(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at Health + Hospitals has led to consternation from those who would have us believe that H+H is an oversized and outdated system.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.