Gotham Gazette http://www.gothamgazette.com/component/tags/tag/1132 Tue, 17 Oct 2017 02:07:11 +0000 Joomla! - Open Source Content Management en-gb webmaster@gothamgazette.com (Webmaster) New York Reasserts Its Historic Leadership as a Haven for Immigrants http://www.gothamgazette.com/?id=6751:new-york-reasserts-its-historic-leadership-as-a-haven-for-immigrants http://www.gothamgazette.com/?id=6751:new-york-reasserts-its-historic-leadership-as-a-haven-for-immigrants Governor Cuomo

Governor Andrew Cuomo (photo: Kevin Coughlin/The Governor's office)


New York Governor Andrew Cuomo has joined the chorus of criticism against President Trump’s ban on refugees and other immigrants from seven predominantly Muslim nations. “I never thought I’d see the day when refugees who have fled war-torn countries in search of a better life would be turned away at our doorstep," the governor said in a statement following the president’s executive order. "We are a nation of bridges, not walls, and a great many of us still believe in the words 'give me your tired, your poor, your huddled masses...' This is not who we are, and not who we should be.”

Mario Cuomo strikes a resounding chord
Andrew Cuomo's support for immigration and diversity echoes the sentiments of his father, former Governor Mario Cuomo, who served from 1983 to 1995. The elder Cuomo was the first Italian American elected as governor of New York State. He had no tolerance for prejudice and worked tirelessly for human equality and dignity. A champion of recognizing merit regardless of sex or race, he appointed the first Black, the first Latino, and the first two women judges to the state's Court of Appeals.

In talking about immigration issues, Mario Cuomo often recalled the story of his parents, Andrea and Immaculata Cuomo. Penniless and unable to speak English, they had come to the United States from the Italian province of Salerno, south of Naples -- Andrea in 1926 and his wife a year later in 1927. After spending three years in Jersey City, they moved to the Queens neighborhood of South Jamaica, where they opened a grocery store and raised their family.

By that time, there were thousands of Italian Americans in New York. But across the nation, there was lots of prejudice against Italians for their religion (mostly Catholic), speech (most learned English, but often it was not perfect) and culture (they retained some old country ways but assimilated into their new land and were proud to be Americans). Congress enacted laws in 1921 and 1924 to cap total annual immigration and impose numerical quotas based on immigrant nationality that favored northern and western European countries. The laws were directed against Italians and others from southern Europe. “The old belief in America as a promised land for all who yearn for freedom had lost its operative significance," with the passage of these laws, wrote historian John Higham in his book “Strangers in the Land: Patterns of American Nativism, 1860-1925.” It had been replaced by a "new equation between national loyalty and a large measure of political and social conformity." By the time Mario Cuomo's parents arrived, a few years after the restrictive legislation, the flow of southern and eastern European immigrants had been greatly reduced.

National immigration policy continued to change and became more open in later years. But Mario Cuomo, born in 1932, remembered the sort of prejudice his parents faced and fought it his entire career. For him, it was a personal matter as well as a matter of public policy.
In a 1992 speech at New York University, Cuomo decried "nativist sloganeering and parochial fear-mongering that's been aimed at every group of new immigrants throughout our history." He recalled his parents' lives. "I thank God the country didn't say to them 'we can't afford you right now; you might take someone else's jobs, or cost us too much,'”, he said. “I'm glad they didn't ask my father if he could speak English, because he couldn't. I'm glad they didn't ask my mother if she could count, because she couldn't...I'm glad they didn't ask my father what special skills he brought to this great and dynamic nation because there was no special expertise to the way he handled a shovel when he dug trenches for a sewer pipe. I'm glad they let him in anyway."

Cuomo worked to rally the Democratic party for the cause of immigrants. "We speak for the minorities who have not yet entered the mainstream," he said in his address to the 1984 Democratic convention. "We speak for ethnics who want to add their culture to the magnificent mosaic that is America."

Andrew Cuomo continues a New York tradition
Speaking at the 2016 Democratic National Convention last July, Andrew Cuomo sounded a similar note. "The Trump campaign is marketing a great distraction, using people’s fear and anxiety to drive his ratings," he told the delegates. "Their message comes down to this: be afraid of people who are different — be afraid of different religions and different colors and different languages. Stop immigration and they believe the nation will automatically rise. It’s not right, it’s divisive, it’s delusional, and we must expose the truth to the people of this nation. Unless Republicans are all Native Americans, then they are immigrants too."

