Gotham Gazette https://www.gothamgazette.com/component/tags/tag/1348 Sat, 19 Oct 2019 15:01:31 +0000 Joomla! - Open Source Content Management en-gb webmaster@gothamgazette.com (Webmaster) PBMs Advocate for New York Consumers to Reduce Prescription Drug Costs https://www.gothamgazette.com/130-opinion/8840-pbms-new-york-prescription-drug-costs https://www.gothamgazette.com/130-opinion/8840-pbms-new-york-prescription-drug-costs rural hel pro

(photo: @albertarpap)


As the debate over prescription drug costs continues, it’s important to understand the role pharmacy benefit managers (PBMs) play in our health care system. Simply put, PBMs are the companies that are driving down prescription drug costs for New Yorkers and consumers nationwide. 

PBMs are widely recognized for reducing prescription drug costs, but PBMs should also be recognized for improving clinical outcomes for patients. For example, PBMs perform a sophisticated evaluation of clinical evidence to construct prescription drug formularies that best fit the needs of patients. These prescription drug formularies lead to improved adherence for consumers and better health outcomes overall.

From a pure cost perspective, without PBMs consumers would pay on average $941 more per year per person, according to a 2016 Visante report. In addition, the report showed that over a 10-year period, PBMs will save New York’s consumers and health care programs nearly $40 billion.

PBMs achieve these savings by negotiating directly with drug manufacturers, who alone set and raise prices. The savings achieved by PBMs are used to lower premiums for all consumers in a health plan, or to reduce costs that consumers pay at the pharmacy counter.

Furthermore, any charge that PBMs are opposed to transparency is inaccurate. The fact is PBMs support transparency that leads to better health care outcomes. PBMs provide real-time benefit tools, so patients and their doctors understand which drugs are available and most affordable. In addition, PBMs provide information to clients on contracting terms, including how PBMs are paid for their services.

While it’s clear PBMs are reducing prescription drug costs, we understand that for too many people the costs are simply too high. For that reason, we encourage Governor Cuomo to look closely at whether recently passed legislation (S.6531) will lower health care costs for New Yorkers. In its current form, the bill eliminates many of the cost-saving tools PBMs employ to help keep consumer costs down and improve care.

The legislation puts consumer safety at risk by removing specialty pharmacy accreditation standards, and limits access to cost-effective drugs in favor of more expensive prescriptions. An analysis by Visante shows the bill would lead to $28 billion in additional prescription drug spending in New York over the next 10 years.

PBMs’ core mission is to advocate for consumers in the fight to reduce prescription drug costs. Increasing competition in the market and expanding PBMs’ cost-reducing tools is the best way to address the problem of high drug costs. Where there is sufficient competition, PBMs have a proven track record of success of lowering drug prices.

We’re committed to working with Governor Cuomo and members of the Legislature to address the prescription drug affordability problem where it exists and bring down drug costs and increase access for all New Yorkers.

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JC Scott is President and CEO of the Pharmaceutical Care Management Association. On Twitter @pcmanet.

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

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PBMs Advocate for New York Consumers to Reduce Prescription Drug Costs Thu, 17 Oct 2019 04:00:00 +0000
Recognizing and Responding to Addiction: What to Know for National Recovery Month and Beyond https://www.gothamgazette.com/130-opinion/8819-recognizing-and-responding-to-addiction-what-to-know-in-national-recovery-month https://www.gothamgazette.com/130-opinion/8819-recognizing-and-responding-to-addiction-what-to-know-in-national-recovery-month ceo amfoster graduation

Ann-Marie K. Foster, the author, addresses program participants (photo: Phoenix Houses)


It’s often said, but worth repeating during National Recovery Month: addiction does not discriminate. Drugs can hook anyone, anytime, anywhere—and it’s more of a problem now than it’s ever been. In New York, for instance, there were more opioid-related overdose deaths in 2017 than there were in the first six years of the 2000s combined.

Today, the types of drugs available are also terrifyingly effective at creating addicts. Fentanyl and other synthetic drugs are perhaps the worst among them. They are 50-times stronger than heroin and 100-times stronger than morphine. They are also cheap and fairly easy to find in New York. And, they flooded in so fast that we are only now fully realizing the seriousness of this public health issue.

There are some obvious actions government can take to turn this crisis around. Continuing to fund state treatment programs and ensuring life-saving medicines are available statewide should be essential parts of any plan. Reducing access to dangerous illegal drugs and engaging in serious education campaigns to prevent use in the first place is also necessary.

But even all of that will never fully free us from the eternal epidemic of addiction. Addiction is wickedly persistent. It has followed us through the centuries and always finds a way to come back in one form or another. But recovery is possible.

National Recovery Month is an effort to increase awareness and understanding of substance use disorders. Everyone should be armed with the knowledge necessary to identify the warning signs of addiction in a loved one because anyone could be an addict. And it could save their life.

The main signs of addiction are: change in baseline behavior from normal; spending more time alone; irritability; mood swings; change in sleeping habits; change in diet and weight gain or loss; eyes dilated or pin-pointed.

As the largest provider of addiction treatment services in New York, we also see other common trends amongst our patients. The majority of the patients we treat have experienced trauma or have other co-existing health or mental conditions. Many are also dealing with deep guilt, regret, and self-loathing about their behavior and the consequences of their actions, which can manifest itself in various, often destructive, ways.

