Gotham Gazette https://www.gothamgazette.com/component/tags/tag/1348 Tue, 02 Mar 2021 03:58:05 +0000 Joomla! - Open Source Content Management en-gb webmaster@gothamgazette.com (Webmaster) Democratic Mayoral Candidates Discuss Addressing City’s Health Care Gaps After Covid https://www.gothamgazette.com/city/10109-2021-democratic-mayoral-candidates-nyc-health-care-gaps-covid https://www.gothamgazette.com/city/10109-2021-democratic-mayoral-candidates-nyc-health-care-gaps-covid 5x5mashup 1

Top (l-r): Carlos Menchaca, Dianne Morales, Scott Stringer, Loree Sutton, Maya Wiley,
Bottom (l-r): Eric Adams, Shaun Donovan, Kathryn Garcia, Ray McGuire, Andrew Yang


Eleven Democratic candidates for mayor appeared at a virtual forum on Tuesday focused on how they would shape health policy to be more equitable in New York City, especially amidst and in the wake of the coronavirus pandemic, which has brought the city’s health care infrastructure under considerable strain and has had a starkly unequal racial impact. The pandemic has thrust the issues of health-care infrastructure and equity to the forefront of the wide-open race to lead the city, which will be decided in the June primary and fall general election.

Black and Latino New Yorkers have been hospitalized and/or died from COVID-19 at rates twice that of white and Asian New Yorkers, according to city data, even though disparity in case rates is not nearly that high. The same goes for people living in “very high poverty” ZIP codes, who have been hospitalized or died at rates twice that of “low poverty” areas but have only marginally higher case rates. And the so-called outer boroughs all have higher rates of cases, hospitalizations, and deaths than Manhattan, which is home to several of the city’s wealthiest neighborhoods. Nearly 22,000 New York City residents are confirmed to have died from COVID-19, with an additional 5,000 having likely died from the disease.

The data shows the highly disparate health outcomes between the haves and the have-nots in the city, a fact which, as noted by the mayoral forum’s hosts, was true before the pandemic but has been exposed and exacerbated by it.

The forum was hosted by the Community Service Society, City & State, Community Voices Heard, and Make The Road New York, and was moderated by Sheryl Huggins Salomon of the NYU McSilver Institute for Poverty Policy and Research. Like some of the other forums, the large number of candidates led organizers to split the event in half, with five candidates appearing in the first session and six in the second.

Participating in the first session were City Council Member Carlos Menchaca, former nonprofit executive Dianne Morales, City Comptroller Scott Stringer, former city veterans’ services commissioner Loree Sutton, and Maya Wiley, a civil rights attorney and former counsel to Mayor de Blasio. The second session included Brooklyn Borough President Eric Adams, former federal housing secretary Shaun Donovan, former city sanitation commissioner Kathryn Garcia, former Citigroup executive Ray McGuire, and Andrew Yang, a former presidential candidate and entrepreneur. (Military veteran and former nonprofit executive Zach Iscol was scheduled to participate, but he has just announced he is dropping out of the race to run for city comptroller.)

The first hour of the forum occurred simultaneously with another mayoral candidate forum, hosted by the Council of School Supervisors and Administrators, the union representing administrative staff in city schools, and moderated by CUNY professor David Bloomfield. That forum focused on education. The two events are indicative of the pace and quantity of digital appearances that candidates are now making with under five months until the all-important Democratic primary.

A recurring theme throughout the health care forum was the lack of trust that marginalized communities have in the health care system, for a variety of reasons.

"Our communities lack trust in the institutions that are supposed to be charged with caring for us,” said Morales, who is Afro-Latina. She and others noted that the city, during the pandemic, had failed to engage communities in meaningful ways, such as through “credible messengers” who are culturally competent and speak the language of those they’re engaging with, and said that those messengers are crucial in distributing the vaccine in marginalized communities.

Menchaca noted in particular that language access had posed a challenge in the city’s outreach efforts to combat the spread of the virus, and that the city had failed in efforts to engage in languages other than English.

“One of the things that we need to do is to ensure that all the languages are included as we bring good information, solid information, dispelling all the myths,” Menchaca said. He said that whenever he makes any public statements, he would assemble a team to translate it before the statement is released so there is no information lag for non-English speaking communities. “That one thing can be transformative.”

Adams also stressed the importance of engaging non-English speaking communities.

“We continue to run this city like it’s an English-speaking city,” Adams said. “Forty percent of Brooklynites speak a language other than English at home. We need to reach out to those credible messengers, similar to what we saw during the Census drive.” Menchaca had made a similar point about learning lessons from the 2020 Census drive for pandemic-era outreach.

Adams also said that the racial disparity in vaccinations should be made transparent by having every vaccination recorded and put in a city database so the data can be analyzed and released.

“Right now today, after repeated calls, we have yet to know who is actually vaccinated and the ethnicities,” Adams said. “That is wrong.”

Adams had announced on Monday that he would file a Freedom of Information Law request for the data. Mayor Bill de Blasio said at his daily briefing Wednesday that the city is planning to release the data in the coming days.

Several of the candidates pitched their experience as well as relationships with state and federal leaders as key to their success in various initiatives, such as getting adequate funding for the city’s public hospital system, New York City Health + Hospitals, which was deeply strained during the first wave of the pandemic last spring.

“The city is the majority of the economy of the state, and the fact that the governor and the mayor have not been on the same page has been very, very negative for the folks who live right here in the city,” Yang said. “We’ve all seen it, we’ve all felt it. I aim to be a friend and ally and sidekick, if necessary, to the governor to make this case to the feds.” Yang noted that he is “friends with his brother from CNN,” referring to Chris Cuomo, and said he is “very easy to get along with” and willing to give the governor all the credit. He also noted his relationships with federal officials made during his presidential run.

Donovan also frequently pitched his connections to federal officials from his years serving in the Obama administration, where he was Housing and Urban Development secretary and also budget director.

“With all due respect to their rolodexes, there’s no one [else] in this race who actually has worked side-by-side with these folks,” Donovan said.

Beyond using connections to gain more funding, the candidates presented other ideas to stabilize the finances of Health + Hospitals, the city’s sprawling public health system that includes 11 full hospitals and many other facilities. Donovan argued that the city should use its bargaining power to force private hospitals to share in the burden of caring for the city’s destitute, rather than forcing them into H+H and thus creating its financial instability.

Wiley made a similar argument, noting that the city’s status as the insurer of hundreds of thousands of people with the MetroPlus system and the large tax breaks that private hospitals receive mean the city has large bargaining power, not only to force private hospitals to share the burdens of caring for the most vulnerable, but also to prevent price gouging and enforce price transparency.

“There is price gouging, but we can make that transparent, we can make it public, we can call attention to it, and we can use collective bargaining power also to create more accountability in the system,” Wiley said.

Throughout the event, candidates pinned many of the issues of health inequity brought up by Huggins Salomon, such as the disparate impact of COVID-19 on low-income communities and communities of color and the financial difficulties of H+H, on the fact that low-income people often lack access to primary care, allowing health issues to stew undetected until requiring a more expensive emergency room visit, or, in the case of the pandemic, making death from the disease more likely.

“One of the things we saw in covid is that there were lots of underlying conditions that made you so much more vulnerable,” Garcia said. “If they are not managed, you put your life at risk. It also is more effective than them ending up in the emergency room.”

Stringer made a similar point.

“An ounce of prevention is worth a pound of cure,” Stringer said. “Obviously prevention is the key.”

Stringer pointed to the need for greater cooperation among agencies, and proposed merging the city’s health department and Health + Hospitals in order to prevent health disparities from manifesting in unequal outcomes in the inevitable next pandemic.

“We’ve got to get the Department of Health back in the game,” Stringer said. “We’ve got to merge H+H and DOHMH so that they are proactively looking at ways to prevent the next virus or the next health-care crisis. And that means we also have to not just invest in hospital or local clinic infrastructure, but we have to invest in personnel. The nurses, the doctors, how are we going to grow that health care in the communities.”

McGuire made a similar pitch, calling for incentives to build primary care clinics in poorly served outer borough neighborhoods. “I would incentivize the development of primary care facilities within the boroughs,” he said, “so that the people in the boroughs have a primary care physician.” He also supported increasing ER capacity in low-income neighborhoods by expanding H+H Express Care Centers, as a means of alleviating the shortage of beds seen during the pandemic at public hospitals serving marginalized communities.

Every candidate except for Sutton committed to creating a commissioner-level position, or even higher, in city government solely devoted to ensuring equity across the work of city agencies. Sutton said that she did not want to create an extra layer of bureaucracy, but that she herself would be the top advocate for equity in the administration.

“That would be one of my core values that I would lay out in a values manifesto, and would share with city government,” Sutton said. “And make sure that all of city government understands that these are the values of a Sutton administration.”

Donovan said he’d go further than a commissioner-level position, and instead create a position reporting directly to the mayor at City Hall that is responsible for creating equity across city agencies, rather than reporting to a deputy mayor. Yang said that he would go a “step further.”

“I think we need to amend the city charter to include addressing the racial health gap as a central mission of all of our agencies, especially the DOHMH,” Yang said. “It’s unconscionable the disparities we’re seeing.” 

Morales and Wiley, while committing to create the position, noted that having a commissioner tasked with enforcing equity will accomplish nothing if the mayor herself isn’t committed to that push.

