Gotham Gazette https://www.gothamgazette.com/component/tags/tag/1348 Wed, 21 Aug 2019 01:14:38 +0000 Joomla! - Open Source Content Management en-gb webmaster@gothamgazette.com (Webmaster) Eric Adams Plans to Put Public Health on the Menu in the Next Race for Mayor https://www.gothamgazette.com/city/8728-eric-adams-public-health-next-race-for-mayor https://www.gothamgazette.com/city/8728-eric-adams-public-health-next-race-for-mayor eric adams healthy food

Eric Adams with healthy food people (photo: @BPEricAdams)


Eric Adams, Brooklyn’s borough president since 2014, can always count on one place for good reviews: vegan magazines and websites.

Forks Over Knives, an organization dedicated to plant-based diets, collaborated with Adams for a 2018 mini-documentary about his lifestyle. Plant-Based News has written several stories concerning the measures Adams has championed as borough president. Vegan blog The Plantiful declared in 2018 that “we are lucky to have an inspirational Borough President” like Eric Adams.

After a 2016 diagnosis of Type 2 diabetes, Adams, a Democrat, transformed his lifestyle, switching to veganism and developing a rigorous exercise regimen. He dropped 30 pounds and became a crusader for health initiatives -- everything from yoga to biking to eating less meat -- in Brooklyn and beyond. His public health focus has earned him attention in more mainstream local media and among advocates, and he’s spearheaded several public policy changes, including getting New York City schools to adopt “Meatless Mondays.”

“At every event, I talk about how health is the cornerstone to our prosperity,” Adams said in a 2017 New York Times profile about his response to his diabetes diagnosis and published shortly after he went vegan.

While Adams will not be running as a single-issue candidate, he appears likely to put public health front and center in making his upcoming New York City mayoral campaign pitch.

The public health programs he’s backed, and the personal story behind them, have made him a popular figure in media devoted to healthy eating and a fairly unique political profile, especially relative to most other politicians, including his likely mayoral race competitors.

Now, as he gears up for a mayoral run toward the all-important June 2021 Democratic primary, Adams will have to see whether he can go citywide with his message of healthy living and gain traction among voters who will also want to hear about education, housing, transit, public safety, and other typical big-ticket issues, among others that may be more niche.

And while the former 22-year veteran of the NYPD and seven-year veteran of the state Senate will surely have plans and talking points on a wide variety of issues as the mayoral race unfolds, his focus on public health may help set him apart.

In a wide-ranging, hour-long interview with Gotham Gazette about his career and the upcoming campaign, Adams made it clear that health will indeed be a major component of his 2021 platform. “Health! Health is crucial!,” he said. “It’s not sustainable,” he added, of the city’s overburdened health care system. He went on to describe tele-medicine, one of many policies he has committed to focus on in order to address the city’s purported health crisis, which includes higher than average obesity rates.

Under Adams’ idea of expanded tele-medicine, patients would have increased options to talk to a doctor online rather than travel to the doctor’s office, potentially a great help to seniors and others who may have difficulty leaving their houses. “There’s no reason people should sit in the emergency room,” Adams said, “when they can use tele-medicine and look right on the screen and speak to a doctor right away.” 

Adams also professed support for improving lunches in New York City’s schools and hospitals, though he did not provide details. He’s also making a push for adding yoga and meditation to school curriculum.

Along with specific healthfulness policies, Adams believes that the best way to reduce the healthcare system’s woes is to reduce the need for so much institutional healthcare to begin with. “While other people are talking about making sure children have access to emergency rooms,” he told Gotham Gazette, “I'm having a conversation about preventing families from going to emergency rooms…I’m going to wean people off being reactionary, and create a proactive form of dealing with health.” 

It’s a philosophy born of Adams’ approach to his own illness. He wrote retrospectively in 2018 that he “wanted to try lifestyle changes before signing up for insulin injections,” and his goal is for everyone else to have the same choice he did. Calling on Mayor Bill de Blasio to increase plant-based medicine at New York City hospitals, Adams had a simple plea: “Give the patient the option.”

Looking at his likely 2021 opponents -- including at least fellow Democrats Comptroller Scott Stringer, City Council Speaker Corey Johnson, and Bronx Borough President Ruben Diaz, Jr. -- Adams said that “what I am offering is different from everyone else that is running because no one else is looking outside the box the way I’m looking outside the box.” 

One key question Adams will face is how much voters want to hear about public health policy, and whether he can make them care enough about healthy living to base their mayoral vote on it, at least in part.

A poll conducted by Quinnipiac in October 2017, just ahead of de Blasio’s re-election that November, asked likely voters in New York City what the most important issue would be for them in deciding who to vote for in that year’s mayoral election; health was not considered notable enough by the pollster to include in its list of options. Only 1% of respondents volunteered an answer other than those provided: the economy, education, crime, housing, homelessness, and public transportation. 

Similarly, an article on NY1’s and Baruch College’s The City Poll from May 2017 listed affordable housing, crime, jobs and the economy, and homelessness as the top four issues for New Yorkers, with no mention of health. Public health issues were little discussed in the 2013 and 2017 mayoral races.

Health care is, of course, a crucial aspect of many peoples’ lives and often a central piece of the national discussion, whether it’s Medicare for All, “Obamacare,” or reproductive rights. The conversation also does come up locally -- there’s been much discussion in New York state government about a state-level single-payer healthcare system, and de Blasio has made recent announcements around expanded city health care for uninsured New Yorkers, especially those who are undocumented. Issues related to health care access, including hospital closures, have been part of the local political discussion in recent years.

In a national poll conducted by Pew Research Center in 2019, health care costs were the second-most important policy priority for voters. This would indicate that voters pay more attention to health-related issues on the federal level, though perhaps more city residents need to be asked about it. 

One challenge for Adams may be to convince voters that the mayor’s office should play a greater role in lowering health care costs and making the city a healthier place. The issue certainly was central at times during the mayoralty of Michael Bloomberg, who instituted a ban on smoking in bars and restaurants and calorie counts on menus at chain restaurants. He also sought to limit the sizes of sodas that could be purchased at some establishments due to high sugar concentrations.

And de Blasio has made mental health a major focus through the at times controversial ThriveNYC program led by First Lady Chirlane McCray, which Adams has mostly expressed support of.

As a pair of studies from 2014 show, Bloomberg, Adams and others are not wrong to focus on health as a major concern. Between 2004 and 2014, obesity among New York City adults increased from 27.5% to 32.4%, while diabetes rates rose from 13.4% to 16.0%. The study’s authors note in the abstract that they “observed increases in eating out and screen time over time and no improvements in physical activity.”

A different study found a 2014 obesity rate of 27.0% in the whole of New York state; if the city had been its own separate state, it would have been the ninth-most obese state in the nation. 

It is against this backdrop that Adams has waged his fight for a healthier Brooklyn, and New York. His first foray into health-related legislation was in 2011, when he was the sole sponsor of a quixotic bill in the State Senate to entirely ban the use of salt in New York restaurants; the bill was introduced twice, and died in committee both times. 

Following his ascension to borough president, and his subsequent diabetes diagnosis, he has increased his efforts exponentially, oftentimes with much greater success. His Meatless Mondays initiative, which requires vegetarian school lunches every Monday, began as a pilot program in 15 schools across Brooklyn less than two years. This coming September, it will be rolled out across the entire city public school system.

“I stood beside Mayor de Blasio and then-Chancellor Fariña in 2017 to announce that fifteen schools in Brooklyn were undertaking Meatless Mondays,” Adams said in March about the rollout. “In less than eighteen months, we can announce that Meatless Mondays has spread to more than one million children at every school across the city, putting us on the path to make our kids, communities, and planet healthier.”

Adams was also successful shepherding a bill through the City Council in 2017 that created a city urban agriculture website, which informs residents about local community gardens and farms. And his general push to make Brooklyn Borough Hall a mecca for healthy lifestyles is evident, with bike-to-work events or vegan meetups happening nearly every month. As a former NYPD officer and now elected official, Adams has also taken a leading role in addressing gun violence as a public health issue, allocating and pushing for more resources to community-based solutions and proactive efforts to reduce vulnerable young people's propensity toward illegally carrying or using a gun.

Some initiatives that Adams has championed remain in limbo. A 2018 bill introduced at his request in the City Council to eliminate processed meats in public schools has not made it out of committee, though some of its provisions are present in de Blasio’s “New York City’s Green New Deal.”

A more recent push this past April to ban junk food advertisements from city property has also made no apparent headway thus far.

With the 2021 primary now under two years away, Adams will soon intensify his citywide healthfulness pitch. He says his Brooklyn constituents have already felt the effects of his initiatives. “It may not be on everyone's radar,” he said, “but it has taken flight.”

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by Joey Fox, Gotham Gazette

Read more by this writer.

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Eric Adams Plans to Put Public Health on the Menu in the Next Race for Mayor Thu, 08 Aug 2019 04:00:00 +0000
As Cuomo and Heastie Trade Comments on Anti-Poverty Efforts, a Closer Look at What They've Done https://www.gothamgazette.com/state/8693-as-cuomo-and-heastie-trade-comments-on-anti-poverty-efforts-a-closer-look-at-what-they-ve-done https://www.gothamgazette.com/state/8693-as-cuomo-and-heastie-trade-comments-on-anti-poverty-efforts-a-closer-look-at-what-they-ve-done albany gov cuomo carl heastie

Speaker Heastie & Governor Cuomo (photo: the governor's office)


Despite previously lauding the 2019 state legislative session as the “most productive session in modern political history,” Governor Andrew Cuomo went on to call the session “not progressive enough,” citing a need “to do more on poverty.”

