Gotham Gazette https://www.gothamgazette.com/component/tags/tag/1348 Thu, 18 Jul 2019 13:22:57 +0000 Joomla! - Open Source Content Management en-gb webmaster@gothamgazette.com (Webmaster) 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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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.

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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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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.

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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.

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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
Max & Murphy Podcast: Will Single-Payer Health Care Come to New York? https://www.gothamgazette.com/state/8139-max-murphy-podcast-will-single-payer-health-care-come-to-new-york https://www.gothamgazette.com/state/8139-max-murphy-podcast-will-single-payer-health-care-come-to-new-york mxm logo

Ben Max, left, of Gotham Gazette, and Jarrett Murphy, right, of City Limits


December 12, 2018 - Max & Murphy Podcast: Will Single-Payer Health Care Come to New York?

wbai dec12 400One of the most hotly-debated issues in state government is whether New York should or will move ahead with the New York Health Act, which would institute single-payer health care. State Senator Gustavo Rivera, a Bronx Democrat, is the Senate sponsor of the bill and will soon be part of the Democratic majority in the Senate, as well as the health committee chair. He joined the show to discuss the broader priorities of the Senate Democrats and the prospects for the New York Health Act when his party has full control of state government come January.

Then, Bill Hammond, director of health policy at the Empire Center, joined the show to dissect the New York Health Act and a variety of ways in which he thinks it is problematic legislation, as well as the political terrain ahead for it.

Listen to the conversation and let us know what you think -- we're on Twitter @TweetBenMax and @JarrettMurphy. You can listen to the show through the embedded audio below or download the episode wherever you get your podcasts, under "Max & Murphy," and listen to Max & Murphy live on Wednesdays at 5 p.m. on WBAI radio, 99.5FM or wbai.org

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by Ben Max, Gotham Gazette
     

Read more by this writer.

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Max & Murphy Podcast: Will Single-Payer Health Care Come to New York? Wed, 12 Dec 2018 05:00:00 +0000
With Full Democratic Control, Sponsors of New York Single-Payer Health Care Hopeful About 2019 https://www.gothamgazette.com/state/8066-with-full-democratic-control-sponsors-of-new-york-single-payer-health-care-hopeful-about-2019 https://www.gothamgazette.com/state/8066-with-full-democratic-control-sponsors-of-new-york-single-payer-health-care-hopeful-about-2019 Cuomo health care

Gov. Cuomo (photo: Kevin Coughlin/Governor's Office)


This is part of AGENDA 2019, a joint Gotham Gazette-City Limits project
Find the rest of the series here

Though Governor Andrew Cuomo has not expressed support for instituting a single-payer health care system in New York, his fellow Democrats campaigned on the issue as they flipped control of the state Senate, landing all of state government into Democratic hands and providing a significant boost of optimism to the lead sponsors of the New York Health Act, which would create a government-administered single-payer health care system.

The bill has passed the Democrat-dominated state Assembly several times and all the members of Senate Democratic conference signed on as co-sponsors at the end of last legislative session in a unified show of support for the program heading into the election season.

Cuomo has said he supports a Medicare for all-type system at the federal level, but cast doubts on the cost and complexity of doing it in New York, and since their resounding wins on Election Day, the incoming leaders of the Democratic Senate majority have indicated that the massive undertaking of single-payer is not at the top of the agenda.

Still, with Democratic control of the Senate and the Assembly by wide margins, single-payer healthcare could be passed as early as the 2019 session, according to Assemblymember Richard Gottfried, chair of the Assembly Health Committee and lead sponsor of the New York Health Act.

“It was clear in the country and New York that healthcare was the number one issue on voters’ minds,” Gottfried said, before pointing to his legislation. “A solid majority of the new state Senate has either been a cosigner, voted for it in the Assembly, or campaigned on it. So I think we’re on track to get it passed in the Assembly and state Senate.”