“Having been in the job,” Wiley said in apparent reference to her time at City Hall, “if the mayor doesn’t hold that work central, that lens and those principles central, does not know exactly how to tell city government ‘here’s the thing you’ve never done before that we’re gonna now do…,’ it doesn’t matter that you have that position filled.”

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by Ben Brachfeld, Gotham Gazette

Read more by this writer.

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Democratic Mayoral Candidates Discuss Addressing City’s Health Care Gaps After Covid Wed, 27 Jan 2021 05:00:00 +0000
Mend the Health Care Safety Net for LGBTQ New Yorkers https://www.gothamgazette.com/130-opinion/10063-mend-health-care-safety-net-lgbtq-new-yorkers-covid https://www.gothamgazette.com/130-opinion/10063-mend-health-care-safety-net-lgbtq-new-yorkers-covid lgbt community center

The NYC LGBT Community Center (photo: LGBT Community Center)


LGBTQ New Yorkers are facing a unique and urgent health care challenge. We already experience significant health disparities, and as a result of COVID-19, the organizations that exist to address those disparities statewide are hanging by a thread. Lawmakers have worked with the community for years to ensure these organizations can serve the nearly 1 million of us who call this state home, but without greater public awareness of the outsized challenges that LGBTQ people have suddenly come up against and a renewed commitment from New York state government, our community’s safety net is at risk of disappearing. 

LGBTQ people are especially vulnerable to COVID-19 because we are more likely to be immunocompromised, and encounter barriers to accessing medical care that the pandemic has only exacerbated. For example, we are at higher risk for heart disease and cancer, and use substances at higher rates. LGBTQ people also experience discrimination from providers and staff, including being refused care. These disparities are compounded for Black people, who are less likely to receive appropriate medical care across the board, from pain treatment to hospital admission. As a result, many LGBTQ people are reluctant to seek care, even in urgent situations.

These challenges are part of why our community relies so heavily on the 70 organizations across New York State that make up The LGBT Health & Human Services Network. Network member organizations provide free and low-cost, affirming health-care services such as primary care, STI and HIV testing, patient advocacy, medication delivery, health education, mental health counseling, and more, in direct response to the needs they see across the state.

The Network’s most recent needs assessment, a survey of 3,800 LGBTQ New Yorkers, revealed that more than one in five have no primary care provider or have had to skip doctor visits due to cost. Nearly one-third cited a lack of LGBTQ-trained health professionals as a barrier to accessing care—and this shot up to 56% for transgender and gender-nonconforming respondents specifically. 

In addition to these year-round services, The Network is also responding directly to COVID-19. Fifty-one organizations have begun providing emergency services, such as offering covid testing, providing PPE and food pantry services, and converting medical facilities to care for COVID-19 patients. Later this month, The Network is launching a search engine to help LGBTQ New Yorkers more easily find affirming, affordable, safe health care services, including telehealth.

However, without access to emergency funding, these services cannot exist. Network organizations currently have a collective deficit of $12.6 million due to the financial strain the pandemic has caused. They face further losses in the hundreds of millions of dollars due to looming policy changes like the Medicaid Carve-Out Plan. The current deficit alone is enough to already do serious damage: Out Alliance, the only LGBTQ community center in Rochester, was forced to let go of all staff and temporarily discontinue operations for the duration of 2020. Eight more members have significant concerns about their organizations’ sustainability. Layoffs and furloughs caused by financial strain are rapidly shrinking the remaining organizations’ capacity to meet a growing need for services. 

Since the HIV epidemic, no other event has had such a profound, overarching impact upon our communities. Not only are individuals particularly vulnerable to illness and isolation; they are also increasingly less able to access affordable, affirming health care. Where are we supposed to turn in the midst of a pandemic if our safety net can’t catch us?

We need lawmakers to understand the crisis we are facing and to take action, by providing emergency funding to ensure sustainable access to life-saving and life-affirming services for our community. LGBTQ New Yorkers can’t do this alone.

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State Senator Brad Hoylman represents parts of Manhattan. Glennda Testone is Executive Director of NYC's LGBT Community Center. On Twitter @BradHoylman, @Glennda_Testone & @LGBTCenterNYC.

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

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Mend the Health Care Safety Net for LGBTQ New Yorkers Tue, 12 Jan 2021 05:00:00 +0000
Community Health Groups Must Be Part of New York City’s COVID-19 Reckoning https://www.gothamgazette.com/130-opinion/10038-community-health-groups-new-york-city-covid-reckoning https://www.gothamgazette.com/130-opinion/10038-community-health-groups-new-york-city-covid-reckoning local health clinics workers pamphlets

Community clinics must be reconsidered (photo: Ed Reed/Mayor's Office)


For generations, health care has been vastly different for the haves and have nots, and the COVID-19 pandemic has only increased the divide that was already so apparent to communities of color in New York. 

Having symptoms of the virus myself in the early months I went to Lenox Hill hospital, farther from where I live because my local hospital was already filled with patients. Now, keep in mind, all private hospitals receive government funding, but their internal policies determine what it means to receive basic care. In my case all that meant was a COVID-19 test and a standard x-ray. Any additional testing I may need, including blood work and an electrocardiogram – standard even for basic check-ups – would have to be paid from my own wallet. 

Like most Afro-Latinos, I had been listening to the news of how the death toll continued to rise in my community of Upper Manhattan, and was afraid I would become one of those numbers. I was pained, too, seeing immigrant neighbors not receive the care they need or getting wrong information. But this is not surprising for those of us who have worked in the healthcare system. There have been consistent cuts to funding for health-focused community-based organizations (CBOs), which have an incredible history of advocating for newly-arrived immigrants who are still adapting to a different culture as well as other residents of low-income communities and communities of color.

But the cuts that occurred on multiple levels of government forced many of these organizations to close. If more health-based CBOs were open when the coronavirus upended our lives, the people who live in zip codes where the pandemic hit hardest would have had more options to receive the medical care they needed and deserved, contact tracing could have been implemented from the start, and the information these residents needed to survive would have been accessible. 

The CBOs that had their doors open in New York provided the best care they could, all while the demand for their services increased. So many of them, like the Commission on the Public's Health System, were able to jump-start volunteer efforts to help deliver meals and groceries, and to collaborate with houses of worship to provide remote services. They are still the go-to health care option for many. Most importantly, they have built relationships with their patients, which is their best chance for these men and women to get over the final hump of this health crisis. 

With the distribution of a covid vaccine underway, one-third of Latinos and fewer than half of Black people recently surveyed said they would not take the medicine. CBOs are the ones that can ease people’s fears so they listen to the advice of health professionals. But they need the financial support to effectively treat these communities. 

While larger health nonprofits have great people working for them, many still fall short of ensuring they can serve a diverse group of people. New Yorkers cannot afford to continue to have an antiquated safety net system that leaves out communities of color. 

Even now, advocates struggle to stop budget cuts to Medicaid and the NYC Health + Hospital System. In the midst of this national pandemic, every state has to exercise autonomy. But for years, public and private sectors have invested millions on studies relating to health disparities in New York City, showing that the more money you have the better healthcare you will receive. 

Before COVID-19, there were many studies showing a lack of services in key zip codes, but nothing was done to address it. Only now, when a vaccine is finally being distributed, are elected officials paying attention to the health disparities that have affected communities of color for decades, and money is being allocated to the tracing efforts necessary of infected New Yorkers who were already living below the poverty line. 

No one can say that we are “all in this together” when so many people are continuously robbed of quality health care. When the coronavirus has been contained and we can finally get back to living a semblance of the lives we remember, changes to the way health care organizations are funded needs to be changed to ensure all communities have access to the care they need. Only then will we be able to ensure all New Yorkers can lead a healthy life and truly be ready for the next pandemic.

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Miosotis Munoz is a proven community advocate and non-profit leader who has worked in the healthcare and education sectors, and for several elected officials in New York City for almost three decades. She resides in Upper Manhattan.

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

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Community Health Groups Must Be Part of New York City’s COVID-19 Reckoning Wed, 06 Jan 2021 05:00:00 +0000
What Covid and the 2020 Elections Taught Us: It’s Time to Do Right by New Yorkers on Health Care https://www.gothamgazette.com/130-opinion/9991-covid-2020-elections-do-right-new-yorkers-health-care https://www.gothamgazette.com/130-opinion/9991-covid-2020-elections-do-right-new-yorkers-health-care f lady visit

Health care remains the top issue for voters (photo: Ed Reed/Mayor's Office)


The Biden-Harris victory is great news and a huge relief. Our country has suffered under Trump.

But we have a problem. A record number of voters rejected a national campaign that stood for greater economic fairness, science-based policies on COVID-19 and the environment, protecting health care coverage, and racial justice.

In New York state legislative races, moderate and progressive candidates did well, achieving strong legislative majorities for Democrats in both houses. But several challengers as well as good incumbents running for re-election lost or won in races that were real nail-biters. After all we went through with Trump, these candidates, and others, should have had stronger results.

As we look forward, we need to ask: What’s wrong, and how do we fix it.

Many working people across the country, in every demographic group, are disillusioned. They believe many of our political leaders are too close with corporate interests and fail to fight on vital kitchen-table economic issues.

Many people have been swayed by campaigns that make dishonest accusations and exploit divisive issues and fears.

But that doesn’t mean they can’t be won back or for the first time, to support policies that would make a real difference in their daily lives and futures.

To achieve that, I believe we must strengthen our progressive message, not move away from it.

Opinion polls have long told us that health care is the number one issue for the most voters. And while the Affordable Care Act has done a lot of good, COVID-19 has further exposed the gaping shortfalls and gross inequality that plague American health care.