At his celebratory, mostly upbeat end-of-session press conference on June 21, Cuomo was asked about what did not get done, and cited three issues he said he would work on next year: legalizing adult-use marijuana and paid gestational surrogacy, and expanding prevailing wage requirements on construction projects that receive state incentives. He did not mention poverty.

But just three days later during a radio appearance, Cuomo questioned whether the legislative session was “progresive enough,” and rhetorically asked WAMC’s The Roundtable host Alan Chartock, “what happened, doctor, to discussion of poverty and civil rights and the minority community?”

It was an apparently off-hand comment that seemed to catch many people by surprise, especially Assembly Speaker Carl Heastie, a Democrat whose district is in the Bronx, which is home to some of the highest poverty rates in the country.

While Cuomo has made significant strides with anti-poverty policies in the past, most notably the minimum wage hike he ushered through a split Legislature in 2016, the third-term Democratic governor did not push any landmark anti-poverty legislation or initiatives this session, which featured a long list of other progressive accomplishments with Democrats in control of both legislative houses for the first time in many years.

Soon after Cuomo’s comment about the session lacking a focus on poverty, Heastie was asked about it.

“If we’re talking about things like poverty, that necessitates putting more money in the budget,” Heastie said on June 25, appearing on WCNY’s The Capitol Pressroom with host Susan Arbetter. “If that’s the governor’s sentiment, next year we should see a robust poverty agenda in the executive budget,” he said.

When asked about the Assembly’s anti-poverty efforts, Heastie mentioned boosting community college enrollment and said such schooling can serve as a key stepping stone to the workforce.

“Every place has a different type of industry, and community colleges can put together training linked with local businesses,” Heastie said on Capitol Pressroom.

In New York, 2,908,471 people live in poverty, according to the New York State Community Action Association in its 2019 annual poverty report. That’s about 15% of the state’s 19.8 million residents; a rate just above the U.S. poverty rate of 14.6%. For white New Yorkers, the poverty rate is 11%, while it jumps to 22.5% for black New Yorkers and 24.4% for Hispanic New Yorkers. Of the 1.8 million adult New Yorkers with no high school diploma, 29% live in poverty.

Though they give both Cuomo and Heastie’s Assembly majority credit for significant steps toward fighting poverty in New York, advocates and other experts believe both have indeed been lacking in moving a number of anti-poverty measures.

Several proposed anti-poverty bills have stalled in the Assembly, and those that have passed the Assembly have not been signed into law by Cuomo, in part due to a lack of support by the governor, who was friendly with the Republican Senate majority that ruled the upper legislative chamber for all of the governor’s first two terms.

As Heastie indicated, some see the need for more state spending on anti-poverty measures, which may only be possible through tax increases, which Cuomo generally opposes. Some say a significant roadblock to many anti-poverty programs is the 2 percent cap on annual state spending increases that Cuomo has insisted on, though he has repeatedly broken that pledge. Still, Cuomo has largely kept state agency operational spending flat year over year and is loathe to add new expensive programs to the budget, especially those that don’t fit his carefully crafted agenda.

But while he has not supported key policies that advocates say would help fight poverty in New York, Cuomo has moved several significant anti-poverty measures, from the minimum wage hike to the Empire State Poverty Reduction Initiative (ESPRI), which provides state grants to localities to fund anti-poverty efforts, to the creation of the Child Care Availability Task Force, which is currently studying how to make childcare more affordable in New York.

Heastie said on Capitol Pressroom that the Assembly focuses on high poverty communities and tries to find ways to revitalize them, including through working with Cuomo to add localities to the ESPRI. Most parties point to the state’s high levels of local education funding as evidence of efforts to fight poverty through educational investments, but that focus has been criticized, even by Assembly Democrats, who believe the state owes billions in funding to poor schools, and Cuomo, who recently started saying he wants more state funding to go to poorer schools without corresponding increases to wealthier schools.

During Heastie’s four years as speaker thus far, the Assembly has pushed anti-poverty efforts, including as a key force behind the minimum wage increase and the paid family leave program that also passed the same year. But there are also some question marks.

In January 2016, Heastie announced an “Anti-Poverty Work Group,” with the goal of finding “ways to break the vicious cycle that forces people to focus on getting by and never allows them to focus on getting ahead,” he said in the press release. The work group consisted of 13 Assembly members, and was specifically tasked with coming up with ideas to improve nutrition, literacy, supportive housing, shelters, rental assistance, fair labor practices, and job training, and increase access to quality child care and health care.

However, little came of the work group -- there’s no other record of its existence in Assembly press release archives or on the Assembly website more broadly.

The work group was organized with the goal of breaking “down the silos we deal with in the Assembly,” Queens Assemblymember Andrew Hevesi, who served on the work group and has chaired the chamber’s social services committee, said in an interview with Gotham Gazette.

According to Hevesi, when former Assembly Majority Leader Joe Morelle left the Assembly at the end of 2018, the work group “fell off the top of everybody’s radar.” But even that would have been nearly three years after the group’s creation, and Morelle did not serve as its chair. Hevesi said the group had only a “couple of meetings.”

Anti-Poverty Initiatives Left on the Table
There are a variety of anti-poverty measures that could be considered by the Legislature and Cuomo. For example, a proposed bill aimed at reducing homelessness would have created a homeless housing task force by each social services district in the state to “develop a ten-year homeless housing plan addressing short-term and long-term housing for homeless persons,” according to the bill. The bill has not moved in the Assembly social services committee.

Anti-poverty measures can be bipartisan. Republican Assembly Minority Leader Brian Kolb is the lead sponsor on a bill to raise the state earned income tax credit (EITC) from 30 percent to 45 percent of the federal level. Currently, a family with three or more children can earn a maximum of $8,682 in their EITC, and a filer without children can earn a maximum of $701 in their EITC, including state, city, and federal credits, according to the New York State Department of Taxation and Finance. Another Assembly bill would expand the EITC to include workers who are 18-24 years old, a demographic that is currently not eligible for the EITC. The state EITC was last raised by Republican Governor George Pataki in 2003.

Neither the Assembly nor the Senate took up state EITC expansion this year.

That Assembly Republicans are leading the fight to raise the EITC is “both ironic and shameful,” said Ron Deutsch, executive director of the Fiscal Policy Institute, a think tank, in an interview with Gotham Gazette. “For the Assembly minority to be to the left of the governor on an issue like this really speaks to the fact that the governor is far more fiscally conservative than he paints himself,” he said.

According to data from the Fiscal Policy Institute, 85,345 young adult workers in the state that would be eligible for the childless EITC are currently excluded because they cannot be claimed as a dependent. These workers earn less than $15,270 as single filers or less than $20,900 as married filers.

Another proposed anti-poverty bill, championed by Hevesi, is known as Home Stability Support (HSS) and would increase rent supplements to families at risk of eviction, homelessness, or loss of housing due to domestic violence or hazardous living conditions. While the Assembly has pushed HSS for several years, it has not made it into the state budget, apparently due to Cuomo’s opposition.

HSS is widely seen as a way to prevent homelessness, and has many backers in both city and state government, as well as the advocacy community. According to data from the Assembly Committee on Social Services’ annual report, each year about 250,000 New Yorkers experience homelessness, and three of five homeless New Yorkers are school-aged children. In 2018, 23,000 more people became homeless, the report says. The number of homeless school-aged children has grown by 69% since 2011 (Cuomo’s first year as governor).

According to data from city Comptroller Scott Stringer’s office, over 10 years HSS could reduce the shelter population in New York City by 80 percent among families with children, 60 percent among adult families, and 40 percent among single adults. As Hevesi and others regularly point out, the cost of HSS subsidies are projected to be recouped in savings where governments spend less on shelters and other aspects of the social safety net.

HSS is projected to cost $9,865 per year for an individual in New York City, $7,320 per year for an individual in Westchester County, and $2,784 per year for an individual in Monroe County, according to data from the proposed plan. HSS advocates argue that the legislation would save the state money, as it would keep individuals and families out of shelters, which cost significantly more per individual per year to maintain. Providing an individual with temporary housing, or shelters, costs $25,925 per year in New York City,  $36,000 per year in Westchester County, and $10,950 in Monroe County, according to data from the plan.

The legislation has had support in both houses, but not enough to move it through both and to the governor. Neither majority appeared to make it a priority this year as the Legislature moved a long agenda of progressive bills.

“Home Stability Support will be a lifeline for thousands of New Yorkers to avoid falling into the cycle of homelessness, and it will also save millions of dollars for towns, counties and cities throughout the state,” State Senator Liz Krueger said in a press release supporting HSS.

Hevesi said that the reason the bill has never been passed is that Cuomo is against it. However, Hevesi said he is confident that the bill will get passed eventually, either legislatively or in the budget.

“It was in the Assembly one-house budget, Senate one-house budget, and the governor unilaterally stopped it,” Hevesi told Gotham Gazette.

HSS has been supported by a number of advocacy groups fighting poverty and homelessness in the state. Still, there was no clear, concerted effort by the Assembly and Senate majorities to push HSS over the finish line and into the state budget before it was voted through on April 1.

