I was greatly heartened and excited to hear Mayor Michael Bloomberg announce in his inaugural address that he planned to form a poverty task force for New York City. For much too long, poverty has devastated the lives of millions of New Yorkers and vast areas of this city.
The mayor stated: “Today I am committing to a major reduction in the number of children, women and men who live in poverty in this city over the next four years. To that end, this year, we'll launch a public-private task force -- modeled on our task force to end chronic homelessness -- that will attack chronic unemployment and poverty in the homes and neighborhoods where the need is greatest.”
The mayor has asked me to participate in the task force, the New York City Commission for Economic Opportunity. I am hopeful that its formation signals the beginning of an effort that will culminate in a coordinated plan to identify the causes of poverty in New York City and to marshal the energy and resources to eradicate it. Does that sound grandiose? Naïve? Do you think that poverty will always be with us? Why, in the wealthiest country in the history of the world – with all of our intellectual and material resources - should we tolerate the fact that millions of our fellow citizens live in poverty?
Urban efforts to combat poverty are on the march. Just last month, the U.S. Conference of Mayors announced that it is forming a Taskforce on Poverty and Opportunity in America.
Yet it has taken a storm of unprecedented magnitude – Hurricane Katrina - to bring the poor to the surface of the nation’s consciousness. Of course, the poor of New Orleans – like all poor people in this country - have known of their precarious situation all along. It is the rest of us who cannot imagine what it is like to live on the edge all the time.
In 2005, the U.S. Census Bureau released a report revealing that the nation’s poverty rate had increased for the fourth consecutive year. New York was the only city with more than a million residents to exhibit a significant rise in poverty in the previous year. The city’s poverty rate went from 19 percent to 20.3 percent. That’s more than 1.6 million New Yorkers living in poverty.
Forty years ago, President Lyndon Johnson declared war on poverty in America. And for most of those 40 years, we’ve been losing that war. At first poverty declined. But as each successive administration cut back on funding and commitment, optimism faded and poverty receded from the national consciousness.
What’s it like to live in poverty in New York City? My organization, the Community Service Society, has an annual survey conducted of low-income New Yorkers. As far as we can tell, this is the only regular polling of a low-income population in the nation. We ask poor New Yorkers – our constituency - about their views on issues of concern to them. Along the way we have learned quite a bit.
First, let’s dispel a stereotype. The great majority of poor New Yorkers live in working families. Our survey found that 62 percent of poor households include a full-time worker; 86 percent include either a full-time or part-time worker in the family.
If an emergency struck, what would these families do? Among poor households with a full-time worker, 65 percent have less than $100 in savings to fall back on; 81 percent have less than $500. Any crisis – a sick family member, the loss of a job – would mean catastrophe for most of these New Yorkers.
It’s no wonder that these families routinely suffer the kinds of hardships that rarely touch the rest of us. Our survey revealed that, last year, among poor households with a full-time worker, 48 percent were unable to fill prescriptions, 48 percent could not get or postponed medical care, 45 percent fell behind in rent payments, 35 percent had to get food from friends or relatives due to lack of money, 18 percent even went hungry.
Here are a few examples of life on the edge in New York City:
Real estate values may be skyrocketing but poor families face staggering rent burdens: 65 percent of the poor pay more than half their household income for rent. As a result, these households have on average less than $30 a week per person to pay for all other basic needs such as food, clothing, and medicine.
The city has added thousands of jobs in the last year. But for low-income workers, job benefits – which most New Yorkers take for granted – are practically nonexistent. Of all low-income New Yorkers employed, only 22 percent get health benefits on the job; 16 percent have family health coverage; only 9 percent have prescription drug coverage; just 13 percent have a retirement plan; less than half get paid sick leave.
A report CSS released last year revealed that black and Latino youth – ages 16 to 24 - were more than twice as likely to be out of school and out of work than white youth - disengaged from any framework that would provide them with a future. In total, 170,000 of New York City’s young people find themselves in this situation. This is the next generation of poor New Yorkers.
Our most common response to poverty has been to try to create more jobs. A CSS labor market report revealed that nearly 40 percent of adult black men in New York City were jobless in 2004. But relying on job growth alone will not alleviate poverty. Without proper training and adequate education, advancement to well-paying jobs is almost impossible.
