopening the federal government through this Thursday, February 8, included a six- year renewal of CHIP, community health centers were one of several health initiatives that were surprisingly left once again without any updates. Thus, thanks to Congressional inaction, anywhere between 10 and 50 percent of revenue dollars for over 400 New York City and over 700 New York State community health centers serving 2.2 million residents across the state, is now at risk. 

FPWA counts community health centers among its member agencies and coalition partners across New York City – and these organizations are alarmed at this political failure.

Community Healthcare Network (CHN), which includes 14 community health centers and a fleet of mobiles operating across four boroughs, says that while CHN centers are not at risk of cutting services or staff, cuts to funding will force many centers in New York to curtail care. Care for the Homeless, a social and health services provider that includes substance abuse among its treatment focuses, believes that without federal funding, health centers may have to consider cutting less financially-sustainable services like Medication Assisted Treatment, a tactic critical to combating the opioid epidemic.

Without the Community Health Center Fund, New York City will lose over $88 million in 2018, affecting more than a million patients. In addition, Medicaid and CHIP patients make up 50% of patients served at health centers - and threats to these programs also threaten these centers. While losing this money doesn’t necessarily mean these centers will close, it does impact what services they’re able to provide, how many hours they are able to put in, how many people they can staff, which puts more pressure on the resources they have left. It also limits patients’ other options – and taxes those other options significantly by forcing these other health providers, such as New York City’s fiscally-challenged public hospitals, to provide potentially uncompensated care. This isn’t responsible, nor is it healthy.

Recent Capitol Hill rumors indicate that community health center funding would be addressed in the next round of budget negotiations in the coming weeks. But these centers, and the communities they serve, have been waiting long enough.

For many Americans, health care is anything but routine. When you’re forced to make the choice between your family’s dinner or your dentist co-pay, between your MetroCard for the week or your prescription glasses, what might you choose? Health shouldn’t be a privilege – it should be a norm. Community health centers validate that right every single day.

Congressional legislative efforts and comments over the past few months have made it clear – the Trump administration wants tax cuts for the wealthy now at the expense of programs that help everyday Americans access affordable care while still making ends meet.

Renewing federal funding for community health centers and other health programs is absolutely a priority and it should have happened by now. It must happen immediately.

Tuesday, February 6, is a nationwide Day of Demonstration for America’s Health Centers. Centers have been waiting for over four months to get their federal funding renewed and we need to do everything in our power to get this prioritized in the next piece of budget legislation.

It was a battle to keep CHIP and the Affordable Care Act alive – but the war on health isn’t over. As an umbrella organization for New York social services agencies with strong ties to community health centers, FPWA urges all New Yorkers to not let our health care fall victim to politics.

Call your senators and representatives – tell them to demand legislation that fully funds the Community Health Center Fund and other crucial health programs now without jeopardizing the health of millions.

***
Winn Periyasamy is a health policy analyst at FPWA, an advocacy and anti-poverty nonprofit based in New York. On Twitter @FPWA.

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

]]>
Community Health Centers, Essential But At Risk, Must Be Funded Now Mon, 05 Feb 2018 05:00:00 +0000
Amid Health Care Funding Fights, Cuomo Explores Special Session http://www.gothamgazette.com/?id=7244:amid-health-care-funding-feud-cuomo-explores-special-session http://www.gothamgazette.com/?id=7244:amid-health-care-funding-feud-cuomo-explores-special-session andrew cuomo

Gov. Cuomo with top health and budget aides (photo: Kevin P. Coughlin/Governor's Office)


Governor Andrew Cuomo has been floating the idea of a special legislative session to address federal cuts to the state’s health care programs, as well as other concerns that have developed, since the state budget was agreed to in April.

In that budget, Cuomo pushed to include and won a provision granting him nearly unilateral power to adjust the state’s financial plan mid-year in the event of at least $800 million in federal cuts to the state. In April, the governor said the provision would ensure that “we do not overcommit ourselves financially” and indicated it allowed him to sign off on a budget that did not otherwise account for likely federal cuts. But, it appears as if Cuomo may call lawmakers back to Albany -- likely with agreement from the legislative majorities to an agenda -- regardless of whether the threshold has been met.

When the state Legislature finished its legislative year in June with a brief special session to pass mayoral control of schools as well as several smaller measures, such as $55 million in state aid for businesses and homeowners impacted by flooding around Lake Ontario, unknowns surrounding President Donald Trump’s promise to “repeal and replace Obamacare” loomed large.

As chatter of a special session to address two lapsed federally subsidized health care programs escalated this week, so did a feud between Cuomo’s administration and that of New York City Mayor Bill de Blasio over $380 million that was earmarked to reimburse New York City Health + Hospitals, the city’s public hospital network, for expenses incurred treating uninsured and indigent patients over the last two years.