In a speech this past November, Andrew Cuomo asserted that he and New York will fight against the spread of anti-immigrant fear. Like his father, he put it in personal terms. "If there is a move to deport immigrants then I say start with me,” he said. “I am a son of immigrants. Son of Mario Cuomo, who is the son of Andrea Cuomo, a poor, Italian immigrant who came to this country without a job, without money, or resources and he was here only for the promise of America."

Cuomo intends to make good on his promise to protect immigrant rights. He has ordered his counsel's office to explore legal options to help anyone detained at New York airports to ensure their rights are protected. Promising more action, on January 29 he said, “As New Yorkers who live in the shadow of the Statue of Liberty, we welcome new immigrants as a source of energy and celebrate them as a source of revitalization for our state. We will ensure New York remains a beacon of hope and opportunity and will work to protect the rights of those seeking refuge in our state."

New York -- Land of promise
The fight over refugees and immigrants is likely to be a spirited one. The Trump administration promises to strengthen restrictions and ramp up stringent vetting of foreigners who want to enter the country. New York State seems likely to insist on continuing its historical tradition of welcoming newcomers. New York has led before and will again this time. It is a natural role for our state, particularly since New York City is where more immigrants have entered the nation over the years than at any other place.

Immigration policies varied over the years, but many of the immigrants have had one thing in common - aspirations for a better life. "More than anything else, the immigrants come with dreams -- dreams that hunger might become a thing of the past, dreams that restrictions and discrimination might be replaced by rights, and dreams that poverty might be traded for security and opportunity, if not for oneself, then at least for one's children or grandchildren," writes Andrew Anbinder in his new book “City of Dreams: The 400-Year Epic History of Immigrant New York.” He continues, "These dreams characterized the New York immigrant story from the arrival of the first Dutch settlers through the heyday of Five Points, the Lower East Side, and Little Italy. Those same dreams dominate the lives of New York's newest immigrants, whether they are Chinese or Guyanese, Jamaican or Dominican, Mexican or Ghanaian. The story of immigrant New York is truly a story of dreams."

***
Dr. Bruce W. Dearstyne's latest book is The Spirit of New York: Defining Events in the Empire State's History, published in 2015 by SUNY Press.

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

]]>
New York Reasserts Its Historic Leadership as a Haven for Immigrants Wed, 08 Feb 2017 03:07:19 +0000
New York: A Sanctuary City with A Plan http://www.gothamgazette.com/?id=6660:new-york-a-sanctuary-city-with-a-plan http://www.gothamgazette.com/?id=6660:new-york-a-sanctuary-city-with-a-plan ferreras-copeland menchaca press conference

The authors: Council Members Menchaca, left, & Ferreras-Copeland, center


New York’s immigrant families are waking up terrified as President-elect Trump, his supporters and growing administration spew hate. In spite of his new stance to “work something out” for Dreamers, Trump’s words are met with lack of trust. As the children of immigrants, we take attacks from Trump and his supporters personally and are filled with the courage needed to fight harder and smarter than ever to protect the rights and freedoms of diverse immigrant communities throughout New York City.

To this end, the New York City Council passed a resolution this week affirming our commitment to remain a sanctuary city for immigrants, and we personally delivered it hours later to Trump Tower. Our resolution codifies past commitments to sanctuary while signaling to everyone that we will invest the time, energy, and resources required to make good on our promises.
Our resolve is clear: we are here to stay.

Our City Council, like those in municipalities across the country, will play a lead role in this fight by redoubling our efforts to keep New York City a true sanctuary city. With the support of our Council colleagues, Speaker Melissa Mark-Viverito, Mayor Bill de Blasio, fierce advocates, and brave New York families, we commit to immigrants that this city will remain a safe home.

This week’s sanctuary city resolution memorialized our commitment, and we will ensure it through, in part, the following:

First, we will defend our victories by preserving existing policies, initiatives, and programs that protect immigrants.