In New York City, we have many assets that could be brought to bear on the problems of urban poverty – enormous financial and intellectual resources. The city is brimming with creativity and innovation. It is home to hundreds of nonprofit and corporate foundations that benefit from tax relief expressly designed for them. Yet they hang back when it comes to a commitment that would benefit the city where they do business.
Most foundations and nonprofit research groups manifest a lack of investment – even a lack of interest – in poor communities. The philanthropic sector, in particular, should be providing resources as a bulwark against the right wing that has made disregarding urban poverty a cornerstone of its policies. But they haven’t anted up.
We must look to our public officials for leadership, responsibility, and accountability. If nothing else, the disaster of Katrina has reminded Americans of the unique role of government as the only institution charged with the responsibility - and capable of commanding the resources - for the protection and economic security of its citizens.
The mayor has thrown down the gauntlet to the private sector, labor unions, nonprofits, and community leaders. For the future of our city, we cannot continue policies that undermine its strength and vitality by acquiescing to a situation that condemns so many of our fellow citizens to a life of poverty.
Income and class – often in conjunction with race – too often determine the fate of millions of Americans. Poverty of the scale and duration we see in New York harms individuals, destroys families, and is corrosive to the city itself.
Mayor Bloomberg has shown that he does not flinch from taking on big problems. In his first term he dealt with long-standing issues of the school system. Now, by confronting poverty, he is tackling the major scourge of urban America. I am honored to be part of this initiative that we all hope will devise strategies that successfully attack poverty in New York City.
David R. Jones is president of the Community Service Society of New York, a social services organization that deals with the problems of poverty. Â
We are sorry. We are experiencing higher than normal call level. Please call back a little later. Click. This was my eighth call in four hours -- none successful -- to one of the 15 health plans in New York for low income seniors or disabled adults.
Previously these New Yorkers had their drug prescriptions covered by Medicaid without charge. Now, thanks to the new Medicare prescription drug plan pushed through Congress by the Bush administration and put into effect at the beginning of this month, they have been automatically enrolled in one of 15 private health plans. They are now required to pay for the medications, sometimes full price.
In the short time it has been in place, the new Medicare Part D prescription drug plan has proven disastrous in state after state throughout the country. "Mix-ups in the first weeks of the Medicare drug benefit have vexed many beneficiaries and pharmacists," the New York Times recently reported. "At least 24 states have taken emergency action to pay for prescription drugs if people cannot obtain them by using the new Medicare drug benefit." One of those states is New York, as announced on January 13th by Governor George Pataki: "Hopefully," the governor said, "the federal government will resolve the difficulties so that all of our seniors and all of our disabled persons will continue to get the drug coverage they need." A follow-up editorial in the Times was entitled The Medicare Drug Mess.
The problems are legion -- inadequate coverage, computer glitches, inadequate training of pharmacists, long delays -- and they fall most heavily on the poor and the mentally ill.
One 57-year old woman in upper Manhattan, diagnosed as paranoid schizophrenic and a resident of The Bridge, a supervised community residence, came away empty-handed this month from the pharmacy that usually refills her eight different medications.
One medication, Provacol, for high blood pressure, was not covered at all, and she was told she would have to pay full price. And her psychiatric medication, Seroquel, was covered, but not in the prescribed amount.
Without enough money even for the copays, she left the drug store without any of her medications.
Her social worker at The Bridge, Karen Davidson Ruddy, spoke with the druggist; he agreed to provide a 15-day supply of Seroquel. The Bridge loaned the woman money to cover all the copays. As for the Provacol, Ruddy learned it could be covered by switching the woman to a different tier of the plan, but only if prior authorization was secured over the phone. For two and a half days, Ruddy and her staff tried unsuccessfully to get through by phone for this authorization.
"The machine kept saying 'We know your time is important so we will get to you soon.' After two days of hearing that," said Ruddy, "you start to believe that your time is not important to them."
The woman had now gone five days without her high blood pressure medication. Giving up on trying to reach the private health plan, Ruddy decided to check with the prescribing doctor at a walk-in clinic on West 97th Street. The doctor prescribed a drug that the plan would cover.
They are called dual eligibles--low income seniors or disabled adults, who qualify for both Medicaid and Medicare benefits. There are about 600,000 such dual eligibles in New York State. Dr. Harriet O'Hagan, medical director at the Bridge, thinks that 20 percent of her dual eligible patients have been running into difficulties.
"We checked the Web sites ahead of time and picked plans to cover medications," she explained. "but when they went to the pharmacy, there were still problems." And some of the problems have O'Hagan dumbfounded.