We believe in treating the whole person to promote the message that recovery in all forms is possible. So we provide medical and dental care, wellness programs, community support, and even recreational activities as part of our continuum of care in addition to evidence-based treatment. 

But, ultimately, overcoming addiction is often about the people around the patient. That is why it is so essential that New Yorkers of all backgrounds have the knowledge to identify addiction, the strength to talk to their loved one about it, and the compassion to support them through recovery.

In this time of crisis, don’t be afraid to talk to a loved one about their possible addiction. And don’t be afraid to ask for help. Addiction is a scary place to be, but there are always paths out. With care and the right tools, addiction doesn’t have to win. First though we have to have the will to fight it.

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Ann-Marie K. Foster is the CEO & President of Phoenix Houses of New York & Long Island. On Twitter @PhoenixHousesNY.

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

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Recognizing and Responding to Addiction: What to Know for National Recovery Month and Beyond Thu, 26 Sep 2019 04:00:00 +0000
Drug Overdose Deaths Drop for First Time in 8 Years, City Reports https://www.gothamgazette.com/state/8759-drug-opioid-overdose-deaths-dropped-first-time-8-years https://www.gothamgazette.com/state/8759-drug-opioid-overdose-deaths-dropped-first-time-8-years mayor bdb first lady chirlane

(photo: Ed Reed/Mayoral Photography Office)


The New York City Health Department announced on Monday that the city’s efforts to curb the ongoing opioid crisis are showing progress, with 38 fewer drug overdose deaths in 2018 compared to the previous year. It is the first year over year drop in eight years, the city said.

There were 1,444 drug overdose deaths last year, down 3% from 1,482 in 2017, according to Health Department data. And the first three months of this year saw 331 overdose deaths, down 45 from the same time last year, and two fewer than the last three months of 2018.

“The decrease in drug overdose deaths is promising, but far too many New Yorkers are still dying,” Health Commissioner Dr. Oxiris Barbot said in a statement. “We are closely monitoring the trends of the epidemic as they evolve and responding to upticks in emergency department visits and deaths with targeted strategies and community engagement. We remain firmly committed to expanding life-saving services and caring for New Yorkers who use drugs.”

The announcement from the city did not include comment from Mayor Bill de Blasio, though First Lady Chirlane McCray was quoted saying, in part, “There is no one solution to the pain and tragic consequences of the opioid epidemic and New York City’s multi-faceted response reflects that.”

Although there was a reduction in overdose deaths citywide, disparities exist across boroughs. Deaths rose in the Bronx, Manhattan, and Staten Island but dropped in Brooklyn and Queens. Among New Yorkers between the ages of 55 and 84, overdose deaths increased for the fourth year in a row. The rates of overdose increased by 5% for Latinos, and decreased 13% for black New Yorkers and 5% for white New Yorkers.

In 60% of all drug overdose deaths in 2018, the deadly synthetic opioid fentanyl was detected.

The city has been undertaking a concerted effort for the last two years to decrease accidental overdose deaths. In March 2017, de Blasio and McCray launched HealingNYC, which has since invested $60 million in overdose treatment, prevention, and outreach measures, according to Monday’s announcement.

Since then, the city has distributed 230,000 kits of naloxone, a drug that can counter an overdose, for free through programs across the city. The Health Department also conducts free trainings in administering naloxone and has launched nonfatal overdose intervention programs in 11 city hospital emergency departments, and will expand it to 15 private hospitals by June 2020. 

The city has undertaken a broad outreach effort as well, working with 374 community-based venues, 88 substance use treatment programs, 140 pharmacies, and nine shelters in the Bronx and northern Manhattan.

The Health Department has trained 1,800 individuals to prescribe buprenorphine, which can reduce opioid dependency, and has funded 14 syringe service programs that helped 18,274 last year. Prior Health Commissioner Dr. Mary Bassett has identified expanded use of buprenorphine as one essential key to bringing down opioid addiction and overdoses. The city also wants to open safe injection sites, but has yet to receive state approval to do so.

Also in her Monday statement, McCray said, “Individuals struggling with substance use disorders and families caught up in this scourge are our responsibility, and we will continue innovating to make sure communities have access to the lifesaving resources, services, and treatment they need.”

The city’s five district attorneys – Darcel Clark of the Bronx, Eric Gonzalez of Brooklyn, Michael McMahon of Staten Island, Cyrus Vance Jr. of Manhattan, and acting DA John Ryan of Queens – welcomed Monday’s news and called for greater action from the state to target the import of fentanyl and its variants, which remain largely unregulated. They called on the state Legislature to designate all those variants as Schedule I controlled substances and for increased funding for public awareness campaigns and police labs, coroners, and medical examiners.

“Fentanyl analogs serve no legitimate medical purpose and are produced by clandestine laboratories outside of the U.S. New types of fentanyl analogs are continually emerging as international labs slightly tweak chemical formulations. As long as fentanyl analogs in all their variants remain unregulated in New York State, they will proliferate unchecked and more lives will be lost,” the DAs said in a joint statement.

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by Samar Khurshid, senior reporter, Gotham Gazette
     

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Drug Overdose Deaths Drop for First Time in 8 Years, City Reports Mon, 26 Aug 2019 04:00:00 +0000
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

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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.

***
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.

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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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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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Crafting a State Budget to Enhance Nurse-Family Partnership and Support Vulnerable New York Families Mon, 25 Mar 2019 04:00:00 +0000