City and State: Health care officials offer diagnoses for New York’s funding challenges

City and State, 2/27

Thanks to a flu season that’s one of the worst in recent memory, it has been a tough winter to stay healthy. Influenza hospitalizations are up and thousands have died. The flu vaccine has proven to be less effective than in years past, and public health experts say the disease may have yet to reach its peak. The spread of the virus is likely to continue for weeks.

It has also been a tough winter for New York policymakers and government officials who rely on Washington for funding. While congressional Republicans failed to repeal the Affordable Care Act, they’ve taken incremental steps to undermine the law, such as eliminating the individual mandate. The federal government has also reduced funding for safety net hospitals and for the ACA’s Basic Health Program, both of which play a major role in New York. Some Republicans in Washington still hope to scale back Medicaid and Medicare as well.

So we checked in with a few of New York’s top health care officials to hear their diagnosis of the situation – and how to remedy it.

RICHARD GOTTFRIED

Chairman, Assembly Health Committee

C&S: What are your health legislative priorities this year?

RG: Our first order of business is, of course, dealing with health care cuts in the budget. This is not the worst year, not the worst budget we’ve seen, nor the best. But there are still serious cuts in health programs and restrictions in Medicaid that I and the Assembly will be trying to reverse. Beyond that, not necessarily in any particular order, passing the Reproductive Health Act in the Assembly again, and hopefully helping to advance it in the state Senate. A particular budget agenda item which we hope to deal with in the budget, and if not we will continue to try to deal with after the budget, is protecting safety net hospitals. The state’s various aid programs for hospitals are not very well targeted to get money to the hospitals that have the most serious financial need. Next, again in no particular order, is strengthening the medical marijuana program. I will be focusing on three issues there. One is to repeal the list of specific conditions for which medical marijuana can be used. There is no other drug that I know of that the law lists the conditions it can be used for. Secondly, today, only physicians, nurse practitioners and physician assistants can certify a patient for medical marijuana use. I think it makes sense that any practitioner who, under law today, can prescribe controlled substances ought to be able to certify a patient for medical use of marijuana as long as the treatment for the condition is within that practitioners scope of practice. The third piece deals with the current business model of producing, distributing and retailing, or dispensing, of medical marijuana. Today, all the licenses that have been issued require the registered organization to grow, process, distribute and dispense the product. There is almost no industry where we allow that degree of vertical integration, and certainly no industry where we require it. The next item is the New York Health Act, my single-payer bill. We will, I hope, pass that again in the Assembly as we have in the three years before. And our goal will be to continue to build support for that around that state. The last item is the Medical Aid in Dying bill that would allow an adult patient with decision-making capacity who is dying from a terminal illness to get a prescription for medication that would end their life. I think that legislation is very morally compelling for New York and I hope we can at least get it to the Assembly floor and pass it.

C&S: How would you assess the state of health care in New York based on what you’ve seen?

RG: It’s mixed. We have some of the finest health care providers, some of the finest physicians and hospitals in the country, but millions of New Yorkers still every year go without health care because they can’t afford or they suffer financially to get that care. Many of our nursing homes provide care that is well below national averages and well below standard. Our systems for inspecting nursing homes are really lacking. We need to invest a lot more of our resources into primary and preventive care, which is very difficult to do in a world where health care is controlled by insurance companies.

C&S: You mentioned your single-payer bill you would like to pass through the Assembly again. Why is that the best way forward for New York to go in in terms of health care?

RG: I believe that no New Yorker should go without health care or have to suffer financially to get it. To use the president’s term, that only gets complicated when the system is focused on the care and financing of insurance companies. And as long as our system is rooted in insurance companies, we will be spending tens of billions of dollars on, necessarily, on insurance company and health care provider administrative costs. You will have insurance companies taking thousands of dollars out of families’ pockets for premiums and deductibles and co-pays without any relation to ability to pay. And insurance companies telling us which doctors and hospitals we can go to, and which services they will pay for. To me, that’s no way to run a health care system. And I don’t know any alternative to a single-payer system that can work.

C&S: And you have seen support for that grow since you first introduced it?

RG: Oh, enormous growth and support, particularly in the last several years, because people have seen that while the Affordable Care Act made a lot of improvements, it still leaves us in the hands of the insurance companies with enormous problems. So people who thought maybe reforming the insurance system would do the job, now see that that really still leaves us falling way short. And it’s also clear that whatever health policy comes out of Washington is going to make things worse in New York, whether it’s for insurance or Medicaid or Medicare. So more than ever, people realize that, whether you call it improved Medicare for All, or single-payer, is really the only answer, and that we have really no alternative but to pursue that at the state level because it’s clearly not coming from Washington any time soon. And so we are constantly picking up more community organizations. There are activists all around the state having meetings with their state senators, there are more unions supporting the bill than ever before, so the issue really is moving forward more than I’ve ever seen.

C&S: Do you have any concerns for what is happening on the federal level, such as cuts in spending or other kinds of legislation that might affect health care in New York?

RG: Their efforts to dismantle the Affordable Care Act will undermine insurance in New York. They are already implementing cuts that are hurting the program called the Essential Plan, which is a subsidized health care program for people whose incomes are a little above Medicaid. And there will be more devastation coming to Medicaid any day now. And their next target will be Medicare. Republicans have had their eye on trashing Medicare since it was enacted in 1965. And that will be coming next. And all of that will be ripping money out of our health care system and putting more burden on out-of-pocket spending by New Yorkers who can’t afford it.