“Unfortunately over the past several years, in our advocacy to pass HSS, the governor has been one of the primary roadblocks,” said Helen Strom, a benefits unit supervisor at Urban Justice Center (UJC), an advocacy organization and think tank focused on bringing people out of poverty.

Hevesi accused Cuomo of profiting off of homeless shelters via Help USA, a nonprofit providing shelter that Cuomo founded many years ago and is now led by the governor’s sister.

“I don’t think he’s fighting homelessness,” Hevesi said. “I think he’s making money off of homelessness. Every policymaker in the state is for stopping the growth of the crisis except for him,” he said.

Via a spokesperson, Cuomo’s office pushed back against Hevesi’s accusation, calling it an “irresponsible lie” in a statement to Gotham Gazette, and saying the governor makes no money from Help USA.

Another issue some advocates and lawmakers raise around fighting poverty is health care, and while the state has very high rates of health care insurance coverage -- roughly 95% of New Yorkers are enrolled, in part due to robust government programming -- costs are still high for many. The Assembly majority had for several years passed the New York Health Act, which would create a universal, single-payer health care system in New York, but did not push the policy, which is opposed by Cuomo, this year, when it actually had a chance of passage in the newly-Democratic Senate. While most of the senators in the new majority had either co-sponsored the New York Health Act last year or expressed support for it during last year's campaigns, the legislation did not move in either house this year. Cuomo has said he believes single-payer health care is the best goal, but that it should be done nationally, that to do it in New York would be unrealistic given how much it upheaval it would require, including raising taxes on many New Yorkers and roughly doubling the state budget.

While advocacy groups agree in their criticism of Cuomo, “no one,” including Cuomo and the Assembly, has made anti-poverty measures “a real priority,” Deutsch said. “We can’t continue down this path any longer.”

Assembly Accomplishments
According to the Assembly majority, in March 2016, it successfully added municipalities to the governor’s Empire State Poverty Reduction Initiative (ESPRI), though it does not appear this was a direct result of the anti-poverty work group given it had just been assembled and seems to have done little overall.

ESPRI invests money directly into 16 communities with high poverty rates. Among communities introduced by the Assembly to the initiative are Troy, Hempstead, Buffalo, Oneonta, Albany, Rochester, and Broome County. Upon being added, these communities became eligible to receive ESPRI funding, which began with a $25 million investment in 2015 and received $4.5 million in the 2020 budget.

ESPRI funding supports programs including financial literacy, job training, mental health and substance abuse counseling, and more.

While advocacy groups agreed that no substantial, explicit anti-poverty measures passed this legislative session, some programs that did move are likely to help fight poverty.

“Despite the state’s fiscal constraints, the Assembly ensured this year’s state budget invested in services for families struggling with the costs of housing, child care and after-school programs while restoring critical cuts to Medicaid and education,” Speaker Heastie said in a statement to Gotham Gazette. “The Assembly Majority remains focused on advancing our Families First Agenda, which includes identifying ways to lift New Yorkers out of poverty,” he said.

The state approved a program to end cash bail in most instances, allowing most people accused of a non-violent crime to remain out of jail while awaiting a court date. In pushing for major limits on cash bail, one central argument was that the use of it criminalized poverty, essentially making it that poor people who can’t afford a few hundred dollars in bail would sit in jail, and risk losing their jobs and other community ties.

In Schenectady County, those arrested spend an average of 40 days in jail before they are charged, with some let go without being charged at all, according to Citizen Action State Organizing and Training Director Jamaica Miles.

“The people most likely to be sitting in jail are those that cannot afford to pay the bail or bond to get out,” Miles said in an interview with Gotham Gazette. “You’ve made their lives more difficult before convicting them of a crime,” she said, if they are ever convicted at all.

Additionally, the state’s newly approved rent regulations, highly favorable to rent-regulated tenants, are expected to be beneficial to many low-income families.

“The hope is they won’t be evicted as easily as they are being evicted now,” Deutsch said.

Looking ahead, the Assembly will be re-introducing a package of bills that “overhauls” the public assistance system, Hevesi said.

With the current public assistance system, many low-wage workers can earn enough to work themselves out of the benefit and lose their vouchers, but when they lose public assistance they can no longer afford to live where they’re living, Strom said.

To remedy the system, the state can raise the eligibility income levels for public assistance or create a different income level for housing vouchers, so those receiving public assistance can retain their vouchers while they transition to being off of benefits and on an employment income, Strom said.

“As it’s currently structured it’s a trap. Once people are on public assistance they are trapped in perpetuity. We have an opportunity to break that system up and give people the incentives they need to get off public assistance,” Hevesi said.

The Assembly had a hearing on the overhaul set for the end of the previous legislative session, but it didn’t come together in time, Hevesi said. The bills have veto proof support in the Assembly, including backing of Minority Leader Brian Kolb, and are over the 32 vote threshold to have a majority in the Senate, but still do not have the support of the governor, Hevesi said. 

The Assembly also pushed the governor for the creation of 20,000 units of supportive housing for the chronically homeless, Hevesi said.

“After a several-year battle [Cuomo] agreed, but then stalled again when we had to force him two years ago to release $1 billion to get the first 6,000 units,” Hevesi said.

Cuomo’s Efforts
Until his June comments on WAMC radio, just after the end of the budget and legislative session in Albany, Cuomo had said very little directly about poverty in 2019.

He did not explicitly discuss “poverty” in any of his three major speeches (a December “First 100 Days” address, his January 1 inaugural remarks, and his State of the State speech later in January) that set the stage for this year in Albany, the first under full and functional Democratic control of both the governor’s office and Legislature in several decades.

Cuomo did mention several programs, both already passed and on his 2019 agenda, that relate to poverty, though, including the minimum wage hike, which has seen the wage hit $15 per hour in New York City, with other increases around the state.

In his December 2018 speech outlining his agenda for the “first 100 days” of his third term, Cuomo called the lack of affordable housing “a crisis,” and promoted what he says is the state’s largest ever investment in affordable housing, which appears to have meant continuation of an ongoing $20 billion program that requires new budget investments each year.

He also called for renewed rent regulations that would improve certain tenants’ rights, which ultimately passed in the Legislature and were signed by the governor to much acclaim by activists, advocates, and lawmakers.

In his inaugural address, Cuomo again avoided the issue of poverty directly, but touted the state’s accomplishments and agenda related to fighting climate change, ending cash bail, legalizing marijuana (which failed to pass during the legislative session), and investment in affordable housing.

In his State of the State address, Cuomo again did not explicitly discuss poverty, but he put forth budgetary and legislative proposals to alleviate burdens for those in or near poverty. Cuomo’s executive budget plan proposed providing more state aid to poorer schools and school districts, while moving ahead with planned funding for affordable housing and to fight homelessness, among other measures that stand to help people living in or near poverty, like cash bail reform and green economics.

In his State of the State policy book, Cuomo did include a short section on “Combating Poverty,” with two planks: one, further supporting the Empire State Poverty Reduction Initiative (ESPRI) and establishing ESPRI representation on Regional Economic Development Council workforce development committees; and two, “reduce hunger and food insecurity.” Cuomo would “establish a goal to reduce household food insecurity in New York State by 10 percent by 2024,” the policy book reads, and will do so by “directing the following actions: create a food and anti-hunger policy coordinator; simplify access to SNAP for older and disabled adults; enhanced resources and referrals in clinical settings; participate in SNAP online purchasing pilot; and expand food access in Central Brooklyn.”

Asked about the governor’s anti-poverty record in light of his comments and Heastie’s response, the governor’s office highlighted a number of programs.

“New York State is leading the fight against poverty through a holistic approach, including raising the minimum wage to $15 an hour, and a $20 billion plan to combat homelessness and create or preserve more than 100,000 affordable homes and 6,000 providing supportive services,” Cuomo Press Secretary Caitlin Girouard said in a statement to Gotham Gazette.

According to the Governor’s office, Cuomo’s poverty reduction programs include 2013’s anti-hunger task force, 2015’s $25 million ESPRI to address regional pockets of poverty across the state, and the $15 per hour minimum wage program that he ushered through in 2016, which is phased in over several years and sets different wages in different regions of the state.

According to data from the “Unheard Third,” a regular opinion poll of low-income households conducted by the nonprofit Community Service Society, half of low-income hourly workers in New York City say that the recent increases in the state minimum wage is making them better off.

The percentage of New Yorkers in poverty decreased every year from 2013 to 2017, from 16 percent of New Yorkers living below the poverty line in 2013 to 14.1 percent in 2017, according to data from Talk Poverty, an organization that tracks poverty levels in every state. Since the minimum wage has passed, 247,775 fewer New Yorkers are living below the poverty line, according according to data from Talk Poverty. (The aforementioned New York State Community Action Association in its 2019 annual poverty report estimates 15% of New Yorkers living in poverty, using recent Census data from 2013-2017.)

Moving ahead, Cuomo has said he wants to continue to invest in education, but with aid directed disproportionately toward poorer K-12 schools. When the new state budget passed in April, education funding increased to $27.9 billion, with over 70% of the increased funding going to schools in poorer districts, according to the budget.

The state has increased funding for higher education, too, which has a distinct budget of $7.6 billion, by $1.6 billion, or 27 percent, since 2012 (Cuomo took office in 2011), according to data from the Governor’s office. Still, Cuomo has faced criticism related to funding for CUNY and SUNY public higher education institutions, and how his signature Excelsior Scholarship program is working.

