Tag health committee

City & State: Albany’s checklist of health care bills

By Rebecca Lewis, 12/10/18

Single-payer health care may be one of the biggest debates in Albany in 2019, but it’s just one of a number of high-profile issues dealing with medical matters. Here are summaries of several health care issues expected to be at the top of the agenda.

✓ Reproductive Health Act

Although the Reproductive Health Act has passed in the Assembly the past two years, it has yet to come up for a vote in the state Senate. A priority for many Democrats in the chamber – and, importantly, for Gov. Andrew Cuomo, who said he wants it done in January – the bill would update the state’s abortion laws and codify federal protections into state law. Although abortion rights are guaranteed under the landmark Roe v. Wade U.S. Supreme Court decision, the laws on the books in New York were passed in 1970, three years before that decision. Although the state’s laws were considered progressive at the time, they have not been updated since. Democrats have argued that if a bloc of conservative judges on the Supreme Court overturned Roe v. Wade, abortion rights in the state would revert back to those passed in 1970. State Sen. Gustavo Rivera told City & State that he hopes the legislation will be addressed early in the upcoming session now that it has the votes to pass. “I would be willing to move that very quickly because I believe that it is very important, particularly with what’s happening on the national level,” said Rivera, who is likely to be named chairman of the state Senate Committee on Health.

✓ Single-payer health care

Perhaps the most expansive and expensive item on Democratic lawmakers’ agenda – and among the most controversial – is the New York Health Act, which would establish a single-payer health care system in the state and is estimated to cost $139 billion in 2022. Many incoming lawmakers campaigned on the promise that they would get it done, but even if it does pass, massive changes likely won’t happen right away. A single-payer system means that a single entity covers the cost of all health care, which is still delivered by private or nonprofit providers. Everyone pays into a single plan run by the government, which in turn is the only provider of coverage paying claims. Assemblyman Richard Gottfried’s bill has proposed one public option and a ban on the sale of private insurance unless it offers additional coverage not included in the state plan. One major obstacle the New York Health Act must overcome is a less than enthusiastic governor. Although Gov. Andrew Cuomo has expressed support for single-payer health care as a concept, he has repeatedly said that it would be better implemented at the national level. Other critics have raised concerns about the cost, although a study performed by the Rand Corp. that found total health care spending could be lower under the New York Health Act than if the status quo were to continue.

✓ Recreational and medical marijuana

The state has been slowly inching closer to legalizing recreational marijuana. Most notably, Gov. Andrew Cuomo has been coming around on the issue. Although he used to consider marijuana a “gateway drug,” the Cuomo administration this year released a report in favor of legalization, set up a working group to draft legislation and hosted a series of listening sessions across that state to gain public input. Although legislation to legalize the drug has never passed either chamber, public support has grown substantially, and candidates, such as former gubernatorial candidate Cynthia Nixon, campaigned on the promise of legalization. The state Legislature now appears poised to pass legislation that would regulate and tax marijuana.

However, the future of the state’s existing medical marijuana program remains in limbo. Assemblyman Richard Gottfried, who sponsored the bill creating the medical marijuana program and has been one of its strongest advocates, said that in the coming session, strengthening and expanding the program will be “a major focus,” as will ensuring that it continues to run smoothly alongside potential recreational legalization. “So how we do that, I don’t know yet. But I know there is a lot of concern and brainpower being focused on it,” Gottfried told City & State. State Sen. Gustavo Rivera said he hopes that recreational legalization would also open the door for additional research to increase and expand the drug’s medical efficacy.

✓​​​​​​​ Opioid epidemic

As the opioid epidemic continues to take lives across the state, state Sen. Gustavo Rivera told City & State that the state Senate intends to resume its work with the Task Force on Heroin and Opioid Addiction – first created in 2014 – and that state Senate Republicans could participate as well. When led by Republicans, the task force did not include Democrats. Additionally, Rivera said that the state Legislature will continue to explore the concept of harm reduction. The idea accepts that drug use will always be a part of society, but that society can take steps to cut down on the negative consequences of drugs. Namely, Rivera hopes to have productive conversations about a bill he sponsors to create safe injection sites, a highly controversial proposal to create legal locations where illegal drug users can get high in a supervised environment. “I believe that there is plenty of evidence-based programs that can be expanded and be created,” Rivera said. New York City Mayor Bill de Blasio championed a pilot program to open four such sites in the city, but the idea still faces major hurdles.