In recent weeks, Cuomo has sounded the alarm over four essential funding streams to New York health care systems that are being threatened by Trump and a Republican-led Congress. While the federal Graham-Cassidy bill -- a replacement to the Affordable Care Act that would have cost New York $16.9 billion by 2025, according to projections -- was defeated, and parts of Trump’s sweeping tax plan that target blue states are on shaky ground, the federal government failed to renew the Disproportionate Share Hospitals funds, known as D.S.H., by October 1, creating a potential $2.6 billion shortfall that is expected to disproportionately hit New York City’s public hospital system over the next year and a half.

If they remain in effect, the cuts will place a $330,000 burden on Health + Hospitals for federal fiscal year 2018, but the city says the state is also unlawfully holding $380 million in federal funds owed to city hospitals for federal fiscal year 2017, which just ended, for services already provided.

This federal funding, which passes through the state, is allocated for municipal and state-run hospitals that treat high volumes of uninsured and indigent patients.

While it is unclear whether the cut would justify a budget adjustment by the executive branch given the April budget provision, Cuomo appears to be courting lawmakers to return for a special session that could address D.S.H. and other looming health care deficits.

Also lapsing earlier this month is the federal Child Health Insurance Plan (CHIP), which subsidizes New York’s Child Health Plus plan, putting New York in a $1.1 billion hole and potentially jeopardizing the health coverage of 330,000 lower-income New York children, according to Cuomo’s office, though it seems likely a federal deal over the children’s health program may soon be reached. Still, the state has been placed in a precarious position.

In a letter sent Wednesday to Eric Hargan, acting secretary of the U.S. Department of Health and Human Services, New York State Health Commissioner Howard Zucker warned that New York will not be able to continue the current Child Health Plus program if Congress fails to renew $1 billion in federal funding, and he said that Governor Andrew M. Cuomo will “have no choice but to call a special session of the Legislature.”

On Tuesday, Cuomo had dangled the special session idea before 13 upstate lawmakers, and in reality a much wider audience, suggesting in a letter that an extraordinary legislative session could also be used to amplify and speed up relief funding for Lake Ontario flood victims.

“I would support a special session of the legislature to return and appropriate an additional $35 million for this program to fund all eligible applicants in a time frame that recognizes the urgency of the situation,” Cuomo wrote. “There are other pending issues that could also be addressed at a special session, including the financial hardship the State will face from potential federal cutbacks.”

In addition to the 11 public hospitals in New York City’s Health + Hospitals system, the D.S.H. cuts directly impact the state-run SUNY Upstate Medical Center in Syracuse and SUNY Downstate hospitals in Brooklyn, Westchester County Medical Center, Nassau University Medical Center and Erie County Medical Center.

None of these facilities will receive payments until adjustments are made, according to Cuomo’s office.

The state has retained an outside consultant, KPMG, to figure out how to help health care facilities manage the cuts and Cuomo has repeatedly suggested that the Legislature may be forced to reconvene Congress signals that the money will not be restored by December 31. In a press conference on the topic last Tuesday, the governor suggested that local governments step up to offset some of the cuts.

“Nassau needs to help their public hospitals, New York City -- with a $4 billion surplus -- needs to help H+H, and SUNY will need to help Downstate and Upstate hospitals,” he said.

The cuts and Cuomo’s approach to dealing with them have ignited another episode in the feud between the governor and de Blasio and on Friday, the de Blasio administration announced its intention to sue New York State for D.S.H funds which administration officials say were expected by the city’s cash-strapped public hospital system for the federal fiscal year that ended on September 30.

City officials say they had budgeted with the expectation that $380 million would come through and Health + Hospitals Interim President and CEO Stan Brezenoff revealed that that the hospital system had begun to cut back on hiring to account for the deficit and was prepared to take other undesirable and risky measures.

“Our ability to deliver on our mission also relies on all levels of government. Unfortunately, the State is showing a shocking disregard for our mission and appears to have confirmed in public statements that they will not be releasing the $380 million Disproportionate Share Hospitals (DSH) funds that we need and deserve for serving more than one million Medicaid, uninsured and immigrant New Yorkers who relied on our care last fiscal year,” Brezenoff wrote in a letter to staff members last week.

As of Tuesday night, a spokesperson for the mayor’s office said the lawsuit would be filed “in state court,” but could say when it would be filed, or who would be named in the suit. De Blasio himself has said that the state’s withholding of past D.S.H payments designated for H+H, "is not normal and there is no excuse for it.”

Cuomo’s administration maintains that it is withholding its final payment to New York City’s public hospitals for the 2017 cycle in September because it is still unclear whether the federal government will renew the D.S.H. program.

“There’s no way to fund the public hospitals with a $1.1 billion cut unless it is rolled back,” the governor said during a press briefing last week. “In the meantime, we have made no D.S.H. payments to any public hospitals since October 1, which is when the law went into effect. You can’t distribute funding until you know how much you have to distribute.”

Cuomo officials say city hospitals should have anticipated the cut, noting that the program, which is associated with the Affordable Care Act, was always intended to be phased out as more New Yorkers became insured.

