Gotham Gazette http://www.gothamgazette.com/component/tags/tag/632 Fri, 15 Dec 2017 10:24:23 +0000 Joomla! - Open Source Content Management en-gb webmaster@gothamgazette.com (Webmaster) 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. 

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by Rachel Silberstein, State government reporter, Gotham Gazette
     

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Amid Health Care Funding Fights, Cuomo Explores Special Session Wed, 11 Oct 2017 04:00:00 +0000
On Election Day, Federal Policy & Funding Stakes High for New York City http://www.gothamgazette.com/?id=6612:on-election-day-federal-policy-funding-stakes-high-for-new-york-city http://www.gothamgazette.com/?id=6612:on-election-day-federal-policy-funding-stakes-high-for-new-york-city clinton de blasio inner circle

Clinton & de Blasio (photo: Michael Appleton/Mayor's Office)


Both Hillary Clinton and Donald Trump will be in New York City on election night, and one of them will be the next President of the United States. Through the results of the presidential election, which comes down to one native New Yorker and one New York transplant, and with the congressional elections on the ballot, there’s a great deal at stake for New York City.

According to the fiscal year 2017 budget summary released by the mayor’s office in April, in 1978 almost 23 percent of New York City’s budget came from the federal government. During the late 1980s, that number was at roughly 11 percent. In 2015, the federal government provided slightly under 9 percent of the city’s total budget. Despite spikes in funding during catastrophic times like the September 11, 2001 terrorist attacks or the Great Recession, decline in federal investment in New York City is nothing new, nor is it purely partisan.

While cuts have been made to federal funding for infrastructure, housing, health care, and other important city programs over the years, New York felt a particular sting when President Barack Obama announced in February a significant cut in anti-terrorism funding in his 2017 budget. Mayor Bill de Blasio, frustrated, traveled to Washington to testify in front of Congress to restore the full amount of federal money granted. In May of this year, Congress passed a Homeland Security bill, which included the original $600 million for the Urban Area Security Initiative, more than the $330 million proposed by the White House.

Federal aid in the form of grants helps fund community development, social service, and education programs -- but who is in the White House and party control in Congress have a great deal of influence over amount of such funding. New York City’s current fiscal year 2017 budget is about $82 billion, less than one-tenth of which comes through federal funds. In 2013, New York City  taxpayers sent $57.3 billion in federal income tax to Washington, according to the Observer, which reported in March on  federal disinvestment in New York.

According to the city’s Independent Budget Office, the top three city agencies that received the most federal aid from 2011-2015 were the Department of Education ($8.4 billion), Human Resources Administration ($7.7 billion) and the Administration for Children’s Services ($6.4 billion).

The fiscal needs of big cities like New York sometimes get short-changed in D.C., explained Jonathan Bowles, executive director of the Center for an Urban Future, an independent policy group focused on improving New York City’s economy.

“Because it’s such a big city, because it’s perceived as a liberal city,” Bowles said in an interview. “For whatever reason, it’s struggled to get its fair share of funding.”

Some also point to cities, especially New York, being seen as economic engines not in need of federal support -- saying that leaders in Washington see New York City more as a booster of federal coffers through tax revenue.

Bowles said the next presidential administration has a real opportunity to include urban areas in new budget proposals, after decades of ignoring them.

“Politicians in Washington really didn’t want to talk about urban areas, and they were perceived as the problem,” he said. “But whether it’s public housing, transit funding or so many other things, New York’s needs are clearly not being taken care of by the federal government.”

Over the past year, Mayor de Blasio has campaigned for Hillary Clinton, his fellow Democrat, on numerous occasions and in a variety of states (this, after he delayed his endorsement of Clinton). De Blasio dedicated his time to campaigning for Clinton instead of stumping for Democratic candidates in key New York State Senate races, where control of that chamber will be decided. In 2014, de Blasio and his allies attempted to swing seats to ensure a Democratic takeover of the last Republican stronghold in New York statewide government. The effort failed and “Team de Blasio” is under investigation for some of the fundraising tactics it used.
De Blasio said he is focusing on the federal election this cycle, and in part doing so due to the large stakes at play for New York.