In December of last year, Cuomo announced the Child Care Availability Task Force, a group of experts assembled to develop solutions that will improve access to affordable child care. The task force examined “access to affordable child care, the availability of child care for parents with non-traditional work hours, statutory and regulatory changes that could promote or enhance access to child care, business incentives to increase child care access, and the impact on tax credits and deductions relating to child care,” according to a press release announcing its creation.

"We want to ensure that working families are provided with the resources for safe, accessible and affordable child care. By promoting and investing in child care, we know it can improve women's participation in the workforce and narrow the gender wage gap,” said Lieutenant Governor Kathy Hochul, who is a co-chair of the Child Care Availability Task Force, in the press release. Hochul has said she expects its initial recommendations to help inform the Cuomo administration’s 2020 agenda.

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by Noah Berman, Gotham Gazette

Read more by this writer.

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As Cuomo and Heastie Trade Comments on Anti-Poverty Efforts, a Closer Look at What They've Done Wed, 24 Jul 2019 04:00:00 +0000
Ending Health Disparities That Disproportionately Impact New Yorkers of Color https://www.gothamgazette.com/130-opinion/8548-ending-health-disparities-that-disproportionately-impact-new-yorkers-of-color https://www.gothamgazette.com/130-opinion/8548-ending-health-disparities-that-disproportionately-impact-new-yorkers-of-color woodhull cm cr ar mt jm

Council Member Carlina Rivera, left, one of the co-authors (photo: John McCarten/City Council)


New York City is one of the largest, most diverse, and advanced cities in the country – in fact, New Yorkers are living one-and-a-half years longer than a decade ago and nearly nine years longer than 25 years ago. Yet behind that positive sheen lies a shameful truth – our city persistently falls short in health outcomes for people of color.

As a New York City lawmaker chairing the committee that oversees our city’s largest public health system and as the founder and leader of the city’s largest physician-led nonprofit health care network, we are troubled that despite economic and technological leadership, our city continues to fall short on health basics.

Persistent health disparities are spread across all five of New York City’s boroughs, most noticeably in communities of color. So, with another Minority Health Month in the rear-view mirror, we are hoping to spur solutions and bring much needed attention to these crises beyond just one month. Whether it is tackling the epidemic of diabetes, maternal mortality rates, or depression and suicides, we can no longer take on these issues without highlighting the disparate rates at which these medical issues affect New Yorkers of color.

And the solutions to these challenges can’t just come from one sector. We need policymakers, community doctors on the front lines, and healthcare experts to all fight together for essential access to preventive care, increasing basic health education and literacy, and addressing the social determinants of health.

Our urban reality is stark: compared to their white neighbors, Latinx women are 60% more likely to be diagnosed with cervical cancer and are 70% more likely to receive late or no prenatal care; Asian-Americans are 30% more likely to be diagnosed with tuberculosis and 10% more likely to be diagnosed with diabetes; and African-Americans are 60% more likely to experience a stroke that could end in them becoming permanently disabled.

In addition, key survey findings in SOMOS’s State of Latino Health report highlighted a series of health disparities Latino New Yorkers struggle with every day. For example, 33 percent of Latinos don’t think people in their community get the health care they need, and 61 percent of providers think that Latinos face unique barriers that keep them from accessing health services.

Many of these conditions are exacerbated by what are known as social determinants of health, or more simply, the conditions in which New Yorkers live. These social determinants are attached to economic stability, education level, social and community context, health and health care; and neighborhood and built environment. And, every single one of these factors can determine a wide range of health risk outcomes.

Overall, New Yorkers who live in poverty and cultural isolation, including immigrant and first-generation New Yorkers, live underserved and in a political climate hostile to the historically disenfranchised. Put simply, this crisis is decades in the making, which is why the City Council Committee on Hospitals has been dedicated to examining these issues at our hearings and advocating for solutions from our city’s biggest medical providers.

We must improve health literacy through building awareness – and use cutting edge technology to meet diverse New Yorkers where they live and how they receive information. New York City has more languages and dialects than the United Nations, and we are stronger and more unique for it – yet in many communities our access to internet services is far too low. We need to translate simple, effective health literacy messages from nutrition and exercise to smoking cessation in order to better reach more families and employ digital and handheld technology to carry the message.

We must make sure nutrition and healthy eating are no longer the purview of elites. It’s worth repeating that farmers markets and supermarkets that specialize in natural, low-calorie, low-sugar, low-fat foods are economically far out of reach for far too many neighborhoods. Lowering food costs and making healthy food far more accessible and culturally relatable can make a huge difference in basic health for hundreds of thousands of New Yorkers who want to eat healthily but simply can’t afford it or aren’t exposed to it. And we know that local vendors who partake in farmers’ markets and sell to health food markets would like to reach more consumers.

Together, we are pursuing a collaborative agenda defined by our partnership, expertise and unique lived realities.

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City Council Member Carlina Rivera represents the 2nd district, which includes portions of the Lower East Side in Manhattan, is Chair of the Council’s Committee on Hospitals and Co-Chair of the Council's Women’s Caucus. Dr. Ramon Tallaj is Chairman of SOMOS, a non-profit, physician-led network of more than 2,000 health care providers serving over 700,000 Medicaid beneficiaries in New York City, with providers delivering culturally competent care to patients in some of New York City’s most vulnerable populations.

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

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Ending Health Disparities That Disproportionately Impact New Yorkers of Color Mon, 03 Jun 2019 04:00:00 +0000
New York City Must Fully Restore Article 6 Public Health Budget Cuts https://www.gothamgazette.com/130-opinion/8547-new-york-city-must-fully-restore-article-6-public-health-budget-cuts https://www.gothamgazette.com/130-opinion/8547-new-york-city-must-fully-restore-article-6-public-health-budget-cuts mathur inte selman

(photo: William Alatriste/City Council)


As health care providers and public health advocates, we believe that all New Yorkers deserve access to high-quality, comprehensive, compassionate health care. We believe that health care is a human right—not a luxury for the privileged. 

And yet, New York State has cut vital public health programs for our city—and only our city. Known as Article 6, these state funds help support critical services provided by local health departments, including immunizations; tuberculosis outreach, education and testing; and sexual and reproductive health. In New York’s most recent budget, New York City’s reimbursement for this program was cut by 16%, resulting in more than $62 million in lost funding to essential city public health programs.

The Mayor’s Executive Budget plan includes $59 million in funding to restore cuts to the Department of Mental Health and Hygiene administrative programs and organizations funded by the administration. However, it does not cover the millions in lost Article 6 matching funding for City Council discretionary-budget public health programs, such as those that support immigrant health, health education, health insurance access, HIV/AIDS prevention and treatment, child and maternal health, viral hepatitis, and more.

Currently, the City Council estimates cuts will result in no less than $3.4 million in lost funding across dozens of community-based organizations.

We are calling upon Mayor de Blasio and the City Council to stand up for our communities and say no to these cuts to our health care funding. We are calling for this funding to be fully restored in the city’s fiscal year 2020 budget, which is due by July 1, including full funding for Council-discretionary funded nonprofit providers.

Funding for City Council public health initiatives is a small fraction of the $90-plus billion city budget. We can't afford to not invest in public health.

Lack of access to quality health care can lead to devastating outcomes, from premature death to high prevalence of chronic diseases, especially in our most vulnerable communities. The leading causes of illness, disability, and death in New York City are largely preventable. Clinical encounters with medical staff are critical opportunities for health promotion and disease prevention and treatment, yet many New Yorkers face egregious barriers to accessing care.

New York City has a long way to go before all our communities are able to access the health care they need and deserve to lead healthy, autonomous lives. We are on the ground every day, from the Bronx to Staten Island, providing care to those who need it most. We still have so much work to do—and what we need is more support for our lifesaving work, not a budget cut that threatens our progress and our communities’ health and futures.

***
By Anthony Feliciano, Executive Director of Commission on the Public’s Health System; Laura McQuade, President and CEO of Planned Parenthood of New York City; Mark Harrington, Executive Director of Treatment Action Group; Jennifer March, Executive Director, Citizens’ Committee for Children of New York; and Charles King, CEO and co-founder, Housing Works.

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

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New York City Must Fully Restore Article 6 Public Health Budget Cuts Mon, 27 May 2019 04:00:00 +0000
At 94%, New York Health Insurance Coverage Best of Four Most Populous States https://www.gothamgazette.com/130-opinion/8503-new-york-94-percent-health-insurance-coverage-best-of-four-biggest-states https://www.gothamgazette.com/130-opinion/8503-new-york-94-percent-health-insurance-coverage-best-of-four-biggest-states protecting hc nyc

(photo: Kevin P. Coughlin/Office of Governor Andrew M. Cuomo)


New York State had achieved the highest percentage of residents with health insurance coverage of the four most populous states in the country by 2017, according to the Kaiser Family Foundation, one of the nation's leading health research organizations.