Detainer Law: The Council’s 2014 detainer discretion law has protected between 3,000 and 4,000 New Yorkers per year from deportation. The law draws a bright line between municipal law enforcement and overly aggressive federal immigration enforcement. All New Yorkers are safer when there is trust between immigrants and the NYPD because crimes are more likely to be reported and witnesses feel safer. Under the Trump Administration, we commit to gear up for legal challenges to this law, and we expect to prevail.

The New York Immigrant Family Unity Program (NYIFUP): NYIFUP provides legal services for New Yorkers who are detained and facing deportation. It has been highly successful and serves as a blueprint for other progressive municipalities. Continued funding for NYIFUP is not guaranteed by the city. The de Blasio administration must increase NYIFUP funding and make it permanent.

CUNY Citizenship Now!: Since 1996, the City University of New York lawyers, paralegals, and volunteers have assisted hundreds of thousands of immigrants with legal advice, representation, and referrals. Programs like this are worthy of celebration and require our continuing support.

IDNYC: IDNYC is the largest municipal ID program in the country with over 900,000 subscribers. It promotes civic participation, the economy, and public safety. We will ensure it continues to thrive. We call on the de Blasio administration to do everything in its power to protect the personal data of IDNYC cardholders. Entities like the NYPD, banks, and cultural institutions must continue to honor this government-issued ID. We will do our part in the Council, and in conversations with the mayor, to protect and defend the privacy of current and future IDNYC cardholders.

Second, we must expand protections and investment for New York City immigrants.

We are committed to building upon our victories, expanding existing initiatives, and creating new services, through efforts such as:

Expanding Funding for Immigration Legal Services: Today, NYIFUP is limited to individuals who are detained and do not have a prior order of removal. In anticipation of the Trump administration, the program should be expanded to provide representation to other classes of immigrants facing deportation. The City Council and the de Blasio administration have also recently invested in legal representation in complex immigration cases. The demand for this type of representation will likely expand under a Trump presidency, requiring increased funding for these services, as well. We commit to fighting for these increases in funding for immigration legal services in the fiscal year 2018 budget negotiation process.

Right to Immigration Counsel Law: A right to immigration counsel enshrined in law would help ensure that all individuals going through immigration court proceedings are represented by competent lawyers. While this might be expensive, we cannot let that deter us from doing what is right. We commit to working with our colleagues in the Council and the mayor to further assess the feasibility of a Right to Immigration Counsel Law.

Protection from Notario and Immigration Attorney Fraud: One of the clearest ways to protect immigrant families is to ensure they are not victimized by unethical “notarios” (notaries who present themselves as immigration legal service providers) and incompetent or sham attorneys. Notario and attorney fraud harms vulnerable New Yorkers seeking immigration assistance. Our constituents encounter fake lawyers, scams, inflated fees, and predatory providers daily. Often, in addition to bilking families out of thousands of dollars, these bad actors cause serious harm to their legitimate immigration cases. We commit to working with the Department of Consumer Affairs, the Mayor’s Office of Immigrant Affairs, and advocates on continuing to protect immigrants from notario and immigration attorney fraud.

Expanding Participatory Budgeting: Each year, through Participatory Budgeting (PB), Council members voluntarily cede capital budget allocation decisions to residents of their districts who collaborate to decide which projects best serve their communities. We have repeatedly seen an overwhelming number of PB ballots in languages other than English, which demonstrates the engagement of immigrants in this process. This also indicates to us that while many immigrants cannot vote in other types of elections due to their immigration status, many are eager to participate in our city’s democratic process. The city all immigrants and other residents love, contribute to, and call home should welcome civic participation. We commit to strengthening PB in our districts and supporting its growth across the city.

We are prepared for a Trump era during which immigrant communities will likely be under attack. New York City will stand as a beacon of welcome, hope, and protection for immigrants.

In the New York City Council, we commit to defending our history of hard-won victories, while also expanding protections for immigrants. We know cities will need to hold the line against Trump administration attacks. As New Yorkers, we embrace that challenge together.

***
Carlos Menchaca is the City Council Member for District 38 in Brooklyn and Chair of the Committee on Immigration.
Julissa Ferreras-Copeland is the City Council Member for District 21 in Queens and Chair of the Committee on Finance.
Follow them on Twitter: @cmenchaca & @julissaferreras.

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

]]>
New York: A Sanctuary City with A Plan Thu, 08 Dec 2016 05:00:00 +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.