Three quarters of our neighbors are afraid that they cannot afford their health care or health coverage and fear medical debt. Each year, a third of families who have health coverage have a household member who goes without needed health care because of cost; their health coverage doesn’t do the job.

We don’t have real choices. The vast majority of employees are covered by a health plan that’s tied to their job. Health plans impose rising premiums, deductibles, and copays, and we have to pay them if we want to keep our insurance. Health plans dictate which doctors, hospitals, and medicines they cover. And they impose the same costs whether you’re a multi-millionaire CEO or a receptionist.

If you lose your job, which has happened to millions of people, you lose job-connected health coverage.

Access to health care is diminishing. Losing hospitals, doctors, nurses, and neighborhood pharmacies is a growing problem in many communities, including rural areas, in large part because “third party payers” (i.e., health insurance companies) underpay them or exclude them from their restrictive provider networks.

We need to deliver a health plan that by law guarantees everyone complete coverage; complete choice of doctors, hospitals, and other health-care providers; and is funded based on ability to pay. It should include long-term care (home care and nursing home care), which can be a frightening cost that can wipe out a family’s lifetime savings.

In New York, this means the New York Health Act to establish universal single-payer health coverage. It’s more comprehensive than any health plan available. Having us all in the same boat – rich and poor alike – is the best way to guarantee it’s the best possible plan.

Passing the New York Health Act is the one best thing we can do for the health and family finances of almost every New Yorker.

Does the covid recession mean we can’t afford it? No.

Taking insurance companies out of the picture will save New York $55 billion a year we now waste on insurance company bureaucracy, marketing, and profit; on administrative costs doctors and hospitals spend fighting with insurance companies; and on the excessive prices we pay to drug companies because no single insurer has enough bargaining clout to force prices down.

These savings would enable us to cover the uninsured and cover what New Yorkers now spend on deductibles, co-pays, out-of-network charges, and other out-of-pocket costs.  Instead of premiums, the New York health plan will be funded through a broad-based tax based on ability to pay.

It will simplify an excessively complicated and convoluted system, for patients, health-care providers, and employers, while providing universal health coverage for all New Yorkers, regardless of ability to pay and not attached to employment.

The New York Health Act has passed the State Assembly four times. We need to do it again and get it through the State Senate. New York’s health depends on it.

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Assemblymember Richard N. Gottfried represents parts of Manhattan and is the chair of the New York State Assembly Health Committee. On Twitter @DickGottfried.

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

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What Covid and the 2020 Elections Taught Us: It’s Time to Do Right by New Yorkers on Health Care Tue, 15 Dec 2020 05:00:00 +0000
We Must Not Return to ‘Normal’: Seizing Our Opportunity to Rethink Health and Health Care in New York https://www.gothamgazette.com/130-opinion/9987-no-return-to-normal-seizing-opportunity-rethink-health-care-new-york https://www.gothamgazette.com/130-opinion/9987-no-return-to-normal-seizing-opportunity-rethink-health-care-new-york aramark redcross robin

Health care workers during covid (photo: Michael Appleton/Mayor's Office)


Last month, Governor Andrew Cuomo delivered remarks at Riverside Church on the inequities in the Trump administration's COVID-19 vaccine distribution plan. He admirably stated that we must prioritize fairness and equity. Communities like many in the Bronx that have suffered the most because of this virus must not be left behind. But that commitment to leaving no community behind must also be applied to addressing the underlying issues that led to disproportionately negative outcomes for impoverished communities of color impacted by the virus. 

Governor Cuomo was right when he stated, ”Covid low tide in America also showed us the deep inequality in our country and the systemic discrimination in this nation. The truth is covid killed Black people in this country at twice the rate of white people. The truth is covid killed Hispanic people at 1.5 times the rate of white people. Those are ugly facts. The covid infection rate was 2.5 times higher among Black and Hispanic people and the hospitalization rate for Black and Hispanic patients was over three times higher compared to white patients.”

This accurately describes our experience at SBH Health System (SBH). For the community we represent, a return to "normal" would be both a disaster and an affront, as it would not address the life and death issues being further exposed by this "low tide" moment in America. According to the New York City Department of Health's COVID-19 database, more than 90% of Bronx residents who have died from COVID-19 had preventable underlying health conditions.  

A recent study by Gibenga Ogedegbe, et al also supported the fact that Black and Hispanic populations were more likely to test positive for COVID-19, and although their in-hospital mortality rate was not higher than white patients, “the structural determinants pervasive in Black and Hispanic communities, including inequality in housing, access to care, differential employment opportunities and poverty…explain the disproportionately higher out of hospital deaths due to COVID-19 infections in these populations.”

Moving forward, we know that access to affordable and accessible quality community health care will be a primary factor in addressing the systemic health-care inequities in New York. Without coordinated patient-centered care, it will not be possible to ensure appropriate care continuity. Coordination is key to prevent redundancies and lost opportunities across the entire health-care delivery system, from vaccinations to highly-specialized procedures.

This means primary care clinicians and specialists, ambulatory surgery centers, specialized procedural centers, hospitals, and post-acute care facilities must seamlessly interact on behalf of the patient. We began to see the immediate benefit of this coordination during the height of the pandemic last spring, when hospital systems and others developed collaborative relationships with each other, in concert with public health officials to effect rapid responses to the crisis.  

We also know that health and wellness depends not only on healthcare delivery, but also on those social determinants of health that interfere with that delivery. New York must immediately adopt policies that embrace and demand value-based health care. This must include a continued and renewed financial commitment to move health-care delivery from a volume- and profit-driven model to a value-based model that encourages providers and payers to collaborate and focus on programs aimed at improving the health, wellness, and resilience of all communities. 

As part of this program, we must preserve the safety net by investing in community-based anchor institutions such as SBH, which has consistently exhibited a commitment to broad-based Bronx community partnerships aimed at improving the lives of the residents of the Bronx.

Our Affordable Housing and Wellness Center Development, in part supported by New York State, is an example of this willingness, and we are proud that we have created opportunities for hundreds of families by investing in safe, clean, affordable, and permanent housing, including for those who were formerly homeless. But it’s not enough. 

The Bronx continues to rank 62nd of 62 New York counties in terms of health and wellness, according to the RWD Community Health Rankings. Housing, physical, and food insecurities; education, income, technological, and health-care disparities -- many of them further revealed by the impacts of covid -- must be addressed to ensure that the next pandemic doesn't wipe out the rest of our community.  

The moment is now to right the wrongs of previous generations and put our communities on a different trajectory. We have a real opportunity and responsibility to address once and for all the structural inequities that have contributed to the overwhelming losses experienced in our community. New York can serve as a model for the rest of the country about who we are and who we must be, and in the process create a “new normal” that guarantees opportunity and fairness for all New Yorkers. 

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David Perlstein, MD MBA FAAP, is President and CEO of SBH Health System. On Twitter @SBHBronx.

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

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We Must Not Return to ‘Normal’: Seizing Our Opportunity to Rethink Health and Health Care in New York Mon, 14 Dec 2020 05:00:00 +0000
Rebuild Hospital Capacity in Queens Before It's Too Late, Again https://www.gothamgazette.com/130-opinion/9978-hospital-capacity-queens-before-too-late-coronavirus https://www.gothamgazette.com/130-opinion/9978-hospital-capacity-queens-before-too-late-coronavirus healhosp elm to

Mayor de Blasio at Elmhurst Hospital (photo: Ed Reed/Mayoral Photography Office)


A study recently released by New York City's Department of Health and Mental Hygiene and the U.S. Centers for Disease Control and Protection had a grim finding: as the pandemic overwhelmed the city last spring, 30% of patients hospitalized because of COVID-19 ended up dying. The findings confirmed the images New Yorkers grew accustomed to seeing — mobile morgues and patients struggling to survive in hallways. 

The problem was particularly acute in my home borough of Queens, where there are only 1.8 hospital beds per 1,000 residents as compared to five beds for every 1,000 residents in Manhattan. Elmhurst Hospital and Northwell Forest Hills became national symbols of the seriousness of covid, with Elmhurst experiencing 13 deaths within a 24-hour period at the height of the pandemic while Northwell Forest Hills experienced 17 deaths within a 24-hour period. This is totally unacceptable.

Even in Manhattan, the situation became so dire that a field hospital in Central Park was erected. Dying New Yorkers were routed to tents to receive care during the cold evenings of early spring.

This temporary facility was built by anti-LGBTQ activist Rev. Franklin Graham. It added insult to injury for a city that was failing to take care of its own. And it was especially difficult to stomach for New Yorkers who lived through one of the city’s other major health crises, the HIV/AIDS epidemic.

For me, it was a horrifying and unexpected combination of my work as a Queens-based LGBTQ organizer and health-care activist. It made plain that it is impossible to separate the medical from the social and the scientific from the political. 

In fact, during the height of the AIDS crisis in New York, I watched a generation of friends and neighbors die because of the indifference of too many people in power. One of my closest friends who guided me through the difficult coming out process ultimately died from complications with AIDS.

We were unprepared for the breadth of the crisis then, just as we were for this pandemic. But just because covid wasn’t expected, that doesn’t mean New York had to lose well over 20,000 lives and counting. 

In Queens alone, ten hospitals have been shuttered over the past 20 years as a giveaway to the real estate industry. A similar dynamic unfolded in Manhattan with St. Vincent’s Hospital, which was one of the few facilities to treat individuals with HIV and AIDS with dignity. 