"Zyprexa, the most widely sold antipsychotic medication in America, is not covered," said O'Hagan. "Same thing with Abilify. And the antidepressant Zoloft--a widely used and highly effective antidepressant. I have no idea why these drugs are not covered. Another one is the Prolixin injection, one of the cheapest medications for psychosis. It is used for people who are noncompliant and it just costs pennies. Why is this not covered? It is blindness or stupidity."
In order to get these drugs for her patients, Dr. O'Hagan now has to produce evidence that she has already tried other medications, and she must prove that the client has been on this particular drug a long time.
"I have been calling the Medicare number, but I cannot get through to a human being," said O'Hagan. "I was on the phone for hours. Now I am calling the plans. I got through to one health plan for one person, but I have about twenty others."
She also found that the local pharmacist was not honoring the transition policy. "He does not believe he will be reimbursed."
Feeling the political heat, President George W. Bush has directed Medicare insurers to take immediate steps to cover 30-day emergency supplies of drugs for dual eligible citizens and the Bush administration insisted that low-income co-pays not exceed $5. Republicans and Democrats seem united in this decision to publicly bolster the transition policy. Meanwhile, the administrator of the Center for Medicare and Medicaid Services, Mark McClellan, has acknowledged the chaos, and said that his agency was working "around the clock" to fix the problems.
In the interim, Dr. O'Hagan instituted her own emergency program: She has been giving her patients medication samples sent by drug companies. "We're giving those out, but they are going to run out soon." The effect of not taking medication for a few days or weeks on people with mental illness can vary, according to O'Hagan. "Some people decompensate (deteriorate physically or psychologically) within days," she said. "For others it is months. I may be forced to make substitutes for some of the medications and that may not be appropriate. There may be side effects. It feels kind of third world."
The Coalition of Mental Health Agencies, an umbrella organization that advocates and assists nonprofit agencies caring for the mentally ill in New York City, reported many of the same problems coming into their Medicare Part D telephone Helpline.
Bill Zeiser of the coalition had a caseworker tell him about a 57-year old mentally ill client from the Bronx with HIV who was about to run out of his AIDS medication. Due to a computer glitch, he was being asked for high co-pays for both his psychotropic and HIV medications. One particular medication was going to cost him $180--and he is on several different prescriptions. The last Zeiser heard, the caseworker was exploring the possibility of having his client admitted to the hospital to get the medications.
Hospitalization was "one of worst case scenarios that we had envisioned," said Zeiser, "but now we see it come to fruition. The grim reality is that people have to do what they have to do to get medication.
"The irony," he continued, "is that it is so much more costly to have these people checking into hospitals to get their medications than if the Medicaid benefits had carried over in the first place."
At a small pharmacy, Price Wise on West 81st and Broadway, the pharmacist on duty, Anthony Mladinov, reluctantly broke away from his work to talk for a few minutes about the drug plan. "This is the first chance I've had all day to catch up." Mladinov estimates he is staying an extra two hours every day to manage all the work.
"Some people come in without an insurance card," he reported, "but there are things we can do to help." He heard that if you go into one of the [chain drug stores] without a card, they tell you to come back when you have it.
The most common problem are customers finding their prescriptions are not on their plan. "Of course, if they did their homework beforehand," the pharmacist said, "and checked online three months ago, and called the plan back then, back when you could reach them on the phone, then they would know which plan to be on. Now you cannot get through to an HMO." For the most part, though, he was optimistic. "It will all be straightened out in a week or two."
"I certainly think things will improve," said Karyn Krampitz, director of Special Projects at the Coalition for Voluntary Mental Health Agencies. "The fact is that the pharmacists for the most part want to help, but they were not properly trained in time and many of them are not going to dispense medications unless they have some assurance that they can bill someone for it."
Social worker Ruddy recommends to her clients that they go to small independent pharmacies rather than the large chains. "They know us and they work with us," she explained. "If you have a good relationship with your pharmacist, the hope is that you can muddle through this together."
Even if many of these short term issues are resolved in the coming weeks, Bill Zeiser sees long term systemic problems that need to be addressed, such as the dual eligible copays and the complexity of the system. "What we want is for the Feds to ensure an uninterrupted supply of necessary medications for dual eligibles," said Zeiser. "After the transition period, a dual eligible would be at square one, still unable to get the medication they need from their plan, which doesn't cover it. In many cases, a thirty day supply will simply not be enough to hold someone over while they navigate the process."