Ninety-four percent of New York's residents had health insurance coverage that year; California was second, with 93%. Both of these states accepted the Obamacare Medicaid Expansion, and both had 26% of their populations served by Medicaid in 2017. Texas and Florida, the other two of the four most populous states, both rejected the Medicaid expansion and had 83% insured and 87% insured, respectively. The United States as a whole had achieved 91% of its population covered by health insurance by 2017.

health insurance coverage1

A report by State Comptroller Thomas DiNapoli actually pegged New York's health insurance coverage rate even higher in January 2018, at 95%, citing Center for Disease Control data. Either number for New York, 94 or 95%, reflects a solid record of attainment of social well-being in the state; not perfect, by any means, but very good.

So how did New York get there?
This article looks at how New York's policies achieved these positive results, as well as prospects for improvement.

First, however, it's useful to take a look at the immediate pre-Obamacare environment for the nation and these most-populous states, as well as how the states and the nation were faring in 1998-2000 as the Clinton administration came to a close in a period of substantial economic growth.

The following tables look at health coverage in the United States and the four big states in 2008 and 2010, as the Great Recession was beginning and ending.

health insurance coverage2

In 2008, 15% of the nation's residents did not have health insurance and 13% were in the Medicaid program. In New York, 12% of residents were uninsured and 13% of residents were on Medicaid. By 2010, after the Great Recession, the uninsured had risen to 16% of the country, and 17% on Medicaid. In New York, uninsured was still 12%, but 22% were on Medicaid.

A 2001 U.S. Census Bureau report showed uninsured rates for 1998-2000.  As the American economy continued to expand at the end of the Bill Clinton years, health insurance coverage reached 14% uninsured by 2000.

New York's situation was worse than the nation in 1998-2000, with 15.7% of its residents uninsured in 1998, and 15.1% uninsured in 2000.

In 2000, California had 17.9% uninsured, Texas 23.2%, and Florida, 17.2%. New York, at 15% uninsured, had a higher percentage of its residents with health insurance of the four largest states, but all four had higher levels of uninsured than the nation.

What happened? First: the Defeat of Block Grants for Medicaid
After the Republican Party won the House and Senate in 1994, the new Republican majorities passed legislation to limit Medicaid spending by providing a capped lump-sum amount of money for Medicaid to every state in the country, effectively eliminating the program as an entitlement. This lump sum was called a Block Grant.

Initially, welfare and other spending for poor people would also be given to states as a block grant. President Clinton vetoed this entire package in December 1995. New York Governor George Pataki made similar proposals, which were rejected by the Democratic-controlled Assembly. Ultimately, Clinton was able to force Congress to separate Medicaid from welfare, with welfare becoming the "Temporary Assistance to Needy Families" block grant (in New York), while Medicaid health care was preserved as an entitlement for the poor.

Enter Child Health Plus and Family Health Plus
In 1997, President Clinton proposed and Congress approved a program to expand health insurance coverage for children up to age 19. In 1999, the New York State Legislature passed legislation, which Governor Pataki signed, authorizing New York to apply for approval from the federal government for a program to be named Family Health Plus, enrolling the parents of children in Child Health Plus (CHP), up to 150% of the poverty level, in the Medicaid program.

Childless adults earning up to 100% of the poverty level would also be permitted to enroll. CHP in New York had enrolled over 500,000 children by 2001, and the federal government approved the Family Health Plus waiver. Implementation was planned for the fall of 2001.

A Health Emergency is Declared in New York After 9/11
The horrific impacts of the September 11, 2001 attacks on the United States and New York are known as part of American history.

But there was a side story about health care in New York that is less well-known. The New York State government's Medicaid computers were in the World Trade Center and were destroyed in the attacks.

These computers contained the information on the eligibility of those enrolled in the Medicaid program. Medicaid was very bureaucratic; recipients had to submit proof of their continued eligibility every year in a recertification process. After the Medicaid computers were destroyed, Governor Pataki announced on September 19, 2001 that New York had received an emergency waiver of the recertification requirements for Medicaid for New York City only through January 31, 2002.

A program known as Disaster Relief Medicaid was implemented that allowed persons to merely fill out a one-page document and attest they were eligible for Medicaid -- 350,000 people enrolled by the deadline.

New York's Family Health Plus program began its implementation shortly after 9/11 as well, allowing adults with children and earning up to 150% of the poverty line to enroll in Medicaid. A national recession was underway at the time of the 9/11 attack -- exacerbated in New York, of course, by the devastation in downtown Manhattan.

New York State lost nearly 200,000 jobs between August 2001 and August 2003, heavily concentrated in New York City. The confluence of all these events resulted in a major expansion of the Medicaid program in New York State; enrollment rose from 2.7 million in 2000 to 3.9 million in 2004.

New York State also began subsidizing small-group private health insurance through a program known as Healthy New York, where subsidized enrollment reached 145,000.

New York 2005-2013: The Great Recession, Medicaid Reform, Preparing for Obamacare
The New York State economy recovered from the recession and the Trade Center attack from 2003-2008, and the Medicaid rolls remained fairly stable, reaching 4.1 million in 2008. The Great Recession began in 2008, with the nation losing 8.5 million jobs from 2008 through February 2010.

New York lost more than 300,000 jobs and about 1 million residents were added to the Medicaid program, bringing Medicaid enrollment to about 5 million before Obamacare, enacted in 2010. This major new program, intended to provide health insurance to 30 million or more additional Americans, had a lead time of several years for the states to develop the ability to implement it.

The recession caused staggering New York State budget deficits. Struggling to cope, both Governors Paterson and Cuomo undertook intensive cost-containment efforts in the Medicaid program while maintaining and even enhancing eligibility. Participation in managed care became standard for Medicaid recipients, even the disabled. New York enacted some utilization limits and tightened reimbursement rates for providers. But the State still took steps to streamline and simplify Medicaid, such as allowing 12-month eligibility periods, eliminating the asset test and fingerprinting, affirming the experience of Disaster Relief Medicaid.

New York also accepted grants from the federal government to get Obamacare up and running by the beginning of 2014. New York integrated its Medicaid program with the new Obamacare health exchanges, in what became known as New York State of Health. Family Health Plus was folded into Obamacare. State government planned for the state to centralize Medicaid administration and take over enrollment processing for persons newly applying for Medicaid as well as the private health insurance plans offered on the exchanges.

Obamacare: 94-95% of New Yorkers Now Insured
By 2013 New York had reached 89% of its population covered by health insurance, and launched Obamacare in 2014. Another 1.2 million New Yorkers were enrolled in the Medicaid program and 250,000 in the new private plans during the Obamacare rollout.

New York adopted a screening policy for applications through the Exchange to enroll residents in Medicaid if they were determined to be eligible, resulting in New York's small private plan enrollments. After all, the federal government was covering 100% of the new costs up to 2019.

New York also received approval in 2015 from the federal government to add residents not eligible for Medicaid into a new insurance program called New York Essential Care, which now covers nearly 750,000, including adults from the Family Health Plus program whose eligibility for Obamacare Medicaid had not been preserved in the switchover. Comptroller DiNapoli's report cited New York as one of only two states in the country to create such a Plan (which is being paid 93% by the federal government). Adding this program to Medicaid enrollment (now 6 million plus) brings 7 million New Yorkers into non-Medicare public plans. 95% of New Yorkers now have health insurance.

The state government recently took important steps to codify elements of the Obamacare rollout into state law through the new state budget, protections toward stability in case there is significant undercutting of the health care law via the Supreme Court or other federal action.

Three Legislators
Three members of the New York State Legislature deserve special mention for extraordinary leadership in the state’s achievements in health insurance. One is Assemblymember Dick Gottfried of Manhattan, the senior member of the Legislature who has chaired the Assembly Health Committee since 1987. Second is State Senator Kemp Hannon, a Republican from Nassau County, who chaired the State Senate Health Committee and supported the Medicaid expansions and shepherded them through the Republican-controlled State Senate. He was defeated in 2018. And third, James Tallon, who served in the State Assembly from 1975-1993, as Majority Leader and Gottfried’s predecessor as chair of the Health Committee. He became President of the United Hospital Fund in 1993 and became the state’s intellectual leader in health care.

What’s Next?
New York still has 1 million to 1.2 million residents without health insurance. The Kaiser Foundation reports that 8% of New York non-elderly adults age 19-64 still do not have health insurance.

Recently the de Blasio administration announced a plan to enroll several hundred thousand more New York City residents without health insurance into a New York City insurance plan based on its network of municipal hospitals and clinics, which have their own Medicaid Managed Care Plan (the city is also attempting to enroll undocumented immigrants, who can’t be insured, into health care plans where they are assigned primary care doctors).

The city’s efforts are a good idea and the New York State government should help the city by paying for outreach and facilitated enrollment.

New York could still build on the substantial increases in health insurance outside New York City as well, and continue efforts to provide small group coverage through its Exchange. The top five states for insurance coverage in the nation have reached 96-97% of their residents insured.

And Single-Payer? Don’t Forget Donald Trump
The New York State Assembly has passed a single-payer health plan, called the New York Health Trust, several times, as recently as 2018,; it is now bill A. 5248 in the current legislative session.

Moving forward with such a plan still has innumerable hurdles, one of which involves folding the Medicare program into a comprehensive New York health insurance plan, necessitating federal government approval under the Trump administration, which is not likely. Single-payer must also pass the State Senate and be supported by Governor Cuomo.

Going into the 2020 presidential election, even if Donald Trump is defeated and the Democrats take back the United States Senate it's not certain there will be a national consensus on single-payer or Medicare-for-All. Incremental progress might still be the choice. It is clear New York State has made great progress and still has the capacity to do better, something New Yorkers should be proud of.