The thinking was that the city had excess capacity and more focus should be on preventing the root causes of hospitalizations. The hospital property could then be repurposed by real estate developers. This was a big mistake.

And while focusing on preventative medicine is laudable, the city also failed on that count. Black and Hispanic residents, as well as vulnerable older New Yorkers of all races and ethnicities, were the most impacted by this virus.

One of the main reasons I’m running for New York City Council is to pass legislation to add hospital capacity and implement health-care impact assessments for every zoning and land use proposal that needs Council approval. We need to understand how new development impacts health-care access before some large projects are built.

That work will also entail creating a Hospital Capacity Task Force to rebuild health-care facilities throughout our city, with a focus on central and southeast Queens. We must ensure that whatever capital allocations are made, that they are dedicated to building additional hospital beds in an expedited fashion so that all communities are safer in the future with nearby access to world-class emergency care.  

With covid cases on the rise and hospitals again facing a possible shortage of beds, we must use this moment to reflect on what we want the city’s health-care system to look like in the future. Hospital beds may not be something the average New Yorker thinks about on a daily basis, but with the inevitable future public health emergencies ahead, we can’t let our own policy decisions be our biggest impediment to recovery. For many of us, it is a matter of life and death.

***
Lynn Schulman is a Democratic candidate for the New York City Council in Queens’ District 29. On Twitter @schulman2021.

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

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Rebuild Hospital Capacity in Queens Before It's Too Late, Again Tue, 08 Dec 2020 05:00:00 +0000
New York Hospitals Brace for a Second Covid Wave. Are They Ready? https://www.gothamgazette.com/state/9943-new-york-hospitals-brace-second-covid-wave-ready https://www.gothamgazette.com/state/9943-new-york-hospitals-brace-second-covid-wave-ready visits covid air

Lincoln Hospital staff (photo: Michael Appleton/Mayoral Photography Office)


As public health officials eye a second major swell of COVID-19 infections and an increase in hospitalizations, New York's hospital systems have begun to brace for another flood of patients. The state has even opened a field hospital on Staten Island in response to rising numbers, a dismal reminder of the devastation of the spring.

In the months since the height of the pandemic in the spring, New York's health care institutions have been making preparations to try to avoid the same chaos and loss of life, which has been partially attributed to a lack of coordination. But in many areas, like before, hospital administrators and staff are just trying to stay one step ahead of the virus, keep staff safe, and maximize patient survival.

The city's hospital systems "faced an unprecedented situation for which no one was fully prepared," wrote City Comptroller Scott Stringer in a review, issued in July, of the city's public hospital system, which saw many of the most severe problems. "The lack of preparedness forced all players to improvise responses, sometimes successfully, sometimes not – but inevitably at a cost in human lives."

Hospital administrators have signaled to their staff, lawmakers, and the public that they don't believe a second covid wave in New York will be as bad as the first -- with lessons learned and months to upgrade facilities, stockpile supplies and ventilators, and develop so-called "surge plans" to be used in the event another round of mass admissions strains hospitals. But experts are questioning whether hospitals will have enough staff and personal protective equipment (PPE) if hospitals see the crisis levels of March, April, and May again, and even ICU nurses onboarding others are expressing doubt about the adequacy of a heavily-truncated training regimen. New York City and State are hoping to better balance patient loads across hospitals to avoid overwhelming any one facility, but no new system has been finalized and much remains unsettled about how a patient diversion program would operate.

In the spring, hospitals were overflowing with covid patients and, along with governments, struggling to procure enough PPE, particularly within Health + Hospitals, the city's network of public hospitals. Government and hospitals worked together to nearly double the state’s bed count from 53,000 to roughly 90,000, and though they were never all filled, there were concerns about the state’s ability to meet the upper projection of 140,000 hospital admissions.

To comply with an executive order from Governor Andrew Cuomo to increase capacity by 50%, hospitals rapidly converted offices and auditoriums into intensive care units; field hospitals were set up in convention centers like Javits, and the USNS Comfort, the Navy hospital ship, docked temporarily in the Hudson. Some facilities, like the now-infamous example of Elmhurst hospital in Queens, one of the city's 11 public hospitals, were overflowing while others had space. At the apex in April, the state had 90,000 additional health care workers, including 25,000 from other states.

More than 26,000 people are confirmed to have died from COVID-19 statewide. According to city data, over 24,000 New Yorkers have died of covid in the five boroughs, which includes unconfirmed but suspected covid deaths, or about 1 in 350 city dwellers.

The spring surge in patients meant hospitals needed more space for beds and more personnel to staff them, more supplies to protect or save both patients and staff, and the systems to manage the new, exhausting demands. Many of those systems remain in place or serve as the basis for current emergency plans, like the "NYC Strategic Reserve” PPE and ventilator 90-day stockpile ordered by Mayor Bill de Blasio that the city says is near completion. These issues were especially acute within the 11 public hospitals run by Health + Hospitals, according to Comptroller Stringer’s report, which had been requested by the governor and also pointed to underfunding by the state.

"All of our hospitals have learned from the devastating first wave of the pandemic and really poured their hearts and energies into preparing for the second surge, which we hope won't happen, but unfortunately we are at risk of given the numbers we are seeing," said New York City Health Commissioner Dave Chokshi, last week.

The next morning Mayor Bill de Blasio said "our hospital system is strong right now," but warned that it remained essential to work to keep covid numbers low and avoid strain on ICUs. At a recent City Council oversight hearing, city public health officials testified about lessons learned from the spring and preparations in place for a second wave, including by noting they now often use less invasive ventilation techniques and new protocols for stabilizing patients before transferring them.

The citywide seven-day average number of hospitalizations per day topped 80 admissions last week, three times what it was in August but still far below the thousands of daily admissions at the peak. As of Monday, 931 people were hospitalized due to COVID-19 citywide, of whom 196 were in intensive care. Test positivity has been ticking steadily upward since the summer and the city and state have begun shutting down key sectors of public life, like in-person schooling, a reprise of the conditions on the eve of the apex. Governor Cuomo, Mayor de Blasio, and others have been sounding the alarm that a second wave is staring New York in the face, and imploring New Yorkers to follow all guidelines.

"Rates go up, you overburden the hospital system, you overburden doctors, nurses...Numbers go up and people die. People die. Period. It is a mathematical equation," Cuomo said at a news conference on Sunday, warning rates could "easily" skyrocket for months "if we are irresponsible."

On Monday, Cuomo announced a field hospital would be opened on the site of South Beach Psychiatric Center in Staten Island in response to a dramatic rise in hospitalizations in New York's most isolated borough. "The hospitals have contacted us, and they say they need emergency beds on Staten Island," the governor said at a press briefing. "Remember when we had to set up field hospitals, emergency hospitals for additional capacity? Well, that's what we have to do on Staten Island.”

Throughout the pandemic, the state has functioned as a regulatory body, coordinating resources among public and private hospitals, suspending some requirements and setting new guidelines. As of August 6, emergency regulations from Cuomo's Department of Health establish the framework to reinstate many of the "surge and flex" provisions imposed at the end of March. Hospitals must have plans to expand capacity by 50%, manage mass casualties, and enlist workers in the event of another state of emergency. Each facility is required to stockpile 90 days worth of PPE.

To manage it all, the plan calls for the state health department to maintain a statewide data system and coordinate patient loads across New York's various hospital systems. In another serious outbreak, the state Department of Health may designate healthcare facilities as covid-priority "trauma centers."

In response, a loose organization of government agencies and private healthcare providers has taken shape across the city and state, mobilizing a massive operation that eight months in is still a bit of a leaky ship.

Space
A big focus in recent months has been upgrading spaces and preparing surge plans for the rapid conversion of hospital units and non-clinical space, the offices and auditoriums, into covid ICU wards.

While much of the space has reverted to its traditional use, officials have retained the knowledge to transform facilities and are building up the infrastructure to do it faster. New York City Health + Hospitals tripled ICU capacity by adding 760 ICU beds, some of which were made permanent, as was much of the digital roadmap for tracking them.

“NYC Health + Hospitals has been on the frontline of the COVID-19 crisis, providing the highest quality care to all New Yorkers in the face of an unprecedented global pandemic – and we stand at the ready to provide that care as we brace for a potential second surge," wrote Stephanie Guzman, a spokesperson for Health + Hospitals, in a statement to Gotham Gazette. "Since the spring surge, the public hospital system has made strategic enhancements in space, equipment and staffing to ensure each of its hospitals is even more prepared now to treat critically ill COVID-19 patients."

The city Department of Health and Mental Hygiene has been working with public and private hospitals using federal grant money to support covid response and improvements at hospitals and long-term-care facilities. Facilities are incorporating design changes to support rapid unit conversion, like negative pressure rooms, which are used to help prevent the spread of the coronavirus through the air.

Health + Hospitals has increased piped oxygen and dialysis capacity to more easily turn beds into covid ICU beds. Hundreds of rooms have been modified to allow for physically distant patient monitoring with more to come soon, according to Guzman.

The city has some sites on stand-by, like the Roosevelt Island Medical Center, which was opened up this spring on the campus of NYC Health + Hospitals/Coler, where Mayor de Blasio announced plans to open 350 additional non-covid beds in March, which by April were also serving covid patients.