“[This election] will decide the presidency, it will decide the future of the Senate, maybe even the House, but it’s also going to reset the American political dialogue,” de Blasio said at a press conference when Gotham Gazette asked why he was choosing to be involved in the presidential race but not state Senate races. Key pieces of de Blasio’s agenda have been limited or blocked by Senate Republicans in Albany.

“I think it’s some of the time that’s going to be best spent in the next few weeks because if it helps us change the trajectory of the country and the federal government, that’s going to help New York City in a very big and very material way,” de Blasio said of campaigning for Clinton. At other times, de Blasio has acknowledged that he is staying away from the state Senate races because of the “atmosphere” of investigations into his team’s 2014 tactics.

Most federal policies impact New York. According to E.J. McMahon, research director at the Empire Center for Public Policy, the outcome of congressional races may affect New Yorkers more so than who becomes the country’s next president.

“Congress controls the purse strings,” McMahon said by email. “Congress basically wrote the two most important pieces of Obama-era legislation, the [Affordable Care Act] and stimulus. The makeup of Congress will ultimately determine whether there is any significant change in tax or infrastructure policy, both of which have major implications for New York in particular.”

As the city’s economic relationship with Washington continues to decline, city officials seek a presidential administration that would resurrect the stronger partnership it once had. Policy and funding are the two key areas, and they are usually linked. Federal policy on immigration, education, health care, and other key areas greatly affect what New York City does -- and there is a great deal at stake in the presidential race in terms of different policy visions. The same goes for those who might control each house of Congress.

In terms of additional funds from Washington, the city is looking for increased aid for bridges, tunnels, and roads; money toward jobs programs and housing vouchers; and more.

While it is not completely clear how a Clinton or a Trump presidency would differ for New York City -- and control of Congress may come into play significantly -- the two major party candidates have outlined different visions on the overall role of the federal government, as well as on trade, immigration, the minimum wage and a variety of other policies.

Dr. Bruce Berg, a political science professor at Fordham University, said there are three levels on which to assess the candidates’ plans and their potential impact on New York. These include each campaigns’ intended agenda, which party controls the House of Representatives and the Senate, and the candidate’s relationship with the mayor. Berg says the issues most at stake for New Yorkers in this election include infrastructure investment, immigration reform, healthcare, and public housing.

New York City’s Aging Infrastructure
Prioritizing investment in the nation’s infrastructure may be the biggest area of agreement for Clinton and Trump. The aging roads, bridges, and water systems of the United States are deteriorating; government data show in 2014, 32 percent of roads were rated “poor,” up from 16 percent in 2005.

During a recent U.S. Conference of Mayors event in Manhattan, Mayor de Blasio said 160 bridges in New York City were built over 100 or more years ago. The average lifespan for a bridge remains about 40 years. Despite being the tenth largest economy in the world, attracting more and more residents and tourists to the city each year, New York City’s aging infrastructure needs a serious upgrade, according to the mayor, as well as many others. And it’s not just New York, de Blasio explained at the USCM event, but cities nationwide that are losing funding for infrastructure projects.

“In the biggest cities in the country, there are more structurally deficient bridges than there are McDonald’s in the entire country,” de Blasio said. “And if you think about something that unites us all, those golden arches...and then think of a lot of bridges tragically on the verge of falling down.”

Although both Clinton and Trump agree the nation’s infrastructure is crumbling, their plans to pay for related projects differ dramatically. If Hillary Clinton wins the election, her first-100-days plan includes investing $275 billion to rebuild the country’s infrastructure. This includes investing in roads and bridges, but also in water systems, increasing wide-accessibility to internet, and improving the rate of completing these projects.

Former Mayor of Philadelphia and Governor of Pennsylvania, Ed Rendell, a Clinton surrogate, said Clinton’s investment will be over five years and paid for through business tax reforms, including  a one-time tax for corporations bringing profits held overseas back to the U.S. She hopes to allocate $25 billion over five years to a national infrastructure bank, which would fund projects that become held up due to political inertia in Congress. According to Rendell, Clinton also hopes to reauthorize the Build America Bonds program, which would finance infrastructure projects entirely from the federal government.