***
Jim Brennan was a member of the New York State Assembly for 32 years, where he chaired four committees. On Twitter @JimBrennanNY.

 

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

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At 94%, New York Health Insurance Coverage Best of Four Most Populous States Tue, 07 May 2019 04:00:00 +0000
What's The [Data] Point? 1,112,975, with Dr. Mitchell Katz, President of NYC Health + Hospitals https://www.gothamgazette.com/city/8430-what-s-the-data-point-1-112-975-with-dr-mitchell-katz https://www.gothamgazette.com/city/8430-what-s-the-data-point-1-112-975-with-dr-mitchell-katz whats the data point


What's The [Data] Point? Episode 71 -- 1,112,975, with Dr. Mitchell Katz, president of NYC Health + Hospitals [You can download What's The [Data] Point? wherever you get your podcasts, including on iTunes]

artworks 000515225592 2py301 t500x500Dr. Mitchell Katz is in charge of the city's public hospital system, which includes 11 hospitals and dozens of other facilities and clinics. Katz came to New York City Health + Hospitals to help turn around the struggling system, especially in terms of its finances, but also in its delivery of care. He recently spoke at Citizens Budget Commission breakfast, after which he joined the podcast to take a few questions -- this episode consists of that Q&A followed by Katz's remarks at the breakfast about what he's doing to change H+H, what progress has been made and what challenges persist.

Listen to the conversation and let us know what you think: Ben Max of GG (@TweetBenMax), Maria Doulis of CBC (@MariaDoulis). Listen below or download wherever you get your podcasts!

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by Ben Max, Gotham Gazette
     

Read more by this writer.

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What's The [Data] Point? 1,112,975, with Dr. Mitchell Katz, President of NYC Health + Hospitals Thu, 04 Apr 2019 04:00:00 +0000
Crafting a State Budget to Enhance Nurse-Family Partnership and Support Vulnerable New York Families https://www.gothamgazette.com/130-opinion/8389-crafting-a-state-budget-to-enhance-nurse-family-partnership-and-support-vulnerable-new-york-families https://www.gothamgazette.com/130-opinion/8389-crafting-a-state-budget-to-enhance-nurse-family-partnership-and-support-vulnerable-new-york-families cityo council john0mc cm

(photo: John McCarten/NY City Council)


We live in a state with enormous resources, and a $175 billion annual budget—yet many New Yorkers still lack access to adequate maternal care. New York's maternal mortality rate is higher than the national average, and even worse in communities of color. Black women are over three times more likely to die from complications during childbirth than their white counterparts.

All too often, the outcome of a woman's pregnancy has less to do with her health than with the quality of care she receives over the course of those nine months. For many women across our state, poverty and a lack of resources can be the decisive factor in determining the outcome of a pregnancy. That's unacceptable. We need better services and a standardized level of care to ensure that all women, regardless of their income level, race, or geography, can experience a safe and healthy delivery.

It’s time for New York to get serious about these issues, and address these startling trends. That’s why I pushed for the New York State Senate to increase funding in our chamber’s state budget plan for maternal health care – and why I’m now calling for that funding to remain in the final budget, to be agreed on by the Governor and the Legislature by April 1.

With expanded funding, we can better support the essential work being done through New York’s Nurse-Family Partnership programs. These programs, located throughout New York City and the state, connect the most high-risk first-time mothers in poverty with their own personal registered nurse through pregnancy and the baby’s first 1,000 days.

These nurses provide more than home visits to assess mom’s health and baby’s development; they offer social support and guidance on many critical facets of a woman’s life. They connect new moms with services to help find stable employment and housing, resources to make ends meet, like local food banks, and healthcare services during pregnancy and beyond. Their visits set the stage for a lifetime of healthy development. In fact, the program has seen significant improvement in pregnancy outcomes, including a reduction in preterm births and healthier pregnancies in New York state.

As the proud parent of two young daughters, I know how important it is that we support families through pregnancy and early childhood. And as a policymaker, I believe that New York has a responsibility to ensure that every family has access to the care they need.

Furthermore, every dollar invested in Nurse-Family Partnership yields $5.70 in return to government. Additional funds will guarantee the program can operate at its current level and potentially reach more vulnerable New Yorkers—something all of my colleagues should support. Investing in future generations isn't just the moral thing to do, it’s smart public policy.

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State Senator Brad Hoylman represents parts of Manhattan. On Twitter @bradhoylman.

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

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Crafting a State Budget to Enhance Nurse-Family Partnership and Support Vulnerable New York Families Mon, 25 Mar 2019 04:00:00 +0000
Coverage Denied No Longer: Expanding Eating Disorder Treatment in New York https://www.gothamgazette.com/130-opinion/8300-coverage-denied-no-longer-expanding-eating-disorder-treatment-in-new-york https://www.gothamgazette.com/130-opinion/8300-coverage-denied-no-longer-expanding-eating-disorder-treatment-in-new-york niley ro am

Assemblymember Nily Rozic, the author


“An eating disorder? I wish I had one of those — I could stand to lose a few pounds.”

Every year, clients, advocates, and professionals visit the New York State Capitol to meet with legislators. When discussing their eating disorder experiences and pushing for legislation to ensure proper insurance coverage, too often they are met with that response and others like it.

These kinds of insensitive quips reveal how little many people know about the danger and severity of eating disorders.

No one intentionally jokes about wanting a life-threatening illness. And the truth that too few people understand is that eating disorders are life-threatening mental illnesses. Not a choice; the disorder is a means of coping and can be attributed to a collection of biological, psychological, social, and genetic factors.

Anorexia and bulimia nervosa are the most common disorders but they are not the only ones. Others recognized by the American Psychiatric Association in the Diagnostic and Statistical Manual include Binge Eating Disorder, Avoidant Restrictive Food Intake Disorder, Other Specified Feeding or Eating Disorder, Pica, and Rumination Disorder. All of these disorders are serious and require medical attention.

People who struggle with an eating disorder are doing precisely that — they are struggling. Part of that pain and stigma comes from their symptoms not being understood as dangerous or serious. Often, symptoms are not taken seriously and they must convince not only their loved ones that they are sick but also insurance providers that approve treatment and coverage.

There remains a troubling gap in insurance coverage. Through Timothy’s Law, eating disorders are ensured coverage but only anorexia and bulimia nervosa are named. Insurance providers use this grey area as reasoning to deny coverage of the other eating disorders.

The story is common: Too many people are turned away due to lack of coverage. Too many people lose their chance of a full recovery because they didn’t meet strict weight requirements to classify as anorexic or didn’t throw up often enough each day to be considered bulimic. Not only is it hard to be approved for coverage, it’s even harder to find a comprehensive care center close to home — there are only three across New York.

It is time that law reflects the most current version of known eating disorders. New York can change the story. Earlier this year, I introduced the Eating Disorders Act (A1619/S3101) that would ensure coverage is provided to all people struggling with eating disorders by codifying all the currently recognized disorders.

The time for awareness is now. The time for change is now.

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New York State Assemblymember Nily Rozic represents parts of Queens. On Twitter @nily.

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

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Coverage Denied No Longer: Expanding Eating Disorder Treatment in New York Sun, 24 Feb 2019 05:00:00 +0000
Creating a Single-Payer Health Care System That Works for All New Yorkers https://www.gothamgazette.com/130-opinion/8273-creating-a-single-payer-health-care-system-that-works-for-all-new-yorkers https://www.gothamgazette.com/130-opinion/8273-creating-a-single-payer-health-care-system-that-works-for-all-new-yorkers health care is a right

(photo: Michael Appleton/Mayor's Office)


In November, New Yorkers voted for a united government in Albany with a resounding directive: fix our broken healthcare system. Those election results are directly linked to the financial strain New Yorkers are facing as they struggle to choose between paying for their medication, premiums, long-term care, and basic needs, such as food or housing.

The high costs of healthcare in our state have devastated hundreds of thousands of New York families by bankrupting those who are underinsured or forcing them to forgo treatment due to the financial burden it usually causes. According to the Campaign for New York Health, approximately 1 million New Yorkers still do not have health insurance; 20,000 New Yorkers have died due to their lack of coverage in the last ten years; and millions more would be bankrupt if faced with a medical emergency under their current health care plan.

The New York Health Act (NYHA) is the only option on the table that would provide comprehensive healthcare coverage to all New Yorkers. It would extend coverage to those that currently have no access while providing quality and comprehensive care to New Yorkers who have been traditionally underinsured.

This year, we are going one step further. We are introducing a version of the NYHA that aims to close an additional gap in our healthcare system by integrating long-term care coverage into the legislation. This shift in policy will address our state’s long-term care crisis and meet the healthcare needs of seniors, people with disabilities, as well as countless family caregivers, who are primarily women, for generations to come.

The benefits of including long-term care in the NYHA will not only be felt by those who will now be able to afford assisted living, nursing home care, or home health care, but it will also have a rippling effect on our economy. In the Northwest Bronx, where we both live and work, thousands of home health aides, care workers, and unpaid caregivers have to withstand low wages, few benefits, and not enough investment in training and retention services. The current system is financially debilitating to families, those who require care, and the workforce that is tasked with administering care, all of whom are predominantly women struggling to provide for their loved ones. For instance, nationally, Latinx family caregivers spend 44% of their annual income providing caregiving services, while African-American family caregivers spend 34% of their income.