"[An]other thing we learned is that temporary field hospitals like the USS Comfort aren't going to be as effective as expanding the current sites or reopening sites like they did on Roosevelt Island," said New York City Council Member Carlina Rivera, chair of the Council hospitals committee, in an interview. The Comfort treated just 182 patients in its one-month stay docked off of midtown Manhattan.

Systems
One of the failures of the first wave was a lack of coordination within and among the public and private hospital systems to balance patient loads.

At Elmhurst Hospital, a Health + Hospitals facility in Queens, health-care professionals were overrun with patients -- one day at the end of March seeing 13 deaths in 24 hours -- despite close to 900 beds open across the public system and 3,500 total beds in New York City, counting private hospitals. The surrounding neighborhoods of Elmhurst, Jackson Heights, and Corona had some of the highest covid mortality rates in the city.

"[T]he problem the Elmhurst situation exposed was not one of hospital capacity, but one of patient load management across all hospitals and hospital systems," reads an excerpt from state Department of Health regulations issued in August and November.

"When it came to patient transfers, I thought, we really wanted the whole system to operate as one," Council Member Rivera said. "And we heard as much in some of the press conferences. But in practice it didn't truly become a reality."

To avoid the Elmhurst syndrome, the city is working with Emergency Medical Services, a division of the state Health Department, and the Greater New York Hospital Association, a consortium of hospital networks, to develop a "unified approach" to balancing patients, according to Victoria Merlino, a spokesperson for DOHMH. The protocol would mean "moving patients from one facility to others that have more capacity available and deferring EMS to overcrowded hospitals when possible," Merlino wrote.

But it is not ready, and there are few details about how it would work in practice. EMT staffing and shortages were ongoing concerns during the siren-heavy months of the first wave, and now will be an even more central component of the city's emergency response if the system is to better balance admissions.

While the state Health Department's emergency regulations say the department "shall coordinate with health care facilities to balance individual facility patient load," the approach appears to be largely decentralized.

"While the determination of when to transfer a patient or divert EMS resources is a local one, the Department monitors facility capacity and is available to assist with the logistics of making a transfer if necessary," wrote Jonah Bruno, a department spokesperson, in an email.

A city DOHMH spokesperson directed Gotham Gazette inquiries to Greater New York Hospital Association who "developed the system for assessing strain and triggers for EMS diversion, which just recently launched."

A spokesperson for GNYHA provided a planning document Monday detailing patient balance strategies, including an outline for redirecting admissions from surging hospitals, but it does not include concrete protocols or thresholds.

Criteria for designations within the three-tiered framework (normal level, elevated surge, and significant surge) are yet to be established, according to the outline, which was circulated to GNYHA member hospitals in late July.

"We're not quite there yet," said Jenna Mandel-Ricci, GNYHA's Vice President of Regulatory and Professional Affairs, and the network's lead on emergency preparedness, in a phone interview Tuesday. "We're making good progress."

GNYHA views itself more as a "thought leader" in surge management, providing insights and a new layer of data, which it hopes the New York City Fire Department will incorporate into its EMT algorithms.

"We're in very close contact with the fire department and we are kind of watching these next couple of weeks," Mandel-Ricci told Gotham Gazette. 

"It's unclear if a real system for patient load has been implemented, or if it has, whether hospitals are actually keen to use it," said Rivera.

Rivera and others have pointed to two decades of hospital closures as contributing the imbalance of the spring apex. Since 2000, the state has lost roughly 20,000 hospital beds due to budget cuts.

"These hospital closures mostly occurred in poor neighborhoods where there were fewer patients who could pay -- not fewer patients, fewer patients who could pay -- so the inequities are clear when there are more beds per person in Manhattan than there are in Queens," Rivera said, adding, "these are also the neighborhoods where more patients are falling ill and dying from COVID-19."

According to Rivera, New York City's public hospitals received $106 million per hospital in federal CARES Act funding, while some private hospitals received four times that amount. The city's safety-net hospitals, where patients are treated regardless of insurance, are struggling to stay afloat as emergency visits have been down significantly since the spring.

FEMA continues to monitor the outbreak and healthcare systems and DOHMH is using federal aid "to improve information sharing and situational awareness of hospital capacity and throughput," according to Merlino.

Staffing
If covid levels reach heights from the spring, officials are worried there may not be enough health-care workers, including temporary personnel, to adequately staff surging facilities.

City health officials say they are working with the state to create a medical reserve corps of volunteers and have devised a procurement plan for emergency surge staffing. But the pool of additional workers eight months into the pandemic is limited, especially as so much of the rest of the country is dealing with spiking covid cases.

"The staffing concern is very real and I think everyone across the board will tell you that it's probably their biggest concern," said Mandel-Ricci of Greater New York Hospital Association.

A Memorandum of Agreement is available to contract personnel from the Department of Defense for private hospitals, according to DOHMH officials, but it is unclear if the federal government will make those resources available.

With covid outbreaks in many of the states where traveling nurses once hailed from, DOHMH and hospital administrators are looking to "cross-train" local non-ICU staff in intensive care, but nurses say the training is woefully lacking.

At Montefiore Medical Center in the Bronx, outpatient clinic nurses are getting online training modules and day of in-person orientation to the intensive care unit.

"These nurses have been out of the hospital for years, you can't expect them to know, to be competent, to adequately care for the patients when they haven't been in that setting," said Shamelee Morrison, who has been a medical/surgical nurse at Montefiore for 11 years. It can take two months to orient a nurse to a new unit, she told Gotham Gazette, "so you can't take these nurses and give them one day and say, 'OK, now go out and take care of these patients in a safe manner.' It's impossible. And that's what they're expecting the nurses to do."

One ICU nurse at NYU Langone Medical Center of Manhattan said it's like the city is already set up for an encore of thousands of nurses scrambling frantically in overwhelmed ICUs.

"I don't feel like I'm an experienced enough ICU nurse to be training anybody to be in the ICU," the Langone nurse told Gotham Gazette, speaking on the condition of anonymity. "And there's nurses who were only trained as ICU nurses during COVID, who are new grads, training new grads now for the second wave, which is absurd."

"The problem with the covid patients is that they're really, really sick and unstable," the nurse said. "They're not like light ICU patients, so to just go in that after a few weeks or like a month or two of being trained by an inexperienced nurse is really dangerous."

Morrison, from Montefiore, believes the hospital had more time to prepare staff for a potential second wave and dropped the ball. "I don't think they're doing much different. They're doing the bare minimum, if anything," she said by phone during a break in her shift. The New York State Nurses Association ​has delivered notice of a two-day strike at Montefiore's New Rochelle campus in an attempt to secure better staffing levels​, wages and benefits.

With numbers rising throughout the city, hospitals are beginning to heighten protocols as staffing levels become an increasing concern. At NYU Langone, nurses are now being told to wear face shields over their masks, an additional precaution, even with patients who don't have covid. More nurses are getting sick, the Langone nurse said, with one floor having ten out.

The nurses Gotham Gazette spoke with said they don't get many details from their hospitals' administration about preparations for a second covid surge, outside of assurances that they have sufficient PPE supplies and indications that a second wave will not be as bad as a first -- both of which there is little proof of.

Supplies
Emergency regulations from the state Department of Health require all hospitals to have had a "90-day supply" of PPE by September 30. In April, Mayor de Blasio said the city would have its own 90-day stockpile, the NYC Strategic Reserve, in addition to the supplies held by individual hospitals. Representatives of the Mayor's Office and DOHMH have both said in separate statements that the Strategic Reserve will be completed "in the next few weeks," though neither office has said whether hospitals are on track to fulfill the state mandate or even whether the city is monitoring hospital supply levels. Guzman, the spokesperson for Health + Hospitals, said that the public hospital system had reached its 90-day goal.

"There are some hospitals that have not been able to achieve 90-days in all of the categories that are required," said Mandel-Ricci, of Greater New York Hospital Assocation. "But even in the categories where they haven't they're at like 70-days or 65-days, so they still have very large inventories," she added, noting, "some of these things are harder to get than others."

Mandel-Ricci pointed out that most hospitals in New York City are part of networks that can mobilize resources among their facilities. 

Ventilators are more widely available than they were in March, when manufacturers couldn't make them fast enough to keep up with New York's most dire modeling.

Merlino, the DOHMH spokesperson, said hospitals were given the option to keep ventilators from national stockpiles and that the city now has "a large cache" for rapid deployment. When he announced the strategic reserve, de Blasio said the city would have a back-up supply of 4,000 ventilators but the administration has refused to say how many it now has.

Council Member Rivera said she has sought documentation on supplies and surge planning from city agencies and hospitals for months using her oversight powers as chair of the Council hospitals committee, without success.

"We have tried to get this information, not just from the Health + Hospital system, but also from the hospitals that are under that larger Greater New York Hospital Association umbrella," Rivera said.

"It's been incredibly frustrating," she added, "they just haven't provided those documents."

It remains unclear what the 90-day supply goal is based on. As Gotham Gazette recently reported, that number appears to be calibrated to PPE burn rates at the peak of the pandemic, when frontline healthcare workers were instructed to reuse equipment like facemasks far longer than what is traditionally advised. DOHMH and the federal Centers for Disease Control (CDC) have both issued conservation guidance to be put in place to reduce severe shortages.

"We were told that Monte had a 90-day stockpile," Morrison said. "But then some of our nurses recently received an email stating that we were going to have to start recycling PPE."

***
by Ethan Geringer-Sameth, reporter, Gotham Gazette
     

Read more by this writer.