“It will bring jobs, growth, improve infrastructure, improve public safety, improve our quality of live and make us more economically competitive,” Governor Rendell said about Clinton’s plan at the Conference of Mayors event.

Calling it “America’s Infrastructure First,” Trump also plans to invest heavily in infrastructure. His plan includes spending $1 trillion over a decade. He says he will pay for this plan not by raising taxes, but instead through private companies by offering a tax credit.  While one-sixth of a project’s cost would be funded privately, government-issued bonds would cover the rest

Trump’s proposal, the details of which were released two weeks before the election, would take advantage of low interest rates and encourage construction companies to spend on road and bridge projects that have revenue attached. These include toll roads, toll bridges and airports. This way, according to Trump and his advisors, the plan will pay for itself.

In June, Trump vowed to create the “greatest infrastructure” in the world with his plan. “When I see the crumbling roads and bridges, or the dilapidated airports or the factories moving overseas to Mexico, or to other countries for that matter, I know these problems can all be fixed, but not by Hillary Clinton,” he said. “Only by me.” 

City of Immigrants
Approximately 37 percent of New York City’s total population is foreign-born. Making up roughly 43 percent of the city’s total workforce, immigrants significantly contribute to the city’s economy. The immigration policies under the next President and Congress will greatly impact the city’s immigrants, half a million of whom are undocumented, as well as prospective immigrants, both documented and undocumented.

Alisa Wellek, the executive director of the Immigration Defense Project, a nonprofit, said New York has long been considered a target for deportation and detention of immigrants by Immigration and Customs Enforcement (ICE), a federal agency.

“After 9/11 in New York, the enforcement apparatus really ramped up those efforts in the city and nationally,” Wellek said. “It’s really an unprecedented scale of mass deportations which affects many New Yorkers who are noncitizens and those who are a part of families that are a mix of citizens and noncitizens.”  

Within her first 100 days as President, Clinton plans to create a pathway to full citizenship, defend President Obama’s executive actions of DACA and DAPA, which extended the amount of time immigrant children and their parents can stay in the country, access to healthcare for all immigrants, and end corporation-owned, private immigration detention centers. During the final presidential debate, Clinton discussed how she would enforce immigration laws.

“I don’t want to rip families apart,” Clinton said. “I don’t want to be sending parents away from children. I don’t want to see the deportation force that Donald has talked about in action in our country,” she said.

Clinton also said she wants to bring undocumented immigrants “out from the shadows” and into the economy in order to protect them from “exploitative” employers and wage theft.

Since the beginning of his campaign, Trump’s top issue has been illegal immigration. His plans include building a wall at the country’s southern border, paid for by Mexico, ending sanctuary cities, and creating a “total and complete shut down of Muslims” from entering the country. He has spoken  unclearly about what a “shut down” actually means, referring to “extreme vetting” of potential migrants and refugees, and saying the ban would not be on Muslims, per se, but on people leaving certain areas of the world where ISIS is most active.

In New York City, the Muslim population continues to grow and estimates range from 600,000 to 1 million individuals. Trump’s plan to create a database of Muslims living in the United States and ban them from entering the U.S. could potentially have significant social and economic effects, though the specifics remain unclear. It is also not clear whether these measures would enhance national security.

During a visit to Phoenix, Arizona this summer, Trump discussed his idea of immigration reform: “We also have to be honest about the fact that not everyone who seeks to join our country will be able to successfully assimilate,” Trump said. “It is our right as a sovereign nation to choose immigrants that we think are the likeliest to thrive and flourish here.”

Wellek said she hopes the next administration will overhaul the immigration system by repealing the 1996 immigration laws, ending mandatory deportation and detention and aligning reforms made in the criminal justice system with the immigration system. According to Wellek, New York has recognized the role immigrants play in the city.

“One thing New York City has done, that’s been very progressive, has been narrowing the collaboration between local police and immigration enforcement,” she said. “I think one big act for the next administration would be to end that collaboration fully.” 