The New York Health Act would replace health insurance companies with New York state government as the payer of healthcare costs for all New Yorkers. It has been passed in the Assembly four years running but has yet to be voted on in the Senate, where Republicans have held control. All of the other 30 Democratic senators joined lead sponsor Senator Gustavo Rivera of the Bronx to co-sponsor the legislation, though the Senate Democratic conference is seeing significant turnover due to primary wins by insurgent challengers. But, those challengers have in general been even more vocally supportive of single-payer health care than their more moderate predecessors. These facts give Gottfried confidence that the New York Health Act will pass during the 2019 session, which begins in January.

But the bill still faces an uphill battle, in part because of the massive changes it would institute, and the fact that though it might reduce overall individual and business healthcare costs after implementation, for the state to run the system it would require raising taxes significantly, something many Democrats have promised not to do and Cuomo is vehemently opposed to. It would also drastically impact the state’s private and public hospitals, the health insurance industry, and more. Some of the changes would of course be beneficial to New Yorkers, but the undertaking is complex and the New York Health Act as currently written leaves a lot of detail undetermined, including funding.

The governor has repeatedly opposed single-payer healthcare at the state level, suggesting that it would be more rational and financially feasible if administered by the federal government. Cuomo questioned in the past how a single-payer system could be put in place without doubling the tax burden, and cited California’s and Vermont’s debates over single-payer — which both ended when supporters were not able to answer one question: where would the funding come from? — as paragons of the impracticality of state-level single-payer.

Gottfried, a Manhattan Democrat, is confident that with his fellow lead sponsor Senator Rivera, who is likely to be the Senate health committee chair come January, and other legislators, he will be able to sway Cuomo to support the legislation.

“He’s obviously not on board yet, but he and his staff are very open to working with the Legislature on the issue,” Gottfried said. “I’m convinced we can satisfy their concerns.”

And after a recent study by RAND Corporation concluded that the New York Health Act would result in a reduction of administrative costs, provide all New Yorkers with healthcare, and reduce healthcare costs for most, Gottfried says the financing of the bill will not be a problem.

“New Yorkers are all going to have to think about what they will do with the hundreds of thousands of dollars that will end up in their pockets, and that’s a nice problem to have,” Gottfried said.

The study has a caveat, however, stating in its conclusion that “the estimated effects depend heavily on the assumptions about provider payments, administrative costs and drug prices.” Politico highlighted these assumptions as well as the likely tax increases that have largely been brushed aside by Democrats supporting the legislation. Wealthy people leaving the state, companies restructuring, the cost of hospital expenses rising at a faster rate or the Trump administration not issuing a federal waiver to redirect all healthcare-related funds to the new state entity are all possible events that could result in RAND’s conclusion falling apart.

For it to work, while health care costs drop, taxes would undoubtedly increase significantly for many New Yorkers. As cited by Politico, “a household reporting $150,000 in income would see its state tax rate increase from 6.45 percent in 2017 to 18.3 percent,” under one model scenario. Additionally, those who receive Medicaid or fall under the state’s Essential Plan, which subsidizes health insurance for low-income New Yorkers, have less to gain from the expansion. According to RAND, though, 1.2 million New Yorkers would gain health coverage.

It is likely that funds for New York single-payer health care would partially come from a new payroll tax, which RAND projects to fall largely on employers. However, RAND suggests the health act payroll tax would cost less for businesses already contributing toward employee health insurance and the Medicare payroll tax, estimating decreases in employer costs fairly quickly.

Concerns about businesses and high-income individuals leaving the state persist, with a tax atmosphere in New York that many, including Cuomo, acknowledge is already burdensome and became more so for many taxpayers, especially top earners, under the new federal tax code.

Senator Rivera, aware that cost is the primary argument against single-payer health care, repeatedly emphasized the need to work towards a version of the bill that would reduce the financial strain.

