Health
Internet resources for what you need to know about NYC Health
Five Favorite Sites For Beginners

The Topic
"Health" refers to the health issues facing the city, touching on everything from the mayor to Medicaid to managed care to mosquitoes.
The Context
New York City is one of the biggest public health challenges in the world. With 7 million residents--over 1 million of whom are uninsured--the city has the largest number of HIV cases and the largest number of intravenous drug users in the U.S. Efforts to contain a tuberculosis outbreak that threatened the city in the 1990's have been a major success--between 1992 and 1998, the deadly multi-drug resistant cases of TB declined by over 90 percent.

New York City has 20 public hospitals which served 1.5 million people in 1998 alone. Run by New York City's public Health and Hospitals Corporation, the hospital system now has a surplus of $21 million, following years of deficits and cutbacks.

The Reporter
Maia Szalavitz is author, with Dr. Joseph Volpicelli, of "Recovery Options: The Complete Guide: How You and Your Loved Ones Can Understand and Treat Alcohol and Other Drug Problems." She writes frequently on health, science and public policy for the New York Times, New York Magazine, the Village Voice, and other publications.

by Maia Szalavitz

Disaster Relief Medicaid

Imagine having cancer -- and no health insurance. Or being unable to see a dentist, even when you have devastating tooth pain. For many of the city's poorest residents, such situations are their every-day reality, even though they may actually be eligible for government health insurance programs like Medicaid and Family Health Plus.

September 11th harmed millions -- but for the thousands lacking health care in the city, it may have been a blessing in disguise. On September 19, Governor Pataki and the state legislature, with approval from the Bush administration instituted a program called Disaster Relief Medicaid (DRM), which instantly expanded access to health care for the poor. It allowed same-day enrollment and guaranteed coverage for at least four months (which has already been extended for most enrollees).

During the enrollment period (which ended January 31st) approximately 380,000 people applied -- eight times the normal number for a similar period. Though other factors like a court decision which returned coverage to legal immigrants and an increase in the income allowance for Family Health Plus may have caused some of the jump, experts believe that most of it was due to a highly simplified application process.

"It has absolutely saved lives by getting people in for care earlier," says Rina Kitazawa, Public Policy Program Coordinator for CancerCare. "A lot of our clients fall between the cracks in the health care system. They wait until the last minute and then go to the Emergency Room."

With cancer, of course, by that time it is often too late for treatment to be effective. One woman, a 37-year-old Hispanic woman and client of Cancer Care had advanced rectal cancer and had been denied Medicaid coverage twice because her income and assets were just over the limit. She could not afford private insurance.

"What was great [with Disaster Relief Medicaid]," says Kitazawa, "was that she was immediately able to schedule an appointment for treatment at Memorial Sloan-Kettering. She would have died without it."

Another client, a 32-year-old woman, had had a lumpectomy to treat breast cancer when she was in Puerto Rico. The cancer recurred when she was in New York-- and Disaster Relief Medicaid allowed her immediately to schedule a mastectomy and follow up care, including treatment for depression which had accompanied the cancer.

Unlike the pre-existing programs for the poor (Medicaid, Family Health Plus and Child Health Plus), Disaster Relief Medicaid did not require months of waiting before coverage began or several lengthy visits to complete the application. Nor did it demand that recipients have so few assets (even owning an air conditioner is questioned) that many people deliberately decide to steer clear and only seek help in dire emergencies.

James R. Tallon, Jr., president of the United Hospital Fund of New York City, points out that many people seek Medicaid because of a condition requiring immediate attention. If the process can be completed the same day, rather than months in the future, many more people are likely to apply.

"It's clearly better from the beneficiary's perspective," says Tallon. Ordinary Medicaid, he says, "requires fairly complicated documentation, it might take a couple of visits to complete the application and for a low income worker, even getting that much time off could be very burdensome. And then it might be another 30 to 60 days before you hear back from the system about whether you are eligible."

Further, Disaster Relief Medicaid has been a boon to the always-strapped city hospitals. The Health and Hospitals Corporation pays 100 percent for care of the uninsured, but the federal government picks up 50 percent of the bill for any type of Medicaid patients.

The Health and Hospitals Corporation serves 500,000 uninsured people , according to Tallon. "Even if you could convert 20 percent to [insured by Medicaid] that would be a significant revenue source." People on Disaster Relief Medicaid will be channeled into regular Medicaid programs through an interview process over the next few months.

Because the program worked so well, State Assemblyman Richard Gottfried, who chairs the Assembly's Health Committee, has introduced legislation to make the simplified application process and reduction in paperwork and asset documentation permanent for Medicaid, Family Health and Child Health Plus. Gottfried noted that about half of the proposals in his plan have already been enacted as part of the health care workforce expansion law passed in January. That proposal included salary increases and funding increases for many healthcare workers and services. But, Gottfried said, it was "much maligned" because it was seen as a sop offered by Pataki to win the votes of the powerful healthcare workers union away from Democrats in this coming gubernatorial election.

These changes will take effect in April 2003. But a crucial change was not included. "The ability to self-certify income at the time of the initial application was probably the single most important [simplification of the process] involved in Disaster Relief Medicaid." said Gottfried. "We will resume the fight for the rest of the simplification package-- at the moment we are amending my original bill to take out [the sections already passed] and then we will hopefully pass it again."

In the current recession, the city's hospital system needs all the help it can get. Though the workforce expansion law will help some, it relies partially on increases in federal Medicaid funding which are unlikely to materialize. This lack won't be felt by the system until next year, however, according to Tallon.

HHC President Ben Chu is actually planning on increasing services so that he can attract more insured patients into the system, according to a recent interview he gave to the New York Times. If Medicaid coverage is simplified so that it can reach more of the people it was intended to help, the health system may be at least partially insulated from further cutbacks and 9/11 may actually have lead us one step closer to access to health care for all who need it.


Maia's Favorite Five Sites For Beginners:

  • New York City Department of Health - Includes health alerts (including West Nile info), information on restaurant sanitary conditions and information on various health-promotion programs.
  • New York State Department of Health - More health data for New Yorkers including information on how to sign up for Child Health Plus and Family Health Plus-- the insurance programs for those who are presently not covered by other plans.
  • Medscape - This site, aimed at doctors, allows you to search Medline, the database of medical journals, for free. Abstracts of most journal articles are available for free as well. Once you have some basic knowledge about a condition you are researching, you can look here to get a sense of what is going on in terms of study in the area. There is a companion consumer-focused site, CBSHealthWatch, which is linked.
  • American Cancer Society - Half of all Americans will face cancer at some point in their lives-- and the New York and Washington-based American Cancer Society web site provides a wealth of information for those dealing with the disease. Includes links to other major cancer sites and resources.
  • AIDS Information - A sort of "AIDS central" for New York city with links to major HIV/AIDS organizations and information sites.


Other Recommendations:

  • Quackwatch - Debunks medical scams and inflated claims made by "alternative" medical practitioners.
  • AccentHealth.com - A consumer health information site, affiliated with CNN.
  • Citizen Action - Healthcare is one of the primary focuses of this New York advocacy group. Includes information on New York's health plans for low income people lacking insurance.
  • Oncolink - An incredible research resource for cancer patients and others concerned about this disease.
  • National Alliance for the Mentally Ill - An organization of advocates for people with mental illness which includes information on treatment and support for various disorders like depression, bipolar disease and schizophrenia.
  • Insure Kids Now - Information on New York state's insurance program for poor kids and information on other state's policies, from the federal government and the governors' association.

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