What Wellek is referring to is a decision by Mayor de Blasio and the City Council to cooperate less with ICE. Indeed, many elected officials from the city, which is dominated by Democrats, have spoken out against Trump’s immigration agenda and said that it would be especially harmful to New York.

New York Health Care
Since it’s inception, President Obama’s Affordable Care Act (ACA) has helped decrease the number of New Yorkers lacking health insurance by 2.5 percent, from 12.6 to 10.1 percent uninsured. Despite data showing this success, uninsured patients still makeup about 70 percent of stays at public New York City hospitals, Health + Hospitals, which is very costly to the city. Some of these patients are undocumented immigrants who were left out of the ACA, but still use public hospitals. This, along with soaring costs and declining revenue, has New York City’s public hospitals in financial crisis. Health + Hospitals is projected to have an operating deficit of $1.8 billion by 2020. The candidates’ two very different healthcare reform plans have the potential to affect the future of healthcare in New York.

Like most Republicans, Donald Trump disparages the ACA, or Obamacare as it is often known, and Trump plans to eliminate and replace the ACA on day one of office, he says. He called Obamacare “a big fat, horrible lie” and a “catastrophe” -- criticism that has received some boost given recent news about rate hikes under ACA exchanges.

Trump has not explained exactly what he would replace it with, but promises something “far better” and cheaper, and has said the country must eliminate “the lines” that restrict how insurers can sell health insurance state by state.

Trump wants to transform Medicaid, the federal healthcare program for the poor, into state block grants. 

If elected, Hillary Clinton plans to preserve the ACA and attempt to expand coverage for those that do not currently qualify for health insurance under the law. This means expanding Medicaid in every state, lowering health care premiums, and providing citizens a public-option insurance plan, which Clinton hopes to push states to offer their residents. A public option could insure over 400,000 people in New York who were left out of the ACA. If Republicans continue to control the House of Representatives, this expansion of the law has little chance of passing Congress.

Clinton also said she wants to double the funding for primary care services at community health centers over the next ten years, which would increase access to health care for many underserved, low-income, and uninsured New Yorkers. According to her campaign website, she also wants to “expand access to affordable health care to families regardless of immigration status by allowing families to buy health insurance on the health Exchanges regardless of their immigration status” - a move that could have drastic effects in New York City given the financial issues at Health + Hospitals.

Funding for NYCHA
As the largest public housing authority in the country, the New York City Housing Authority (NYCHA) currently serves about 600,000 New Yorkers, including Section 8 voucher holders. Based on the July 2015 Census, 4.7 percent of the city’s population lives in public housing. No new public housing buildings are being constructed and New York is one of few places in the country that has committed to keeping its public housing stock. At the same time, federal funding for NYCHA has shrunk considerably, with the federal government moving more toward housing vouchers, which are used at some NYCHA facilities. 

The de Blasio administration has invested considerable additional funds into NYCHA, but the authority is also in serious financial trouble. The mayor launched a 10-year plan titled NextGeneration NYCHA, which includes a variety of initiatives, one of which is a program that leases underutilized land to developers to build both affordable and market-rate housing.

This plan hopes to combat the decline in federal funds dedicated to public housing, especially after NYCHA’s expected deficit jumped from $25 million to $60 million in 2016. NYCHA has struggled to meet basic maintenance and operation costs, though it has instituted several new reforms to improve the situation. Bowles, of Center for an Urban Future, said that Congress has not increased funding for housing projects in New York and other major cities for decades.

“Public housing has been starved at the federal level for years,” Bowles said. “It’s been decades since we’ve seen a real appetite in Washington to support the public housing infrastructure.”

Public housing is one piece of the overall affordable housing picture. Despite being a major issue for most cities nationwide, tackling affordable housing and the cycle of poverty never became a major focus during this presidential election. In September, Clinton wrote an op-ed in the New York Times addressing housing.

“If we want to get serious about poverty, we also need a national commitment to create more affordable housing,” Clinton wrote. “Too many people are putting off saving for their children or retirement just to keep a roof over their families’ heads.”