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New York Hospitals Brace for a Second Covid Wave. Are They Ready? Tue, 24 Nov 2020 05:00:00 +0000
The Covid Crisis Made the New York Health Act More Urgent, More Unlikely, or Both https://www.gothamgazette.com/state/9910-covid-crisis-new-york-health-act-single-payer-care-urgent-unlikely https://www.gothamgazette.com/state/9910-covid-crisis-new-york-health-act-single-payer-care-urgent-unlikely 2 commish

New Yorkers at a hospital, pre-pandemic (photo: Michael Appleton/Mayoral Photography Office)


When Mariana Pineda was diagnosed with COVID-19 in April, she spent several days in the hospital being treated for pneumonia and sepsis after not being able to see a primary care doctor due to a recent change in insurance plans.

Pineda, an asthmatic, is one of an untold number of New Yorkers who put off seeking treatment for the coronavirus due to complications with insurance plans or not having health care coverage at all.

“The third day of feeling very sick at home I drove myself to urgent care because it felt like my lungs were filling with wet cement,” she said.

After her stay in the hospital and what seemed like a successful recovery, Pineda began to experience chest pain and difficulty breathing in August. A month later she underwent surgery for a pulmonary embolism and had to have six blood clots removed from her lungs.

Due to long-term complications from COVID-19, Pineda has been unable to work and was set to lose her employment-based insurance on October 19.

She was planning to enroll in COBRA, which will cost her thousands of dollars a month for coverage for herself and her four children, instead of the $400 she would usually pay monthly to get coverage through her job as a special education teacher.

“I'm not working and I don't have an income, there's no way I'm going to be able to afford the COBRA,” she said, “so I have to decide whether I just force myself to go back to work against doctor's orders to keep my health insurance.”

The pandemic has further exposed issues with how health insurance is so often tied to employment in the United States. According to the Kaiser Family Foundation, almost 50% of New Yorkers got their health insurance via their jobs in 2019. Overall, the percentage of New Yorkers with health insurance was about 95% in 2019, a record high thanks to the state’s insurance marketplace and other factors.

But massive job loss has thrown health insurance coverage into question for many thousands of New Yorkers, and during a pandemic no less.

In New York City, the unemployment rate was only 3.4% in February, a record low for the city. However, coronavirus restrictions forced many businesses to close in March, tourism came to a halt, and unemployment numbers began to rise, peaking in June at 20.3%. The most recent numbers released by the Department of Labor show that the city unemployment rate was 13.2% in October. Unemployment has been marginally better statewide. Up from 3.7% in February, it peaked in July at 15.9% before coming back down to 9.6% in October. 

For some, the link between getting health insurance through an employer and sudden job loss during a pandemic has highlighted the need for the passage of the New York Health Act, a bill in the state Legislature that would create a version of a single-payer healthcare system for universal health coverage in the state. The pandemic has dealt a significant blow to people who get their insurance from their jobs, leading proponents of the Health Act to call it more urgent than ever. As of September, the number of New Yorkers enrolled in Medicaid is up by over half a million from the same time last year.

For others, however, the legislation and what it portends is still too expensive and too disruptive, as it would completely change the way health insurance works in New York, and necessitate an overhaul of the tax code and a massive expansion of state government. Governor Andrew Cuomo, a third term Democrat, has long opposed passage of the New York Health Act on the grounds that it would be too expensive and disruptive, and while it passed the Democrat-controlled Assembly multiple times, the bill has not moved in the Assembly or Senate since Democrats took control of both chambers at the start of 2019. The bill’s future appears murky, and there is little indication that either majority plans to make it a top priority in 2021. The offices of Assembly Speaker Carl Heastie and Senate Majority Leader Andrea Stewart-Cousins did not respond to requests for comment about the status of the New York Health Act in their respective chambers.

Under the Health Act, all residents of the state would be enrolled in a state-run insurance system for health care coverage, and one that would remove copays, concerns about finding “in-network” doctors, and other problems often associated with the current health insurance system. Proponents say that major inequalities in the current health insurance and health care systems that have been further exposed by the coronavirus pandemic would have been prevented or to a significant degree mitigated if single-payer health care had been in place in New York.

“If we had the New York Health Act sooner I would have had a primary care doctor all along,” said Pineda, who is working with the Campaign for New York Health to raise funds to cover the cost of her COBRA coverage and is a proponent of the legislation. “I probably would have gone to see him instead of trying to wait it out before I wound up, you know, with pneumonia and sepsis.”

The bill, the lead sponsors of which are State Senator Gustavo Rivera of the Bronx and Assemblymember Dick Gottfried of Manhattan, both Democrats, has passed the Assembly four times since 2015, but has not yet passed the Senate, and neither house has passed it since Democrats regained control of the State Senate in January 2019. Just before those elections, the Assembly passed the bill and all the Democratic members of the Senate signed on to Rivera’s bill as co-sponsors if they hadn’t already.

When both houses of the Legislature had majorities and began passing many progressive priorities, there was greater expectation among advocates and other supporters of the bill, including legislators who’ve sponsored it, that it would move. But given Cuomo’s long-standing opposition as well as questions about its feasibility and criticism from some labor unions, the legislative majorities put the bill on the back-burner while Rivera and Gottfried continued to discuss it with key stakeholders, especially the unions, and held a series of hearings on the bill while tinkering with its language, hoping for further discussion in 2020 and potential movement in 2021, after another state legislative election cycle that is unfolding this year. 

Then the pandemic hit.

Assemblymember Gottfried believes that the New York Health Act would have helped prevent some of the now more than 26,000 deaths caused by the pandemic because New Yorkers would have had better, cheaper access to health care, both before and during the deadly outbreak.

“I believe a lot of people who developed COVID-19 symptoms put off going for care because they were afraid of the cost. And many of those people got a lot sicker, and many died as a result,” he said. Many New Yorkers who died, or got very ill, from COVID-19 also suffered from significant pre-existing conditions, like asthma and diabetes, that can develop or be worsened by insufficient medical care.

According to Gottfried, the bill is likely to have more support than ever in the upcoming session, beginning in January 2021, which he attributes to the pandemic and the new class of progressive Democrats taking office, some joining each of the Senate and Assembly. Several progressive candidates who beat Democratic incumbents in New York City or won open primaries in the city and elsewhere ran on the New York Health Act.

Senator Rivera, whose district has been among the hardest hit by the coronavirus in the five boroughs, says now is the time to get the legislation passed.

“We need to start going in that direction and do so aggressively,” he said. “If not, every time that we delay, it’s people that go broke because they get sick or die because they don't have care.”

The bill faces opposition from Republican legislators, who are not convinced that a single-payer health-care system would be something the state can successfully implement, as well as some moderate Democrats, labor unions, and others.

At a joint legislative hearing on the Health Act last year, Republican Senator Patrick Gallivan said a government-run, taxpayer-funded system was not the way to solve any issues within the current health-care system.

“This seems highly impractical in that no taxpayer-funded program can afford unlimited and unrestricted health care,” he said. “As I learned during a recent meeting with health-care experts in Toronto, approximately 30% of Canadian health care is funded by private insurance and out-of-pocket expenses.”

Bill Hammond, Senior Fellow for Health Policy at the Empire Center, a conservative think tank, said the legislation would be more disruptive than helpful, noting in an interview that 95% of New York’s population is already insured, and implementing the legislation would only disrupt their coverage. Hammond went on to say that the Health Act would consume the state Legislature “for the years that it takes to implement the plan, and probably forever after.”

Currently, the bill is in committee in both houses and the co-sponsors say there haven’t been any changes made to it as a result of the pandemic, though they had been making changes prior to the covid crisis based on the public hearings they held around the state last year.

In an interview on the Max & Murphy podcast earlier this year near the height of the pandemic in the city, Rivera emphasized the need for the New York Health Act and that it was imperative that the legislation gets passed as soon as possible.

“For those folks who would argue that it is complicated and is expensive: I would argue that it is neither as expensive or as complicated as the situation we find ourselves in right now,” he said.

The earliest the bill could pass is 2021, and only after significantly more debate, though that seems especially unlikely given the state’s ongoing public health, fiscal, and other crises wrought by the coronavirus outbreak. The influence of new, more progressive members in both Democratic conferences, including several backed by the New York City Democratic Socialists of America, could prove influential, but a path to passage is currently unclear. For something of this magnitude, a three-way deal with Governor Cuomo would also likely be a prerequisite to passage in the Legislature, and while Cuomo has come out in support of single-payer health care, he has said it should only be done at the federal level.

In August, Democratic State Senator Julia Salazar of Brooklyn, who is backed by the DSA, spoke about how the Legislature should be prioritizing the passage of the New York Health Act, particularly because of the impact the pandemic has had on communities of color.

“We really need to find a way to pass the New York Health Act or to ensure true universal health care,” she said on the Max & Murphy podcast. “A disproportionately high number of Black and brown New Yorkers are or have been dying from COVID-19 due to inequitable access and distribution of healthcare resources.”  

Phara Souffrant Forrest, a nurse and Assemblymember-elect after winning this year’s election, in which she first triumphed in the primary over a Democratic incumbent in Brooklyn, has the passage of the New York Health Act at the top of her campaign platform. She said it was one reason she ran against Assemblymember Walter Mosley, echoing other challengers in recent years who’ve said that Democrats must really fight for the progressive policies they say they support.

During a late October interview on Max & Murphy, Souffrant, also a DSA member and endorsee, suggested that in order to repair the state’s budget and find the revenue to pay for the New York Health Act, the state needs to “instill justice into this budget where we have people paying their fair share.”

