City & State – Setting the Agenda: Health

By Ashley Hufpl, November 25

In the wake of Gov. Andrew Cuomo’s announcement in April that the federal goverment had approved an $8 billion Medicaid waiver so that New York can apply that money to reform the state’s healthcare system, the main goal of the state Senate during the 2015 legislative session will be to implement major healthcare system changes. Meanwhile, the Assembly will seek to pass publicly funded, single-payer health coverage.

With the waiver, the state will overhaul the current system to fully implement the Medicaid Redesign Team reforms, such as promoting community-level collaborations and lowering avoidable hospital admissions by 25 percent over the next five years.

“Watching that will be a great thing,” state Sen. Kemp Hannon, chair of the Senate Health Committee, said. “We’re dealing with very difficult populations at the moment, and so it requires a great deal more of thought and configuration.”

Assemblyman Richard Gottfried agreed, saying he expected legislative proposals to arise during the implementation process.

“I haven’t seen an agenda for legislative action beyond monitoring and helping to shape implementation,” Gottfried, chair of the Assembly Health Committee, said. “The state is making a massive move toward integrated delivery systems and care coordination. I think that’s a strong concept, but the Legislature and all New Yorkers need to make sure this is implemented in ways that protect individual healthcare providers and individual patients.”

Gottfried will be focusing on getting his bill, titled New York Health, to the Assembly floor for a vote. The bill would provide publicly sponsored single-payer health coverage, like Medicare, for everyone in the state. In 2011 Vermont became the first state to move to a single-payer system, which will be up and running in the state by 2017.

“I think virtually every problem that we face in healthcare in New York—whether as patients or providers or employers or taxpayers— is made worse and more difficult to solve because of our insurance-based healthcare system,” Gottfried said. “I think moving New York toward a common-sense universal public coverage program is enormously important.”

The bill last passed the Assembly in 1992 and now faces major hurdles, including the Medicaid waiver and the federal requirements from the Affordable Care Act. Gottfried is also unlikely to get much support in the Republican-controlled state Senate.

“The major difficulty of that— single-payer—is the federal government has the rules for two of the biggest sources of medical payment in the state: Medicare and Medicaid,” Hannon said. “The challenge, then, if you want to change the system is, How do you get the federal government to change their Medicaid and Medicare [requirements] and not scare the population that’s being covered by [the two programs]?”

There are 5.8 million people in the state covered under the Medicaid program alone, Hannon noted.

“The insurance industry and its allies have always opposed this concept,” Gottfried said. “Fortunately, they do not control the Assembly, and I think this issue will help hasten the day where they don’t control the state Senate, either.”

Both Hannon and Gottfried said the commercialized delivery of outpatient care needs to be confronted in the upcoming legislative session. In recent years there has been a significant expansion of urgent care clinics, as well as retail clinics in pharmacies and supermarkets. Currently the state has no laws addressing these emerging outpatient options.

Although outpatient clinics can serve an important purpose as an alternative to an emergency room visit for minor ailments, Gottfried is concerned about large retail chains taking business away from smaller primary care doctors.

Walmart, for example, has recently opened five primary care locations in South Carolina and Texas, and plans to expand more nationally.

“Right now there is nothing in New York law to stop that from happening here,” Gottfried said. “I think that kind of development would be very harmful to healthcare in New York. I think it really makes a difference whether your doctor is responsible to himself or herself or is responsible ultimately to corporate executives and stockholders.”

Along with the new emerging outpatient services and Medicaid waiver reform, there are ongoing issues with New York’s health information technology. The state has been rolling out SHIN-NY, a secure network for sharing clinical patient data across the state, and I-STOP, which monitors the prescribing of controlled substances to combat drug abuse.

“Lots of questions concerning that— How it would work? Who would be able to access the content? How people would opt in to their individual records or opt out, privacy concerns—all those need to be done,” Hannon said. “There’s a work group going on that the Legislature is a part of, but the more we discuss it, the farther we get down the road to where it can be resolved—and it has to be resolved.”

Several additional policy areas will also be addressed in 2015.

Last month Cuomo unveiled a new task force to end HIV/AIDS in New York. The state aims to provide better access to condoms, promote public outreach campaigns and offer other initiatives to end the epidemic.

The state Senate also created a task force last year to prevent Lyme disease. More than 450 new cases of Lyme disease were documented in 2014 in New York, and the federal Centers for Disease Control estimates that number will continue to rise. Hannon would like to continue the state’s efforts by carrying out recommendations in the task force’s report.

Additionally, Hannon proposes to address the potential hazards of electronic cigarettes by making sure they are covered by the Clean Air Act and ensuring their liquid nicotine refills have proper labels that identify the substance as dangerous and addictive.

“Right now you pick it up and it doesn’t look any different from some kind of cherry juice enhancer for soda or something,” Hannon said. “We need to monitor all that and move forward.”