Clinton calls for expanding Low Income Housing Tax Credits in areas of high-cost to create more affordable housing in viable neighborhoods.

Trump, a real-estate mogul, has released no specific plan to address affordable housing and nothing on his campaign website mentions it. However, the Republican Party’s platform calls for “responsible homeownership” and giving more control over zoning procedures to local authorities, rather than from the federal government.

Congress, the President and Mayor de Blasio
The relationship between the Mayor of New York City and the next president is important, as is the next president’s commitment to urban issues. Additionally, the makeup of Congress and the major funding decisions regarding aid sent to cities remains of utmost importance. If Democrats are able to retake control of the Senate, New York Senator Charles Schumer is likely to be Majority Leader, which could be a boon for New York.

Despite a long relationship with Clinton, including managing her 2000 campaign for U.S. Senate, de Blasio waited months after Clinton announced her presidential candidacy to endorse her, wanting to push her more to the left on issues. In recently hacked emails, the Clinton campaign expressed annoyance with de Blasio, jokingly calling him a “terrorist.” Donald Trump has called de Blasio “incompetent” and the “single worst mayor in the history of New York City,” but has praised the mayor after he was elected.

In part due to obstruction by congressional Republicans who want to see less government, President Obama has issued over 250 executive actions to get around legislative gridlock. Bruce Berg of Fordham University says if Clinton wins the presidency, she may face similar barriers to getting laws passed in Congress, which would affect federal aid granted to New York City and elsewhere. 

“I think the most likely scenario, looking at the election right now, is a Clinton victory, where she comes in as a rather crippled president and we get very little major initiative in the next four years,” Berg said. “I think what that means is that routine federal aid to New York continues to decline slowly as it has for the last several decades.”

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by Devin Gannon for Gotham Gazette

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On Election Day, Federal Policy & Funding Stakes High for New York City Sun, 06 Nov 2016 04:00:00 +0000
Clarity on the City's Investment in Health + Hospitals http://www.gothamgazette.com/?id=6333:clarity-on-the-city-s-investment-in-health-hospitals http://www.gothamgazette.com/?id=6333:clarity-on-the-city-s-investment-in-health-hospitals Health and Hospitals facebook

(photo via Health + Hospitals on Facebook)


New York City Health + Hospitals is a model public system, the country’s oldest and largest commitment to safety-net health care. Yet Mayor Bill de Blasio’s recent plan to shore up finances at Health + Hospitals has led to consternation from those who would have us believe that H+H is an oversized and outdated system.

In a recent New York Daily News column, Errol Louis made this argument while saying that the burden of undocumented immigrants is a key flaw in Health + Hospitals’ current structure. Misunderstandings and misrepresentations of this structure and Health + Hospitals’ role in today’s health care landscape and within the city budget are, unfortunately, becoming more widespread.

Concerns about the financial standing of such a critical community institution are merited. The solution, however, is to promote policies that support quality, cost-effective care at Health + Hospitals, starting with Mayor de Blasio’s budget proposal.

The suggestion that H+H is unable to keep up with the health care system’s changing tide away from hospital-based care and toward preventive, community-based services overlooks the fact that Health + Hospitals is already providing comprehensive and culturally competent services across the care spectrum, from primary care in more than 30 community healthcare centers and 25 school-based health centers, to its better-known network of 11 hospitals providing acute and ambulatory care.

H+H has a diverse staff that represents the culturally and linguistically diverse communities it serves. In recent years H+H has responded to almost 700,000 patient requests for interpreter services.

In his column, Mr. Louis cites a 2014 report that one-quarter of hospital admissions are avoidable. He is right, but this is a problem of health care in general, not of NYC Health + Hospitals specifically. New York State’s Delivery System Reform Incentive Payment (DSRIP) Program is currently providing health systems across the state $8 billion in incentive payments to better coordinate care and reduce avoidable hospitalizations by 25% by 2020. The largest of the state’s 25 DSRIP systems is spearheaded by none other than Health + Hospitals. Whether DSRIP is successful remains to be seen, but there is no doubt that Health + Hospitals is at the forefront of system change.

