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What the New Administration in Washington Means for  Health Policy in New York

By Assembly Health Committee Chair Richard N. Gottfried

The election of Donald Trump and Republican control of Congress are a serious threat to programs and policies that protect our health.  Washington could make radical changes to Medicare, Medicaid, the Affordable Care Act, reproductive care, and other programs that could drastically undermine our right to health care, cost New York State billions of dollars a year in federal funds, and destabilize health care providers.

The first step in stopping or reversing these attacks is to clearly understand what’s at stake and spread the word.  There is hardly anything more rigged against working people than health care.  The Trump-Republican agenda will make it worse.  This is a time to redouble efforts in more progressive states like New York to create universal access to health care, with funding based fairly on ability to pay, through an “improved Medicare for all” system.

For years, congressional attacks on funding and programs have been defeated by the threat or use of presidential vetoes.  Now we will have a president who may be leading the charge.

Under the Affordable Care Act (ACA), we get 90% federal matching money, instead of the usual 50%, for the “expanded” Medicaid population.  ACA repeal would take away the additional funding and cost New York over $2 billion a year.  ACA repeal would also eliminate federal funding for the new Essential Plan, blowing an additional $800 million hole in the state budget and potentially leaving 100,000 New Yorkers without health coverage.

President-elect Trump has vowed to eliminate funding for Planned Parenthood, and Vice President-elect Mike Pence is an anti-choice extremist who carried legislation doing just that.  This is a major platform for the Republican Party and it’s likely that Congress would eliminate federal support for family planning services.  If President-elect Trump has his way, a new Supreme Court majority would not only overturn Roe v. Wade, but could go further and outlaw some or all abortion – overriding New York’s law that protects legal abortion.

We will have a federal government committed to protecting corporate interests at the expense of just about anything else.  Cuts in Medicare and privatizing it by turning it over to insurance companies could destabilize hospitals and other providers, shift costs to patients, and cut their access to care.

Federal laws and regulations that protect the rights of Medicaid recipients and nursing home residents could be gutted, and enforcement of remaining protections undermined by underfunding federal agencies like the Department of Health and Human Services or Centers for Medicare and Medicaid Services.

Efforts to control rising prescription drug prices could be stopped before they start, and pharmaceutical companies would likely face less oversight of drug quality or safety under the slogan of “lifting government restrictions and regulations.”

When Trump and Republicans in Congress say “repeal and replace Obamacare,” the agenda is eliminating financial help for low and middle income people who can’t afford high premiums and deductibles, shifting more of the cost of health care from insurance companies to consumers, and eliminating consumer protections.  They talk about letting insurance companies sell in any state, but insurance companies already can do that.  What they really mean is making out-of-state insurance companies exempt from state consumer protection and financial solvency laws.

Gutting Environmental Protection Agency regulations to reduce carbon emissions will undo the progress we’ve made on environmental protection, clean energy, and environmental health.  That means more asthma, more cancer-causing chemicals in our drinking water, and more disastrous storms and floods from global warming.

The new administration may try to trash state medical marijuana laws.  Federal law does not allow selling marijuana for medical or recreational use.  But for years, the federal government has officially looked the other way to allow states to have medical marijuana programs and even recreational marijuana laws.  An administration driven by outdated “drug war” thinking could shut down programs that provide relief to patients in need in almost 30 states

Much of our state public health policy is driven by federal funding, laws, regulations and oversight.  We must protect the federal policies and programs New York depends on, and respond with appropriate changes to state law when needed.

Fighting for the Right Answer: the New York Health Act

Our health insurance-based system is a major contributor to economic inequality and lack of opportunity.  The insurance company wants the same premium and imposes the same “cost sharing” whether you’re a multi-millionaire CEO or the receptionist struggling to make ends meet.  For a median-income household, the cost of insurance can be over a quarter of your income (whether paid by the worker directly or indirectly by your employer lowering your wages).  And that’s not counting possibly thousands of dollars in out-of-pocket costs.

It doesn’t have to be that way.

The New York Health Act is my bill to provide complete universal health coverage (called “single payer” or “improved Medicare for all”), eliminate financial barriers to care, and let people go to the doctor and hospital of their choice.  Instead of regressive premiums, deductibles, co-pays and out-of-network charges, it would be funded fairly through broad-based taxes based on ability to pay.

The Assembly passed the bill in 2015 and 2016 – helping to move it from being “a great idea that could never happen” to something really achievable.  In 2017, we will continue to work to build public support so it can ultimately pass the Senate.

There is increased talk about the need for government to respond to the needs of working and middle class people and treat them with respect and fairness.  The New York Health Act is a key action we can take.