A healthcare system that guarantees long-term care coverage would help ease the financial burden of thousands of families across our state while dramatically improving the system for those who receive and provide care. According to a study recently released by the RAND Corporation, even with the addition of long-term care, the NYHA would cost less than what is being spent under the current healthcare system. It is simply the most fiscally responsible step to take.

The majority of New Yorkers have spoken loud and clear. They are demanding a healthcare system that works for them and not for the most powerful corporations. This new version of the NYHA and our new leadership in Albany bring us one-step closer to making healthcare a right and not a privilege for all New Yorkers.

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State Senator Gustavo Rivera is the Senate sponsor of the New York Health Act. Karla Lawrence is a direct care worker specializing in gerontology and long-term care; she is a member of 1199 SEIU and the National Domestic Workers Alliance, and a leader in the New York Caring Majority.

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

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Creating a Single-Payer Health Care System That Works for All New Yorkers Mon, 11 Feb 2019 05:00:00 +0000
A Closer Look at ‘Vital Brooklyn,’ Cuomo’s Plan for ‘One of the Greatest Areas of Need in the Entire State’ https://www.gothamgazette.com/state/8144-a-closer-look-at-vital-brooklyn-cuomo-s-plan-for-one-of-the-greatest-areas-of-need-in-the-entire-state https://www.gothamgazette.com/state/8144-a-closer-look-at-vital-brooklyn-cuomo-s-plan-for-one-of-the-greatest-areas-of-need-in-the-entire-state billion vital bk

Cuomo & Vital Brooklyn (photo: Mike Groll/Governor's Office)


In March of 2017, Governor Andrew Cuomo unveiled what he described as a groundbreaking initiative to “bring health and wellness to one of the most disadvantaged parts of the state.” That place was Central Brooklyn, where roubling health indicators of all types plague residents, from diabetes rates to poverty levels to inadequate access to quality health care.

Cuomo said the plan, named Vital Brooklyn, came with $1.4 billion in state funds to pay for a long list of items across the borough, from playground renovations to job training to resiliency projects — all with the aim of fighting “entrenched pockets of poverty” in a comprehensive way, he said at the time.

“What is the area in this state that has the greatest social need? If you look at unemployment rates, food stamps, physical inactivity, number of murders, one of the greatest areas of need in the entire state is Central Brooklyn. And it’s not even close,” Cuomo said.

Since then, the governor has made nearly a dozen announcements related to Vital Brooklyn, six of them taking place from June to September in the lead-up to this year’s gubernatorial primary in which candidates for statewide offices heavily courted Central Brooklyn voters. At those events, Cuomo emphasized state funding for an oyster reef restoration project ($400,000), 22 community gardens ($3.1 million), fresh food programs ($1.8 million) and a new 407-acre state park to be named after iconic Brooklyn Congressional Rep. Shirley Chisholm — an announcement made eight days before the primary.

In total, the governor’s office says there are 8,800 projects funded under the Vital Brooklyn umbrella, funded by the $1.4 billion (a dollar amount unchanged since spring of 2017, according to the state budget office). However, it’s important to note that those touted by the governor — such as those gardens, farmers markets and state park — make up a small slice of the total funding. The much larger pieces of the pie fall into just two (albeit very big) categories: housing and health care.

In fact, nine out of every 10 dollars spent through Vital Brooklyn fall into the housing and health care columns: $578 million for subsidized housing in rapidly gentrifying areas (for example, a 2,400-unit project just announced in East New York) and $700 million, allocated in 2015, for a new health care system that aims to restructure and revive three of Brooklyn's struggling hospitals.

While some aspects of Vital Brooklyn are quickly taking shape, others will take months or years to materialize. Some officials, including several who have excitedly joined Cuomo at celebratory announcements, are lauding the investments, but critics of the project worry it’s not enough — and take issue with how Vital Brooklyn was rolled out, and how the money is divvied up.

Brooklyn Borough President Eric Adams said in a recent interview that his office wasn’t asked to give input on the project (the state instead took comments from advisory boards convened through the area’s elected state Assembly members) and he feels the funding is too small in scope and dollar amount, even if the governor’s frequent appearances make it appear otherwise.

“We have to have a re-examination of the state allocations and are we doing what’s right by Brooklyn,” he said, particularly in relation to the Bronx, which Adams feels has gotten significantly more financial help from the state; Bronx Borough President Ruben Diaz, Jr. is a close ally of the governor.

Earlier this year, he put it more bluntly earlier in an interview on the Max & Murphy podcast.

“You can’t keep brushing off and rolling out the same billion-dollar project,” he said in May.

When asked to respond to that claim — and whether or not the Vital Brooklyn announcements were made in relation to this year’s primary — Cuomo spokesperson Tyrone Stevens’ comment was brief: “Bogus.”

“This is simple: Our significant new investment in Brooklyn is based on a multi-pronged strategy to uplift communities that have been ignored for too long,” Stevens said in an email. “We’re proud of this effort, and we will not be shy about talking to local residents about the important work we’re doing to make their neighborhoods a better place to live.”

Big Spending: Health Care
Of Vital Brooklyn’s $1.4 billion, fully half is dedicated to a new health care system for Brooklyn. That funding comes from a $700 million capital grant made through the Health Care Facilities Transformation Program included in the 2015-2016 state budget, allocated two years before it was announced as part of Vital Brooklyn.

The funding will go to One Brooklyn Health System (OBHS), a newly formed operator that will combine the management of three previously separate Central Brooklyn hospitals — Kingsbrook Jewish Medical Center in East Flatbush, Interfaith Medical Center in Bedford-Stuyvesant, and Brookdale University Hospital Medical Center serving Brownsville and East New York — into one not-for-profit corporation.

LaRay Brown, previously the president and CEO of Interfaith, is heading up the new venture. She says she’s been pushing for years for the “incredibly impactful” amount of state funding that will support dozens of major projects throughout the new health care system.

Inside the buildings, the $700 million will pay for “boring things, but essential things,” Brown said, like replacing elevators, repairing HVAC systems and updating an outdated fire alarm system.

“I say they’re boring, but they’re critical to providing safe and comfortable patient care,” she said.

The medical centers will get major upgrades to their patient facilities, too. According to Request for Proposal documents from OBHS, Brookdale will build out a new 33-bed intensive care unit, renovate a 40-year-old operating room suite and upgrade all of the facility’s inpatient psychiatric units among others improvements. At Interfaith, the medical center’s emergency room will be upgraded and expanded, inpatient medical units will be renovated and new equipment such as MRI and x-ray machines will be installed. Major medical equipment will be replaced at Kingsbrook, as well, the documents show.

Overall, the idea for the restructuring and redesign is to merge services among the three hospitals in order to form a more streamlined organization — and hopefully, in the end, become more financially stable.

That’s according to state officials from the Public Health and Health Planning Council who approved the creation of OBHS in December of 2016. A report to the council at the time concluded that, operating separately, the hospitals require hundreds of millions of dollars in operating subsidies from the state every year “and are otherwise not financially sustainable.” (According to budget data from a PHHPC report, operating funds given to the three hospitals from the state totaled $169 million in 2015-16, then rose to $245 million in 2016-17 and $250 million in 2017-18.)

“They've come together … in an effort to try to restructure and become more efficient and reduce its dependence on specialty subsidies,” state health department official Charles Abel told the council before it approved the OBHS application.

To achieve those efficiencies, OBHS will reorganize how certain operations run within the three hospitals. For example, Brown said, Kingsbrook will no longer have inpatient medical-surgical beds and, though it will still have an emergency room, patients in need of ongoing acute or complex care will be transferred elsewhere, likely to Brookdale, which Brown said will become the system’s “center of excellence.”

LaRay Brown Brooklyn“As the inpatient acute care role diminishes at Kingsbrook, that role increases at Brookdale,” said Brown (pictured).

But Brown is careful to note the restructuring effort should not be considered a consolidation. Current assessments by OBHS show no material difference between the number of current beds and projected beds in the system, according to OBHS’ Dona Green. In the end, Brown says the quality and quantity of services will expand.

“Because these hospitals are coming together and because of the state’s commitment to invest in these hospitals, the Central Brooklyn community served by these hospitals will get more services, and not less,” Brown said.

That sentiment was echoed by Assemblymember Latrice Walker of District 55 in Brownsville, who has been waiting for years to see this funding come through for the hospital system, particularly at Brookdale, where many of her constituents go for care — and where her own brother died of gunshot wounds when he was 19, she said.

“I’m confident the services will be reinvigorated and enumerated. I don’t think we’re going to lose anything here,” she said. “Quite the contrary — we’re actually gaining.”

By the totality of the health facilities in the works under Vital Brooklyn, that appears to be the case. A chunk of the initiative’s healthcare funding — $210 million in all — is allocated to create 32 new ambulatory care facilities, or community health centers, under the OBHS umbrella. The goal there is to create more medical offices, outpatient surgical facilities and urgent care options with a more long-term goal of reducing unnecessary trips to emergency rooms.

“We need to start moving toward people having primary care physicians so that the emergency room isn’t their doctor office,” Walker said.

Cuomo put it this way when announcing some of the 32 ambulatory care locations in July of this year: “It's not just about a hospital where you go when you're very sick.”

“Prevent the illness in the first place,” he continued. “Have more community-based healthcare systems that are focused on wellness, and health, as opposed to waiting for a person to get sick, and then be in acute need.”