As a public network, Health + Hospitals provides care to anyone who needs it, regardless of ability to pay or immigration status. It is an important provider of care to the city’s 375,000 undocumented immigrants, who face daunting restrictions in access to both public and private insurance. Mr. Louis uses this fact to support his unfounded claim that undocumented immigrants crowd emergency rooms because they have nowhere else to go for their basic health needs.

The truth, demonstrated in rigorous public health studies, is that undocumented immigrants use health care services, including emergency rooms, at lower rates than U.S. citizens and other immigrants. Because Health + Hospitals provides comprehensive and coordinated services, undocumented immigrants do indeed use the public (read: primary care) system for “routine health needs,” as Mr. Louis says – exactly as they should.

Contributions to the tax base should not be a prerequisite for receiving health care in a modern, humane society, but it is worth noting that undocumented immigrants in New York state, about 70 percent of whom live in New York City, contributed $1.1 billion to the state’s economy in 2012, according to the Institute on Taxation & Economic Policy. They are hardly free-riders.

In the true spirit of the safety net, Health + Hospitals provides care for uninsured patients, citizens and immigrants alike, without being reimbursed for it. This is a fundamental problem for the system’s finances. The solution is not to reconsider the mission of Health + Hospitals but to support policies that reduce unreimbursed care by promoting federal and state funding for health systems and increasing access to health coverage for those who remain uninsured. These are real, meaningful steps to ensure that health care providers are adequately reimbursed for services.

Mr. Louis casts the financial needs of the city’s public health system as a threat to education, transportation, and housing. Pitting public services against one another in this way is unfair and does not recognize that preservation of health is the foundation upon which New Yorkers take advantage of educational opportunity and lead rewarding, productive lives.

A city that abandons its obligation to fill the gaps in the frayed federal and state health care safety net does itself and its residents a disservice. New York City doesn’t need a smaller or less generous public Health + Hospitals system; it needs a system that is recognized for the value it provides to our communities and that is supported accordingly.

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Max Hadler is the health advocacy specialist for the New York Immigration Coalition. On Twitter @theNYIC.

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Clarity on the City's Investment in Health + Hospitals Fri, 13 May 2016 04:00:00 +0000
Government Investigator Explains 43% Budget Bump http://www.gothamgazette.com/?id=6212:government-investigator-explains-43-budget-bump http://www.gothamgazette.com/?id=6212:government-investigator-explains-43-budget-bump peters doi

DOI Commissioner Mark Peters (photo: @DOInews)


The New York City Department of Investigation has become a more proactive body focusing on systemic problems at city agencies, said Commissioner Mark Peters at a City Council budget hearing on Monday afternoon. Peters explained his office's increased productivity and impact in attempting to justify a nearly 43 percent increase in the department's budget for fiscal year 2017, which begins July 1.

The City Council's evaluation of Mayor Bill de Blasio's $82 billion preliminary budget is now in its second week and administration officials continue to testify before committees on their agency expenses and programs. On Monday, the Committee on Investigations, chaired by City Council Member Vincent Gentile, heard testimony from Peters on how DOI has changed its procedures and added responsibility, and why it requires a significant increase in funding.

De Blasio's preliminary budget allocates $44.2 million to DOI, a $13.2 million, or 42.7 percent, increase over last year's adopted budget. The increase is largely due to a major agency expansion, adding 59 new staff members, for $4.5 million, bringing the total staffing to 361. Much of the workforce addition, at least 25 employees, will go to the Inspector General unit for the Department of Buildings. (DOI also oversees another 261 employees in oversight roles at city agencies, but those are not budgeted under DOI).

Of the 59 new personnel, 38 positions were baselined in the November financial plan for a total of $1.5 million, which will grow to $2.9 million in fiscal 2017.

"DOI, in the last two years, instead of being a reactive agency, which tended to react to complaints and react to tips coming in, has now become a proactive agency," Peters said in response to Council Member Gentile inquiries about the increased budget and shift in approach. Concerns were raised in prior hearings that DOI was not arresting as many city employees as the agency had under prior commissioners.