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

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

]]>
Clarity on the City's Investment in Health + Hospitals Fri, 13 May 2016 04:00:00 +0000
New Data Indicates IDNYC Popularity Among Immigrants http://www.gothamgazette.com/?id=6085:new-data-indicates-idnyc-popularity-among-immigrants http://www.gothamgazette.com/?id=6085:new-data-indicates-idnyc-popularity-among-immigrants idny bdb mmv museum

The Mayor & others flash their IDNYC (photo: Madeleine Ball)


It has been one year since New York City launched its ambitious municipal identification program, dubbed IDNYC, and reports show that the program has been a resounding success. More than 725,000 card applications have been approved, about 10 percent of the eligible population of New Yorkers 14 years of age or older.

One of the primary purposes of the program is to provide valid identification for undocumented immigrants living in New York City, of which there are an estimated 640,000. By the very nature of the program -- accepting applications regardless of immigration status and not asking about it on application forms -- quantifying enrollment among undocumented immigrants is hard, if not impossible. But, as the success of the card has led to its celebration and assumptions that undocumented New Yorkers are taking advantage of the program, there is indeed evidence that the de Blasio administration and advocates point to.

Ancillary data provided to Gotham Gazette by the Mayor's Office of Immigrant Affairs, which is one of the agencies leading implementation of IDNYC, indicates that immigrants in large numbers have availed of the program.

By the end of last year, 732,630 people had applied for the ID, with a high ratio of enrollment coming from immigrant-rich communities across the five boroughs. In Queens, 25,366 identity cards were issued in Corona, another 28,707 in Flushing and 13,654 in Jackson Heights. In Sunset Park, Brooklyn, 22,139 people were issued IDNYC. In Manhattan, 10,142 Chinatown residents and 27,213 people from Washington Heights enrolled in the program.

In providing further indication of interest from immigrant New Yorkers, MOIA reported that 52 percent of IDNYC inquiries to the city's 311 helpline were from non-English speakers. Of these, 88 percent spoke Spanish, 4.6 percent spoke Mandarin, followed in turn by Cantonese, Russian, Korean, and at least nine other languages.

"We knew there was a huge need for identification but the dramatic response was more than we expected," said MOIA Commissioner Nisha Agarwal in an interview. "This indirect data suggests that immigrants are benefitting from it."

Non-profit organizations that work with immigrants agree that IDNYC has been an unqualified success. "If hundreds of thousands of people are getting the IDs, you can imagine that tens of thousands of undocumented immigrants are getting it," said Thanu Yakupitiyage, communications manager for the New York Immigration Coalition. NYIC is an umbrella advocacy organization that works with more than 200 groups across the city helping immigrants and refugees.

"Immigrants now feel that they're part of the city in a meaningful way," said Yakupitiyage. "For immigrants, the IDNYC is supporting police-community relations. They can now enter municipal and federal buildings, sign a lease and get a bank account. It's a badge of being a New Yorker." She also cited the program's unprecedented success compared to other municipal identification initiatives elsewhere in the country, such as San Francisco, where enrollment in the first year only touched about two percent.

Other groups tell similar stories. Jose Calderon, president of the Hispanic Federation, said that thousands of the people they serve have received the identity cards and now feel a sense of safety and security from it. "It's changed lives in ways that it's hard to quantify, but it's transformative," he said. "It has opened up a new city to people who for decades, even generations have been denied it."

Calderon said the next step forward would be ensuring that immigrants can receive all the benefits of the card. "We're hoping this ID creates a bridge between the financial sector and this largely unbanked community," he said. "The hope is to make that connection that's long been missing."

This will take some work. Major banks operating in New York recently announced that they would not be accepting IDNYC as a primary source of identification in opening a bank account. This was met with disappointment by leading elected officials, including Mayor Bill de Blasio, Comptroller SCott Stringer, and City Council Speaker Melissa Mark-Viverito. Amalgamated Bank, among about a dozen financial institutions operating about 75 branches across the city, does accept IDNYC for banking purposes.

In announcing an expanded year two for IDNYC in December, de Blasio called it "the leading municipal identification program in the country, and an example to cities all across the world."

In a statement at the time, Mark-Viverito pointed to access for all, saying, "No matter your status, whether it's immigrant, economic, financial, or if you're homeless or transgender, New Yorkers will be able to take advantage of benefits by signing up for this valuable card."