“We have 126 billionaires living in New York City that made billions during a pandemic. So money is being made. It's just people aren't getting any of it, and some people are getting all of it,” she said.

But both legislative majorities have a diversity of Democrats, and there are few beyond the furthest left candidates and incumbents who cite the Health Act as a top priority for the near future.

Gottfried said both he and Rivera are prepared to make the appropriate amendments in order to get the legislation passed and signed. What those amendments may be is not totally clear, however.

“It’s not really the state’s responsibility”
Whenever it is brought up, the New York Health Act faces scrutiny over the estimated cost of the program, though those concerns are heightened for some now that the state is facing large deficits given the massive drop in tax revenue due to the covid shutdown and resultant job losses and limited economic activity.

A 2018 assessment done by the RAND corporation has been the main source of information about the potential impacts of the New York Health Act. Overall, it showed that the state would need to collect massive additional amounts of tax revenue, but that that revenue would negate similar overall expenditures on health insurance and health care that New Yorkers currently pay. Depending on the tax structure involved, many New Yorkers would save money on health costs.

The study suggested that if the Health Act was soon passed, state government would be spending about the same amount of money in 2022 as it currently spends on health care and would only see significant savings in health care costs by 2031 -- a roughly 3% decrease in overall spending. The report went on to say that in 2022, the state would need to collect $139.1 billion in tax revenue to pay for the program, a 156% increase from what the state collected in tax revenue at the time. However, what the state collects in taxes for the program would replace what New York was spending on health care services, about $141 billion.

All New Yorkers enrolled in the state’s single-payer health care program would only pay the taxes taken out of their income -- every other cost associated with health insurance and care would be covered under the program. The Health Act is similar to how health insurance and care works in Canada and several other countries around the world, automatically providing residents access to both.

The proposed tax would be based on a person’s ability to pay -- anyone making less than $25,000 a year would be exempt. Rand’s 2018 assessment estimated that the new tax would range between 6.1% and 18.3%, depending on income, for everyone else.

However, under this model, Rand estimated that 98% of New Yorkers would end up paying less for their health care than they do now.

The state would require that all residents enroll in the program, which would essentially make private insurance in New York obsolete. This includes those enrolled in Medicare and Medicaid as well -- with permission from the federal government, the state would use the funds it receives from the federal government for those existing programs to pay for executing the new single-payer system. That would be in addition to a payroll tax, some of which would come out of workers’ paychecks and vary depending on how much money they make annually, with higher taxes on those making more income. Employers would pay at least 80% of the tax on payroll, and employees would pay up to 20%.

In order to use the funding the state gets for Medicaid and Medicare for implementing the New York Health Act, the state would need to receive a waiver from the federal government. Assemblymember Gottfried said New York may be able to get that waiver under a Democratic presidential administration, but that the state can proceed with creating a single-payer system if the legislation is passed.

“It is very clear that even without federal cooperation, a state can create a single-payer system without losing any of our current federal funding. Federal cooperation would make it simpler but is not really necessary, legally or financially,” Gottfried said, noting that a Biden administration may be more open to the idea of single-payer in New York, but did not elaborate on how the state would be able to implement the plan without a waiver.

One of the most prominent voices regularly arguing against the New York Health Act is Hammond, who says that the real issue is containing health care costs, which requires different answers. Hammond and other opponents of the legislation argue that the necessary taxes could discourage the wealthy from living in New York, and that the shifts involved would be incredibly disruptive to the way insurance and care work in the state.

“The majority of people have private coverage, it's not really the state's responsibility to take care of that,” Hammond said in an interview. “They're taking care of it on their own, either with their own money or their employer's money.”

Medicaid enrollment is up by about half a million people after the pandemic led to thousands of New Yorkers losing their jobs and their employment-provided insurance. To some, this means there are already systems in place to ensure people have access to insurance and care.

Hammond said there are more important things that state legislators should be focused on instead of creating a single-payer health-care system.

“We have a deficit of unprecedented proportions. We are right now thinking about major cuts to existing spending on schools, and transportation and health care,” he said.

The state budget deficit is estimated to be around $14.5 billion in the current fiscal year, which runs through March. Legislators and advocates have been pushing tax increases on top earners and the wealthy to plug that gap as well as to help fund the New York Health Act and other progressive priorities.

According to Lev Ginsburg, Senior Director of Government Affairs at the Business Council of New York State, introducing another income tax now could drive businesses and the wealthy out of New York.

“We already see a lot of problems in New York State with companies relocating out of the state or not coming to the state because of various expensive burdens,” he said. “We think that it would be a true economic disaster to put it in place now.”

Government Regulation, Health Care, and Labor Unions
Advocates for universal health insurance and care coverage in New York say that the system already in place for both private and state insurance plans is confusing and hard to navigate. They also point to the battles people must wage with their health insurance companies to get coverage for care.

Elisabeth Benjamin, Vice President of Health Initiatives at the Community Service Society, a nonprofit advocacy group focused on advancing opportunity for underserved communities, said that the current pricing system for hospitals is the biggest indicator of why the state needs a single-payer health system.

Hospitals charge a person depending on what insurance they have, rather than establishing a fixed set of prices for every service they offer. This can result in patients paying different amounts based on the type of insurance they have, and can discourage them from seeking care.

“If the hospitals charge the health plans more, the health plans can charge the consumer more, right? No one has an incentive, actually, to control costs,” she said.

Benjamin believes that there should be more government regulation on how much hospitals can charge patients, and said a single-payer health-care system can help achieve that. There are proposals to mandate uniform hospital and health care charges without moving to a single-payer insurance and care system.

A report done by the Campaign for New York Health, an organization advocating for universal health coverage for all New Yorkers, found that 50% of those surveyed said they were on private health insurance but couldn’t afford to use it because of copay costs. Katie Robbins, Director of the Campaign for New York Health, said that rising health-care costs likely contributed to the spread of coronavirus in New York.

“It would be really critical for a better response to this kind of pandemic to make sure that people have coverage as a guaranteed right and they don't delay because they're afraid of how much the treatment is going to cost,” she said.

The New York Health Act has garnered the support of several labor unions in New York, including the New York State Nurses Association (NYSNA) and 1199 SEIU, a union for many health care and hospital workers. Both unions potentially see job security for their members in such a system.

Having health care off the bargaining table would allow the unions to negotiate better contracts for their members and potentially lead to a stronger union presence in New York, according to Judy Sheridan-González, the President of NYSNA.

“If unions seek out support for people, whether they're in their union or not, union density grows and union credibility is much more valued,” she said.

Sheridan-González said the passage of the New York Health Act could also lead to more job creation in the healthcare industry as a result of heightened demand for doctors.

“I certainly see it in primary care. I think that the initial phase-in, if people know that they don't have to pay anything, I think more people would access preventive care and primary care,” she said.

Not all unions are on board, however: the New York State United Teachers (NYSUT) has testified against the bill, most recently in 2019.

In a statement, NYSUT spokesperson Matthew Hamilton noted that the union supports efforts for universal health care, “especially during a public health crisis,” but that the union believes “a national health care system would be the most effective way to address this issue.”

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by Caroline Leddy, Gotham Gazette
  @GothamGazette

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The Covid Crisis Made the New York Health Act More Urgent, More Unlikely, or Both Mon, 23 Nov 2020 05:00:00 +0000
Citing Lessons Learned, City Officials Outline Preparations, Cautious Optimism for Handling Potential Second Covid Wave https://www.gothamgazette.com/city/9899-new-york-city-preparations-for-potential-second-covid-wave-cautious-optimism https://www.gothamgazette.com/city/9899-new-york-city-preparations-for-potential-second-covid-wave-cautious-optimism lh hc w

Covid testing (photo: Michael Appleton/Mayoral Photography Office)


City Council members and public health professionals gathered over Zoom late last week to discuss how the city can better support public hospitals so that they’re prepared for a potential second wave of COVID-19, which experts say could overlap with the annual flu season and recent case upticks indicate may be looming.

The public hearing — held by the Council’s Committee on Hospitals and billed as an oversight hearing “Examining the City's Support of NYC Hospitals During the COVID-19 Pandemic” — covered issues including the widely agreed upon underfunding of public hospitals, access to personal protective equipment, and improving equity. 

Looking ahead, Council members said one key goal is to mitigate the disease’s disproportionate effects on working-class people and people of color, the very people who are disproportionately “essential workers” and who the city’s public hospital system, NYC Health + Hospitals, struggled to serve during the worst of the initial outbreak, especially in Brooklyn, the Bronx, and Queens.

The hearing, chaired by Council Member Carlina Rivera, a Manhattan Democrat, featured representatives from Mayor Bill de Blasio’s administration and from the public hospital system who defended the city’s record and said the city is ready for another surge of coronavirus cases. After city officials testified, advocates spoke on issues like funding for Health + Hospitals (H+H) and equity for marginalized people.

“This pandemic proves that our healthcare system is too disparate, not just in times of crisis but year-round,” Rivera said in her opening statement. “We are committed to ensuring that the path we build forward out of this pandemic is more equitable for all.”

Joined only by Council Members Mark Levine and Diana Ayala, Rivera asked about PPE access, transfers between hospitals, equity, and the city’s preparedness for a second wave, while officials signaled cautious optimism thanks to lessons learned from March and April. “We are better at caring for sick patients” now, said H+H President and CEO Mitchell Katz.