Peters reiterated that he had moved the department to focus more on macro issues to prevent the type of misconduct that can often result in an arrest, but he also pointed out that DOI has been making more arrests. In the 2015 calendar year, DOI made 569 arrests, an 83 percent increase from 2014, based on more than 1500 investigations, and received over 700 criminal prosecution referrals, nearly double from the prior year. Peters did again caution against using arrests as an efficient metric, a point he repeated when questioned by Council Member Rory Lancman later in the hearing, saying that his office has become fairly prolific in writing insightful investigative reports.

Peters and the Council members seemed to agree that there is a good balance for DOI to strike in making arrests for theft and graft and issuing more sweeping reports. Council members indicated that with DOI's increase in arrests, it appeared to be finding the sweet spot of rooting out corruption and, through its reports, influencing preventative change.

Reports that Peters cited include a comprehensive examination of the Department of Homeless Services, which necessitated an overhaul of the city's homeless shelter policies; a report on the failure of the NYPD and NYCHA to share information about the arrest and removal of criminal offenders from NYCHA housing, which resulted in changes in both departments; and an analysis of the use of force by NYPD officers, which led the department to announce that it would track all uses of force.

"In total we have issued 25 reports of this type," Peters said, "that collectively mean that children will not live in homeless shelters with decaying rats on the floor, that we are less likely to have bricks fall off buildings and kill two-year-olds, that police are less likely to use improper force." In comparison, DOI only issued 10 reports in the four years before Peters' leadership, he said.

DOI's jurisdiction has also expanded in recent years. In 2013, the NYPD came under its ambit and in December 2015, NYC Health + Hospitals was also included.

Unsurprisingly, the issue of agency savings, which has underscored the entire budget process, came up when Gentile noted that the preliminary budget didn't mention any savings for DOI. Peters responded with a proposal, which he said he had presented to the city's Office of Management and Budget as well. Accordingly, overtime for DOI employees is paid through federal forfeiture funds and if the city were to formally transfer the payroll of 261 investigators in other city agencies to DOI, it would keep the city from spending some of its own money, replaced by federal funds.

"We run a remarkably lean shop," added Peters.

Peters did note in his opening testimony that DOI had indefinitely lost an important stream of funding. In accordance with a recent change in federal law, the U.S. Department of Justice announced in December 2015 that equitable sharing payments that are made to state and local law enforcement from federal asset forfeiture programs will come to an end. These payments, separate from overtime payments, facilitated funding for equipment, renovations, vehicles, and training, to name a few. In fiscal 2015, DOI received about $27 million in these funds. Peters estimated the fiscal 2016 amount at $12,000. (DOI has roughly three years to spend this money). But he also reassured Council Member Helen Rosenthal that this would not affect the current budget under consideration.

Council Member Lancman and Commissioner Peters did "quibble" back and forth, albeit congenially, about DOI's lack of focus on the "nuts and bolts" that led to lower arrests two years ago and then a substantial increase in arrests last year. Peters said many cases only "paid dividends" in 2015 after being carried over from the previous year.

"Let me quibble with your quibble, a little bit," Lancman said in response to Peters at one point. His concerns were that run-of-the-mill corruption cases may be getting overlooked compared to larger investigations that the department was conducting. "Something must be different at the department if the only reason that you're back to a pre-de Blasio era arrest level is significant investigations that you've started that have reached fruition," Lancman said, asking Peters if DOI recognized this issue.

Peters, cognizant of the issue, called it a "philosophical question" about the best use of finite resources. He stressed that he had heeded the Council's feedback from last year and tried to stick to a "middle course" of ensuring that systemic investigations as well as low-level corruption were handled adequately and that the agency portrayed a message of zero tolerance.

"That is a valid, legitimate conversation," Peters said, "and it's one I have with myself and with my staff almost daily."

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by Samar Khurshid, City government reporter, Gotham Gazette
     

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Government Investigator Explains 43% Budget Bump Tue, 08 Mar 2016 05:01:59 +0000