“The federal cuts to DSH have been pending for seven years and we are sure that all responsible CEOs of the state’s public hospitals have been accounting for these potential shortfalls in that time,” said Jason Helgerson, New York State Medicaid Director, in a statement. “The suggestion that the state is somehow in a position to reverse federal cuts is willful political ignorance and a distortion of reality -- only the federal government can possibly restore cuts they’ve enacted. Save for the federal government restoring these funds, there is no way the remaining DSH dollars can reimburse all hospitals at 100 percent.”

Cuomo’s office says that it has been in contact with city hospital officials and shared a letter Helgerson sent Brezenoff on September 29, referencing a meeting of healthcare providers to discuss the potentially imminent demise of D.S.H.

“While we implored Congress to act, as the October 1 deadline approaches, it is clear they are failing to do so,” the state Medicaid director wrote. “The Governor convened health care providers on September 19 to discuss the possibility of these cuts and held a press conference with the group outlining how harmful they will be.”

City officials claim that they have been singled out, and that all the state-run public hospitals have received their payments for the past fiscal year.

Regarding the potential lawsuit from New York City, Cuomo spokesperson Dani Lever called the threat “political theatre.”

“A more productive action would be to sue the federal government since they are making these devastating cuts, or if it actually cared about patient care, to use its funds to improve the hospital network that it owns,” said Lever.

One strategy -- requiring a legislative fix enacted through a special session -- would be to disperse the initial $380 million burden across hospitals throughout the state, most of which do not treat a large number of uninsured patients, state budget director Robert Mujica said in an interview with NY1 last week.

“The way the federal law interacts with the state law presently, is the first year of the cuts really impacts H+H first, under the law,” said Mujica. “So does that mean trying spreading the pain across all of the hospitals? That’s something we really have to look at. But always, redistributing is going to be very challenging. We hope it doesn’t come to that. We hope that the feds restore restore the cuts.”

U.S. Senate Democratic Leader Chuck Schumer of New York, who told State of Politics he’s been leading the charge to restore the hospital funding, described the battle in Congress as “neck-and-neck.”

The expiration of CHIP appears less dire; while the funding ended on September 30, states will not run out of the money for several months, and protecting children’s health is an issue that has bipartisan appeal. Schumer, who has been pushing to attach the renewal of CHIP funding to an Obamacare fix intended to stabilize markets and lower premiums, said he is working with his Republican colleagues to find a way to pay for the program.

About one-third of patients at the city’s public hospitals are uninsured and the network currently receives the largest D.S.H share. However, divvied up across state health care institutions, the $380 million burden would only account for less 1 percent of all hospital revenue, according to Bill Hammond, director of health policy at the Empire Center for Public Policy, a think tank.

"The lost money, if you look at just the federal losses, it’s about $330 million and that grows to $500 million in the second year, so it grows more and more every year. Spread across all the hospitals it would not be such a big deal, but right now it’s concentrated among 11 H+H hospitals, which is a problem,” Hammond said.

The ongoing federal health care crisis has also breathed new life into the debate over whether New York State would be well-served by a single-payer healthcare system, which Cuomo recently signalled tepid support for in an interview with WNYC radio’s Brian Lehrer.

A state-level universal health care bill, which guarantees health coverage to all New Yorkers regardless of ability to pay or immigration status, has repeatedly passed the Democratically-controlled Assembly, but has been defeated in the Republican-led state Senate by a sliver of a margin.

Assemblymember Dick Gottfried of Manhattan, who sponsors the bill, acknowledged that even if a version of his legislation was enacted tomorrow, it would take several years to fully implement, but said it warranted a second look given the uncertainty coming from Washington.

"It would not provide immediate relief, but the cuts that are likely to come from Washington will not come all at once, they will like snowball over the next couple of years," said Gottfried. “If we recognize health care as a right and provide health care coverage to every single New Yorker…Under a single-payer system, safety net hospitals and public hospitals would make out much better than they do today.”

Hospitals would save millions of dollars in administrative costs and the state would be in a much better position to bargain with drug companies, as it would represent 20 million patients, Gottfried added.

“Those savings are about the only way, realistically, that we can fill the gaps from whatever federal cuts are coming, without significantly damaging other programs or raising taxes,” he said. Critics, including Hammond, have said that Gottfried’s single-payer plan would be far costlier to the state that the Assembly member suggests.

When reached for comment on the health care cuts and whether the Assembly is prepared to return to Albany to deal with the situation, Mike Whyland, spokesperson for Assembly Speaker Carl Heastie, said, “We care deeply about these hospitals and are closely monitoring it.”

A spokesperson for Senate Majority Leader John Flanagan did not respond to a request for comment. 

***
by Rachel Silberstein, State government reporter, Gotham Gazette
     

Read more by this writer.

]]>
Amid Health Care Funding Fights, Cuomo Explores Special Session Wed, 11 Oct 2017 04:00:00 +0000