Make the Road New York's co-executive director, Javier Valdes, called IDNYC a "homerun." He said it provides immigrants security and alleviates the anxiety in interactions with the police. His main concern is related to banking, he said.

Valdes also hoped that the program stays affordable. "It's going to be free for the second year as well, which I think should be done in perpetuity," he said. There had been some speculation that the card would cost around ten dollars in the second year, but the city announced it would remain free and that there were enhanced benefits, continuing its efforts to make the card appealing to all New Yorkers.

Besides keeping IDNYC free of cost, the city has already announced partnerships with more cultural institutions for 2016, bringing the total to more than 40 museums and other organizations. The IDNYC also provides discounts on pet adoptions, the New York Theatre Ballet, soccer matches of New York Football Club, and CitiBike memberships, among other benefits.

For MOIA's Agarwal, the next big step is increasing outreach efforts, particularly in immigrant communities. Last year, IDNYC held pop-up enrollments in 53 locations and the outreach team attended at least 1,700 community events, besides its massive advertising campaign. Agarwal said they would set up more pop-up enrollment centers and also look into bringing art and culture to the program with the help of an artist-in-residence at MOIA.

"We're exploring the next generation of IDNYC enrollment," she said. Her focus will be reaching out to vulnerable groups such as youth populations (Last year, 21,239 minors received the card) and using more portable technology to work with seniors while making it easier to connect the card with city services.

"I think it unifies our city," said Valdes from Make the Road NY, "regardless of who you are, where you live or where you're from."

***
by Samar Khurshid, Gotham Gazette
@samarkhurshid     @GothamGazette

]]>
New Data Indicates IDNYC Popularity Among Immigrants Thu, 14 Jan 2016 00:15:25 +0000
As Healthcare Landscape Changes, City Hospital Authority Charts New Path http://www.gothamgazette.com/?id=5939:as-healthcare-landscape-changes-city-hospital-authority-charts-new-path http://www.gothamgazette.com/?id=5939:as-healthcare-landscape-changes-city-hospital-authority-charts-new-path Dr Ram Raju via Twitter RamRajuMD

HHC's Dr. Raju (photo: @RamRajuMD) 


New York City’s Health and Hospitals Corporation was thrust into the spotlight a year ago when, last October, its Bellevue Hospital treated Craig Spencer, the doctor who returned from West Africa with Ebola. But every day, HHC also serves many thousands of New Yorkers, some of them uninsured or undocumented. The quasi-public agency is one of the largest, yet perhaps least-understood parts of New York municipal government.

HHC plays a key role in providing New Yorkers health care, but it has operated on shaky financial footing and its current CEO, Dr. Ram Raju, who is appointed by the mayor, is overhauling its operations. This change comes at a critical time as insurance payment models, federal funding, and city residents’ needs are all changing.

What is HHC?
HHC is a public-benefit corporation—similar to the MTA (Metropolitan Transportation Authority)—that runs the largest public hospital system in the United States. Consisting of 11 hospitals in four of New York City’s five boroughs, HHC treats around 1.4 million patients per year, according to its 2014 Report to the Community. HHC also administers MetroPlus, a low-cost health insurance program open to New York City residents.

As a “safety-net” hospital whose stated goal is to provide healthcare “regardless of ability to pay,” around 80 percent of HHC patients are Medicare or Medicaid recipients, or uninsured. The system also serves the estimated 500,000 undocumented immigrants—of which 200,000 are undocumented and uninsured, according to the New York Immigration Coalition—living in New York City.

Starting next year, HHC will also provide health services to inmates at city jails and prisons—a role Mayor Bill de Blasio assigned to the agency in June after a city investigation revealed that contractor Corizon Health Inc. hired doctors with disciplinary problems and criminal convictions.

“De facto, it serves a lot of very vulnerable patients in New York, in very high volume,” said Andrea Cohen, senior vice president for program at the United Hospital Fund, a healthcare research and advocacy nonprofit. “What it does today is provide an essential safety net.”

At a November policy breakfast hosted by Citizens Budget Commission, HHC CEO Dr. Raju explained his general healthcare philosophy and the organizing principle behind HHC services. “I would argue,” he said, “you do have a stake in the good health of the cook preparing the meal in your favorite restaurant and the good health of your nanny, and the good health of your housekeeper. My health depends on that cook’s health, upon that maid’s health, upon your health.”