These new ambulatory centers are meant to handle a diverse slate of same-day health services, including diagnostic work, rehabilitation, or even major procedures such as hip replacements, according to Bill Hammond, the Director of Health Policy at the Empire Center think tank.

Ambulatory centers have a lot of benefits, he said. For the patient, it’s generally a more comfortable experience to avoid spending a night at a hospital, and there’s less risk of infection. For hospitals, increasing outpatient services makes a lot of financial sense.

“It’s less expensive,” he said. “Hospitals come with a lot of overhead.”

That idea is in line with a healthcare trend more generally to move patients out of traditional inpatient hospitals and toward ambulatory centers for all kinds of services, from preventative doctor visits all the way up to certain surgeries. The move from “reliance on hospital-based services” to more outpatient services “is a major policy shift,” said Brown of OBHS. And it takes place within the context of years of financial struggle, and at times closure, for many hospitals, particularly those serving low-income communities, as costs have continued to rise.

To combat that, the Vital Brooklyn plan puts a priority on the financial viability of health care projects funded under the plan. Included in guidelines for evaluating applicants to Vital Brooklyn, the state’s website says it will consider “the extent to which the proposed projects further the development of primary care and other outpatient services; the extent to which the proposed projects contribute to the long-term sustainability of the applicant or preservation of essential health services; and the extent to which the proposed projects involve partnerships with community-based health care providers,” among other criteria.

With the funding for the new 32 health facilities, the state hopes to roughly double the number of ambulatory care visits in Central Brooklyn, increasing capacity for 742,000 more visits every year, according to the governor’s office.

Exactly where all that new health care capacity will be built is unknown; all 32 locations have not yet been finalized. But Cuomo announced plans in July for renovations and the expansion of several existing health care centers, including the Bishop Walker Health Care Center in Prospect Heights, the Pierre Toussaint Health Center in Crown Heights and the Brownsville Multi-Service Center. In addition to those locations, several health care providers including the Bed-Stuy Family Health Center, Community Health Network, and ODA Primary Health Care Network have been chosen by the state to build new health centers in Brooklyn, providing both primary and specialty care.

Some of the 32 new ambulatory health centers will be built within new developments underwritten by the second largest piece of the Vital Brooklyn funding: affordable housing.

Housing on State and Hospital Sites
In all, the state will spend $578 million — or more than 40 percent of the total Vital Brooklyn package — on subsidized housing, with a goal to build 4,000 new units over several years.

The governor has repeatedly linked overall health goals of Vital Brooklyn to housing, particularly in rapidly gentrifying areas such as East New York where speculative buying and building, combined with a 2016 rezoning, has put pressure on poor residents.

“It starts in the home, having the right housing, having the right environment, having the right support. And that's where we're going to start. We need afford affordable housing because out people are being displaced. Gentrification is everywhere,” the governor said at a Vital Brooklyn event earlier this year.

How all those units will be constructed is still up in the air, but details on some of the development sites are beginning to emerge. Late last month, the state announced four winning bids to develop housing on land owned by the three OBHS hospitals or on state-controlled land, including one complex in East New York that’s set to deliver the bulk of the subsidized housing funded under Vital Brooklyn.

On Nov. 29, the state chose Westchester-based L+M Development Partners, Harlem-based construction group Apex Building, and two social services organizations — RiseBoro Community Partnership and Services for the Underserved — to bring a massive, 2,400-unit development to the site of the former Brooklyn Developmental Center, a home for developmentally delayed adults that closed in 2015. The three other chosen projects — two to be built on land owned by Interfaith hospital and another on land owned by Brookdale Hospital — will bring another 328 subsidized units to the borough.

At the same time the state announced those projects, it rolled out another set of request for proposals (RFPs) on eight state-controlled sites around the borough, including several hospital parking lots set to be replaced by new buildings. Proposals for five of the sites are due by February 28, 2019 and the three others are due by April 30, according to the RFP documents.

A majority of the affordable housing will be funded by $568 million allocated through the state’s Homes and Community Renewal agency, with a goal of creating 3,000 units. In addition, the governor said in August $15 million in federal tax credits have been allocated by the state for future housing developments on land controlled by the New York City Housing Authority (NYCHA). In his announcement on that initiative, the governor said he hopes to support the creation of 1,000 units of housing. However, no specific sites for those developments have been announced and will be “reviewed on a rolling basis by HCR as NYCHA makes properties available through its disposition process,” according to a press release.

The need for housing is the number one priority for Brooklyn residents, Borough President Adams said, and he gave credit to Vital Brooklyn for addressing the issue. He also acknowledged the plans would bring much-needed resources — including park space and options for healthy food — to the area. But he thinks it doesn’t go far enough.

“We’re dealing with historical inequities. People who were denied food access before — OK, let’s give them more farmer’s market,” he said. “Those things are great. But if we’re going to invest, let’s be visionaries in our investment.”

He would have liked to see more funding allocated to grandparent housing, which is set aside for grandparents who are the primary caregivers to young children, and even more resources given to the hospital network, he said.

More criticism of the governor’s Vital Brooklyn plan came from the East New York district where the large Brooklyn Developmental Center site is set to be rebuilt under the initiative. The complex will have 100 percent subsidized apartments set aside for a combination of formerly homeless New Yorkers, households earning less than 50 percent of the area median income (AMI) — a federal guideline for determining the cost of affordable housing — and the rest for households earning less than 80 percent of the AMI. Currently for a family of three, 80 percent of AMI equals $62,150 a year.

That may sound like a win in a low-income area like East New York. But with the median household income of East New York at $34,512 per year (according to data from the city’s Housing Preservation and Development agency), the development doesn’t satisfy one of the neighborhood’s longtime leaders.

Assemblymember Charles Barron says his district needs even more low-cost units because only a fraction of its residents are in the 80-percent income range. And, overall, he thinks Vital Brooklyn doesn’t go far enough in a state with a $168 billion budget, and billions more in capital spending.

“You see $600, $700 million and think it’s wonderful and a lot of money,” he said. “That is peanuts.”

In particular, he wants to see more support for the healthcare system.

“It’s simply not enough money for three hospitals,” he said.

In response, Cuomo spokesperson Stevens said in a statement that the Vital Brooklyn investment is “delivering substantial resources and coordinated services to support neighborhoods that have long been neglected.”

“We believe this massive commitment is something to celebrate, not politicize with cheap attacks that are untethered to reality,” he said.

Looking for Results
The governor has often said, for him, Vital Brooklyn is a project that brings his own career full circle, from when he was working on housing in East New York as a young man, to now. In speaking about it, he says he has wanted to help turn Brooklyn around for years.

Cuomo Brooklyn“I never lost the inspiration, and the hope, and the optimism, of what you can do when you do it right,” he said in a speech on the project in April, nearly half-way through his eighth year in office. “For me, this is something special. This is something that is long overdue. It's an investment in people who desperately have needed help, and have been ignored for too long.”

But it may take quite a while to see all of the Vital Brooklyn projects come to life. Some of the smaller pieces of the puzzle, like a pilot program for youth-run food markets and construction on new playgrounds, are beginning this year and next, the governor has said. For the larger, more complicated parts, however, it could take years; for example, some of the first units of housing are estimated to come online in 2021 and others — like the East New York project — is not slated for completion until 2026, the governor’s office said.

The health center restructuring, too, will takes years to finish. When it’s finally complete, it remains to be seen whether the largest part of Vital Brooklyn — the $700 million in health care capital funding — will make a substantive difference to financially shore up the three Central Brooklyn hospitals.

Hammond of the Empire Center said if the plan is a good one that reconfigures the facilities’ operations significantly, it “could put them in a different position to succeed,” though he was hesitant to say whether he believes the restructuring will prove successful long-term.

But the health funding is not peanuts, as Barron said, nor is it a groundbreaking amount, as one may think from the governor’s announcements. The reality is somewhere in the middle.

“The state routinely spends billions and billions of dollars on health care all over the state,” both in discretionary grants and capital allocations, Hammond said. “On any given day, you could go to a different community and announce a very large-sounding dollar amount…and it would be absolutely routine.”

However, on a per-resident basis, Brooklyn is getting more than the average — while falling far below the state’s most generous allocations. Hammond found the state spent $190 per resident in capital health care spending in the last five years in New York State. In Kings County, the per-resident breakdown equaled $264 per resident, which is “significantly more than the state average,” he said. But that figure is dwarfed by another capital grant also given in 2015 to a hospital system in Oneida County, where spending totaled $1,297 per resident.

For all those funding plans, however, the dollars have not yet started to flow, according to Brown of OBHS. Before that happens, several bureaucratic steps must take place, including complying with transparency regulations approved by the state comptroller’s office. She hopes that will be complete in the new year.

“Everyone is endeavouring to get [approval]…by early 2019,” she said, while emphasizing it’s hard to make an exact estimate, as she and her team are figuring out the complexities of the project as they go along.

“We’re all entering a new journey here,” she said.

***
by Rachel Holliday Smith for Gotham Gazette
@rachelholliday
@GothamGazette

All photos via the Governor's Office on flickr.

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A Closer Look at ‘Vital Brooklyn,’ Cuomo’s Plan for ‘One of the Greatest Areas of Need in the Entire State’ Thu, 13 Dec 2018 05:00:00 +0000