Many fear that copayments may discourage mentally ill clients from taking their medications. "My clients say, 'OK, I'll take the medications,'" said Ruddy, "but when we tell them they have to pay for them, they don't want to do that."
"Some of the mentally ill would just as soon not take their medications" stressed Karyn Krampitz "So any reason that disrupts it, they just do not take it, and that is a major problem."
Medicare Part D Plan Finder
Good comparison tool for health plans.
ePocrates
A private company that has their own interactive online tool, which allows an individual to compare formularies.
Government source for basic Medicare Part D info
New York State Long Term Care Ombudsman's office
For individuals in long term care facilities who have problems getting medications, no matter what their diagnosis.
Coalition of Voluntary Mental Health Agencies
The Coalition's Part D Helpline: 212-742-1873. Available Tuesdays and Thursdays from 10 AM - 5 PM
New York Chapter of NAMI (National Alliance for the Mentally Ill)
311
The Department of Aging has centers around the city where volunteers and staff will help people. A person need only call 311 and say "I need help figuring out Medicare Part D" and the operator will refer them to the nearest DFTA Center.
1-800-MEDICARE
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The city's improved fiscal outlook presents the opportunity to reexamine and refocus budget priorities by investing in the not-for-profit human service sector, especially in the context of increasing poverty and federal budget cuts. The Census Bureau released data in August that show that the national poverty rate increased in 2004 for the fourth consecutive year to 12.7 percent or 37 million Americans. In New York City that rate increases to 20.3 percent or one in five of us. One in three children are poor. The rate for non-Hispanic blacks is 29 percent. And finally, the Bronx and Brooklyn are among the top 10 most impoverished counties in the nation.
These are grim statistics, and they reflect an even grimmer reality to the 1.6 million people -- children, families and elderly -- who rely on social services and call New York City their home. Cuts at the federal level continue to erode safety nets. They disproportionately impact New York City residents because of the high poverty rate, and they further deplete already inadequate resources for programs. The January issue of the Non-Profit Times highlights the devastating impact of the federal budget cuts on the non-profit sector. According to the Aspen Institute, federal programs of interest to non-profit organizations, which should serve as the backbone of communities in times of crisis, will be cut between $40 billion and $71.5 billion over the next few years. One quote reads, "While proposed reductions would almost certainly increase demand for non-profit services they would simultaneously reduce the funding many non-profits have available to meet this demand."
These shortfalls will leave many community groups scrambling. In 2005, 76 percent reported government funding had failed to keep pace with increased costs, with the increase in health and liability insurance, office space and transportation having been particularly onerous. The large majority of these providers had made significant changes in order to remain viable and continue to serve. This included laying off staff, failing to give employees raises or cost of living adjustments, and even closing programs.
This is bad business. It's time to reexamine our budget priorities and increase our investment in services that pay for themselves many times over in long-term savings. Academics and policy makers have found that proactive investment in high quality community-based human services saves government and taxpayer money over time and improve the quality and economic well being for those who use the services. It sounds like a winning formula to me.
The most devastating fallout of the historic underfunding of the non-profit sector has been the recruitment and the retention of a qualified workforce. Of the agencies included in a 2000 Human Services Council survey, the average turnover rate among full-time direct care workers was 38 percent, with vacancies that remain unfilled for months. We must be able to pay fair and competitive salaries if we are to reverse this trend.
Similarly, the non-profit human services sector must be able to keep pace with rising overhead and fixed costs. They must have adequate technology to meet the information and tracking demands of government and other funders. They must pay skyrocketing health and liability insurance costs and, more recently, skyrocketing energy costs.
The sector can no longer manage the already enormous and growing demands placed upon it by doing more with less, thinking out of the box, being creative or a little belt tightening. It's 'been there, done that.'
Private dollars? The same Non-Profit Times article I quoted earlier goes on to say that experts believe that private contributions would have to double or triple if the private sector were to make up for cuts.
We are indeed fortunate to contemplate a budget surplus or a more positive fiscal outlook given the serious fiscal challenges this city has faced since 9/11. By investing in social services, New York City is uniquely positioned to realize a long-term return that promotes equality, opportunity, and economic development in all communities, and makes a real difference in the lives of those 1.6 million children, families and elderly who rely on social services and call New York City home.
Fatima Goldman is executive director of the Federation of Protestant Welfare Agencies
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