At the height of the pandemic, the public hospitals struggled to provide their employees with adequate PPE such as N95 masks, gloves, and gowns. Katz said the hospital system ordered PPE in January but “those shipments never arrived” because of a surge in demand worldwide. But NYC Emergency Management Commissioner Deanne Criswell said the city will be prepared this time around for whatever comes its way.

“Each hospital, even outside of the NYC Health + Hospital system and the independents, all have their own 90-day supply of PPE,” she said, “and then through our PPE Service Center we have an additional 90-day supply of PPE.” Criswell said the city also monitors state and federal PPE stockpiles.

According to NYC Test and Trace Corps Deputy Executive Editor Jackie Bray, some of this PPE can be manufactured in New York, but other equipment, like N95 masks, must be purchased from outside the state.

Katz also said that the city is unlikely to experience the same ventilator issue it faced in spring. “Intubation is not always the right answer,” he said; in fact, many patients do better with non-invasive ventilation, like devices that push air into the patient at high pressure.

Katz also shared takeaways about transferring patients between public hospitals, an important issue since during the height of the outbreak in the spring some intensive care units, especially in parts of Queens, were much more crowded than Manhattan ICUs. But there were some cases where hospital administrators wanted to transfer people between H + H hospitals but didn’t because they were unstable.

“You can’t put a patient into an ambulance to go to a less crowded hospital if you think they’re about to go into cardiac arrest,” Katz explained. If there’s a second wave, “we will stabilize patients and transfer them before we run out of space in our ICUs so that every hospital will still have available ICU beds.” This could help ensure that New Yorkers, especially people of color and working-class people who live in areas without many hospitals, can still access adequate care.

H+H has also changed the physical layout of its rooms, adding windows so that people can see each other without breathing each other’s air, putting video and sound monitors in every room so that nurses understand patients’ needs before they visit them, and expanding use of tablets for patients to communicate with loved ones, Katz said. 

Something else the city hopes to do is send out health-related text message alerts in more languages. Notify NYC, the city’s emergency alert system, recently began sending text alerts to more than 31,000 New Yorkers in Spanish, but it hopes to expand. “One of our goals as we move forward is to work with our messaging platform and cell service providers to be able to issue these real-time alerts in additional languages,” Criswell said.

After officials spoke, advocates discussed issues of underfunding and inequality. H+H, which is run by the city but technically its own public benefit corporation, gets funding to treat uninsured patients from the state and city governments, and has faced what some call chronic underfunding. The pandemic has only added to the hospital system’s expenses, though significant federal aid has helped.

Elisabeth Benjamin, Vice President of Health Initiatives at the Community Service Society of New York, a nonprofit focused on the city’s most vulnerable residents, said historic underfunding is part of the reason the pandemic had a worse effect on people of color and people living in boroughs other than Manhattan. “New York State has made a series of policy decisions that have resulted in really unfair allocation of health-care resources, that have in fact exacerbated the disparities in the covid pandemic,” she said.

They include giving aid to bad actors among private hospitals that could’ve gone to public hospitals, Benjamin said. She pointed out that while hospitals in Manhattan have grown, hospital closures have negatively affected communities in the less wealthy boroughs and neighborhoods, including areas served by Elmhurst Hospital, which was overwhelmed during the worst of the first wave in New York and is situated near the sites of four closed hospitals. The Queens neighborhoods around Elmhurst Hospital, an H+H facility where mobile morgues stored increasing numbers of dead bodies this past spring, was one of the areas hardest hit by the pandemic.

Benjamin also criticized the city’s use of indigent care pool funding, which is funding from the government that’s meant to go to hospitals that serve poor people. “Every hospital gets a little bit of this funding, whether they serve poor people or not, whether they offer financial assistance or not, whether they sue their patients or not. That’s wrong,” Benjamin said. The state recently closed a loophole allowing hospitals to collect funding from the indigent care pool for bad debt even if that debt was from wealthy people, but Benjamin said that’s not good enough. “Maybe we should only then be spending the indigent care pool money on the hospitals that are about to go under first of all, but also that serve high-need communities and communities of color.” Coronavirus-spurred CARES Act funding from the federal government also went more to private than public hospitals, Benjamin said.

“I agree with you wholeheartedly,” Council Member Rivera told Benjamin.

The devastating coronavirus outbreak in the city led to and exposed a shortage of skilled medical staff and a lack of PPE. Judith Cutchin, a director of the New York State Nurses Association and director-at-large at Woodhull Hospital in Brooklyn, said that at the height of the pandemic, it was possible for one nurse to have to tend to “as many as eight patients at a time.” According to the New York Times, the situation was even worse than that in some places. “In the emergency room, where best practices call for a maximum of four patients per nurse, the ratio hit 23 to 1 at Queens Hospital Center and 15 to 1 at Jacobi Medical Center in the Bronx,” the Times reported.

“This is unacceptable,” Cutchin said, later adding that when the hospitals did hire more workers or recruit them from other departments within the hospital, she was concerned by the last-minute nature of their training. “We are going into a next surge and we have to assure that people are properly trained,” Cutchin said. “Lives are at stake.”

Anthony Feliciano, Director of the Commission on the Public's Health System, a nonprofit that advocates for equal access to healthcare, said he thinks funding for public hospitals should come from the budget of the NYPD, echoing calls to “defund the police” in light of the Black Lives Matter movement that surged earlier this year after high-profile police killings of Black people in other parts of the country. “We need to ensure that the Board of Health declares racism as a public health crisis,” Feliciano said.

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by Lauren Hakimi, Gotham Gazette
   

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Citing Lessons Learned, City Officials Outline Preparations, Cautious Optimism for Handling Potential Second Covid Wave Wed, 11 Nov 2020 05:00:00 +0000
Supreme Court Hearings Could Be the Beginning of the End of Your Healthcare https://www.gothamgazette.com/130-opinion/9888-supreme-court-hearings-beginning-of-end-of-healthcare-affordable-care-act-scotus https://www.gothamgazette.com/130-opinion/9888-supreme-court-hearings-beginning-of-end-of-healthcare-affordable-care-act-scotus hospital health care emergency room sign

Hospital emergency room (photo: Michael Appleton/Mayor's Office)


It has been a tumultuous week for all of us. The uncertainty about who will lead the country for the next four years has left America anxious, scared, and exhausted.

But with that question appearing settled, other threats remain. Starting Tuesday, the Supreme Court will hear oral arguments in a case that will decide the fate of the Affordable Care Act.

The consequences could not be more dire. As a health-care professional, I see firsthand how important access to quality, affordable health-care is to Americans—especially our country’s most vulnerable.

The timing could also not be worse. Medicaid budgets are shrinking across the country as a pandemic ravages our communities and finances.

Should the ACA be repealed, millions of Americans will lose their healthcare overnight. Premiums will skyrocket. Protections for pre-existing conditions will disappear. The tens of millions who have benefited from the Affordable Care Act will suddenly find themselves scrambling for healthcare—and likely a more expensive version than what they currently have.

It did not have to be this way. The ACA allowed states to expand Medicaid, allowing more Americans access to the core health-care program that’s benefited our country for decades. It allowed young adults to stay on their parents’ health-care plans until the age of 26. It ensured that the one-third of Americans with pre-existing conditions – like diabetes and cancer – are not discriminated against when it comes to health insurance.

I know from both work and personal experience the importance of these aspects of the ACA. As someone who has lost a loved one who battled cystic fibrosis and passed away from pancreatic cancer, I know first-hand how important these protections are, and have dedicated myself to working in healthcare to ensure that I can save as many lives as possible.

Yet for four years, President Trump, his administration, and the Republican Party have done everything in their power to dismantle the ACA and see that millions of Americans either lose their healthcare altogether or pay a higher premium for the care they deserve. The failed attempt to repeal the ACA altogether was a blow to the GOP, but thanks to their changes to the individual mandate, they now have another chance at destroying a landmark health-care law that has proven for more than a decade how valuable it is to the American people.

There have been over 100,000 new COVID-19 cases every day over the past several days. More than 1,000 Americans are dying every single day. The fact that Americans have to even worry about their access to healthcare is not only disconcerting; it’s un-American. As a health-care worker I know first-hand that we take care of one another, and I have been risking my life to save the lives of others for months now.

Despite the efforts of my colleagues and me, we are nowhere near off the hook when it comes to protecting American lives amid this devastating pandemic. We need funding for our hospitals, funding for Medicaid, funding for PPE, and broader assistance from those leading the country. It’s not just my life that depends on it, or the patients I care for in hospital beds; it’s the lives of every New Yorker and every American that are at risk.

The stakes could not be higher. The Supreme Court will rule one way or another in the coming weeks; regardless, we must find solace in unity, and that means we cannot lose hope but must be spurred to action. Under the leadership of President Biden and Vice President Harris, we can not only preserve -- or reinstate if needed -- quality, affordable health-care our fellow citizens deserve, but strengthen the laws and insure even more Americans.

Every voice matters in this fight while we wait for a ruling from the highest court in the land. Call your local representatives, call your Congressional representative, call your U.S. senators. And most of all, call your family to tell them to make calls to remind our lawmakers that healthcare should be a human right, not a privilege.

Together, we can fight this virus, and keep America healthy into the future.

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Mary Maggio Fischer has worked at Flushing Hospital for 39 years and is a local political activist. She is a member of 1199 SEIU.

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

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Supreme Court Hearings Could Be the Beginning of the End of Your Healthcare Sun, 08 Nov 2020 05:00:00 +0000