“I will continue working diligently with Assembly Member Gottfried, Senate Majority Leader Stewart-Cousins and the Senate Democratic Conference to make the New York Health Act a bill that is not only fiscally responsible, but that provides comprehensive coverage to all New Yorkers,” Rivera wrote in an email to Gotham Gazette.

The bill and its potential ramifications have been studied closely by Bill Hammond, director of health policy at The Empire Center, a think tank. "Regardless of which party controls the state Senate, the New York Health Act remains a wildly unrealistic idea," Hammond said by email. "It means putting New York's entire health-care system — representing one-fifth of the economy — in the hands of the same state government that struggles to run the subways. It requires massive, draconian tax hikes, enough to roughly triple total state revenues."

"Plus, a true single-payer plan would need federal waivers that the Trump administration has vowed to block," Hammond continued, also noting a political angle -- that if Democrats spend great sums of money and political capital on a health care overhaul of this magnitude, what will they ignore, like fighting climate change or improving mass transit.

"It was easy to cast a symbolic yes vote for a single-payer bill that had no chance of passing," Hammond said. "Now that that it might actually happen, supporters are going to be forced to confront the practical realities. Then, hopefully, they’ll focus on helping the 6% of New Yorkers who still lack insurance, rather than disrupting coverage for those who already have it."

agenda19v2 aRivera acknowledged that moving to single-payer would not satisfy everyone, especially those who benefit from the current system, and that there are negotiations to come that will likely adjust the bill to make it more palatable to holdouts.

“The biggest challenge will be to reach a consensus among stakeholders that the NY Health Act is feasible [and] fiscally responsible,” Rivera wrote.

Citing “healthcare practitioners, prescription drug companies, healthcare providers, employers, unions and New Yorkers,” as the various groups involved, Rivera also mentioned courting Cuomo as an important step to take in the coming legislative session.

“Our main priority for the next legislative session is to continue shaping the bill so that it is feasible, affordable, that the Governor is willing to sign, and that primarily, provides quality healthcare for everybody,” Rivera wrote. “During the next legislative session, we will focus on making the necessary amendments to the bill so that it truly reflects the different healthcare needs affecting all New Yorkers.”

For now, it is very difficult to imagine Cuomo coming on board, especially given the pains he’s taken to keep state spending increases at around 2 percent per year and to lower taxes. Asked about single-payer health care during a Thursday appearance on The Capitol Pressroom with host Susan Arbetter, Cuomo painted it as unrealistic given budget constraints. He said Democrats are generally in agreement on the concept, but legislators will have to deal with reality in working with him on a state budget next year, while he also said he thinks it's much more workable on the federal level. “Single-payer health plan, for example," Cuomo said, "conceptually I think it’s the right way to go in. I believe it’s more feasible financially on the national level. No state has been able to finance the transition costs.”

A variety of factors, including the challenge of getting Cuomo’s support and not wanting to come into power quickly pursuing something as revolutionary as single-payer health care, may be why the likely next Senate majority leader, Andrea Stewart-Cousins, and her likely deputy, Senator Michael Gianaris, have not highlighted it as top priorities for the coming session.

Assemblymember Gottfried noted that state Senators’ public approval of the bill gives him no reason not to “take them at their word,” and said he expects the legislation to move through the Legislature. He knows that private health insurers are certain to vehemently oppose the continued push.

“The insurance industry will be fiercely lobbying against the bill and they have a lot of money, going up against their lobbying will take a lot of work,” Gottfried said. “but I’m convinced with so many senators on the record in support of the bill, we will prevail.”

This is part of AGENDA 2019, a joint Gotham Gazette-City Limits project
Find the rest of the series here

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by Victor Porcelli, Gotham Gazette

Read more by this writer.

This article has been updated with Cuomo's comments from 11/15/18 on The Capitol Pressroom.

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With Full Democratic Control, Sponsors of New York Single-Payer Health Care Hopeful About 2019 Tue, 13 Nov 2018 05:00:00 +0000