HHC was formed in 1969 to take over the city’s former Department of Hospitals. According to James Colgrove, a sociomedical sciences professor at Columbia, HHC was created partly in response to a perceived cost crisis earlier in the decade. With its own - albeit mayor-appointed - board of directors, HHC has “more bureaucratic flexibility and cost controls” than regular city agencies, Colgrove said. This means that HHC is more independant—both organizationally and financially—and less affected by changes in city policies and finances than typical city agencies.

The corporation’s budget in fiscal year 2016, which began July 1, is projected to be nearly $6.5 billion—of which only $215 million, or 3 percent, will come directly from the city. But with operational independence comes financial challenges--HHC projects an operating loss of more than $750 million in 2016, growing to $1.5 billion in 2019.

Ongoing and New Challenges
According to HHC’s preliminary 2016 budget, the corporation’s past and projected deficits are due to years of New York State Medicaid cuts combined with growing patient numbers. In 2014, more than 80 percent of HHC’s revenues were been from Medicaid- or Medicare-related fees. The remainder comes from non-Medicaid or Medicare fees and a variety of federal, state, and city grants.

President Barack Obama’s Affordable Care Act also includes reductions in Medicare and Disproportionate Share Hospital (DSH) funds—a form of supplemental Medicaid given to hospitals that serve large numbers of uninsured patients. The rationale behind these cuts is that with a smaller number of Americans uninsured, hospitals will not need as much federal funding—but that doesn’t mean HHC will benefit in the short-term. The corporation received $1.8 billion in DSH money in 2014—more than 27 percent of its intake that year—while it expects to only receive $1.2 billion by 2018.

HHC’s current financial situation isn’t new or surprising. That’s partly because it’s politically difficult to reorganize or close hospitals, institutions with large union staffs and high levels of community involvement. While running for mayor, de Blasio campaigned against the planned closing of Long Island College Hospital in Brooklyn. Former Mayor Ed Koch’s decision to close HHC’s Sydenham Hospital in 1980, as part of an attempt to close a budget deficit, sparked protests across Harlem. “Concerns over cost are as old as hospitals themselves,” Colgrove said.

Debt-rating agency Fitch affirmed its ‘A-plus’ score on HHC bonds in February, saying HHC’s role as a safety-net provider positions it “well to secure sufficient levels of funding from city, state, and federal sources necessary to continue to operate and pay debt service.”

What lies ahead for HHC?
Raju, appointed by de Blasio at the start of 2014, announced in September plans to restructure HHC’s corporate hierarchy with the goal of ultimately expanding services and growing revenues. The plan came five months after Raju outlined his vision for a financially stable HHC by 2020.

City Council members expressed concerns about HHC’s deficit during a budget hearing in May. Watchdog group Citizens Budget Commission published a report last November describing the corporation’s “troubled” financial picture.

Raju’s plan is to replace HHC’s current structure of hospitals in a network with an organization based on lines of service. The new hierarchy will reduce bureaucracy and allow ambulatory and post-acute services to grow more quickly over the coming years, Raju told Politico New York last month.

Cohen said Raju’s plan doesn’t pose immediate financial risks for HHC—but has a large upside potential should it succeed.

“[HHC] has had a deficit for a long time, but it has always found new ways to restructure,” Cohen said. “Dr. Raju’s strategy is growth, and it’s a very ambitious and positive strategy.” New payment models in healthcare, she added, “allow strategies which don’t just look at the cost side but caring for the full patient.”

Another part of Raju’s goal for 2020 is to expand HHC’s MetroPlus insurance membership to 1 million—an additional potential source of revenue. Although MetroPlus was the most popular plan on New York’s health insurance market in 2014 and more than 428,000 individuals were enrolled in 2015, that’s only a 7 percent increase compared to 2010.

“The whole system is really undergoing substantial transformation, and HHC has absolutely embraced it in a huge way, but it’s hard,” Cohen said. “There is execution risk, but they are ambitiously tackling it.”

***
by Christian Zhang, Gotham Gazette
@GothamGazette

]]>
As Healthcare Landscape Changes, City Hospital Authority Charts New Path Tue, 20 Oct 2015 05:00:00 +0000