✓​​​​​​​​​​​​​​ Nurse staffing ratios

The issue of nurse staffing levels within hospitals has long been a priority of the New York State Nurses Association, a powerful union in the state. However, a bill on the subject has never passed the state Senate and rarely passes the Assembly. The main component of the bill would create a set ratio of patients per nurse to ensure that nurses are not overworked by caring for too many people, and to ensure that patients are receiving adequate care. However, other powerful interests have also opposed the legislation, including business groups and hospitals, who argue that while the bill addresses real problems with how care is administered, nurse staffing ratios are the wrong remedy. Like many pieces of legislation that have languished under Republican control of the state Senate, Democratic control of the chamber could give the bill a better chance to become law. “We’ve passed it before and I trust we will do it again,” said Assemblyman Richard Gottfried, who has long been a supporter of nurse staffing ratios. “And it’s very exciting that we now have a shot at having that pass the state Senate.”

Buffalo News: Editorial: Pass bill to better monitor nursing homes

12/8/18

A story in The News on Thursday showed that it’s far too easy for the operators of nursing homes that provide low-quality care to buy more of the facilities.

The state Health Department — which reviews applications to operate nursing homes — has submitted a bill to the state Legislature that would give the department more muscular oversight of long-term care facilities. The Legislature should pass the bill when it convenes in January.

The ongoing nursing home series in The News has shown that 16 of the 47 facilities in Erie and Niagara counties have been bought since 2007 by for-profit owners from out of town. Many of the homes are among the worst-rated in Western New York.

And the state has given licenses to operate at least 10 Buffalo area nursing homes in the last decade to new owners who had been fined for providing poor care to residents at other facilities.

Few families don’t interact with nursing homes. More than 1.3 million people are in long-term care across the country, with approximately 7,000 in Erie and Niagara counties.

It’s not an easy business in which to make a profit. Despite the aging of the baby boom generation, some experts say demand for nursing home beds is going down.

“There are fewer people in nursing homes today than there were 10 years ago,” said Tony Szczygiel, a retired University at Buffalo law professor who specialized in elder laws. Szczygiel said medical advancements mean fewer nursing home stays are required after surgeries, and new home care options let some people stay in their own homes longer.

“So there’s a lot of empty beds out there,” Szczygiel said.

Bill Ulrich, a health care consultant in Washington State, said national figures indicate the industry is at an all-time low of average occupancy in nursing homes, “hovering right around 80 percent, which is very low.”

Lower demand means some Western New York facilities will eventually close. The best outcome for consumers is for the homes given the lowest ratings by the federal Centers for Medicare and Medicaid Services to be the first to go. But more vigorous oversight by the Health Department would also help.

The bill in the Legislature would authorize the Health Department to appoint an independent quality monitor at chronically deficient nursing homes, increase the amount of the maximum fine the state can impose for violations from $10,000 to $20,000, and require more ownership transparency with individuals buying homes listing if their partners are relatives. The bill, sponsored by Assemblyman Richard N. Gottfried, D-Manhattan, and Sen. Kemp Hannon, R-Garden City, hasn’t gotten out of committee.

Emerald South Nursing and Rehabilitation Center on Delaware Avenue in Buffalo was one of the troubled facilities featured in The News’ series. The home, previously operated by a company belonging to Benjamin Landa of Long Island, and later by his wife, Judy Landa, is due to close at the end of January. The Health Department imposed a $10,000 fine on Emerald South after investigating the June 4 death of an 87-year-old resident who fell to his death while attempting to climb out a window.

Benjamin Landa told The News that financial troubles at both Emerald South and Emerald North were caused by inadequate compensation from the federal government. He said the homes were running at a loss “due to the state’s grossly unfair Medicaid reimbursement schedule.”

Ulrich, the consultant, agreed that the Medicaid system in many states “does not come close to paying reasonable and adequate costs to care for Medicaid residents,” but said that nursing homes have traditionally made up the gap by taking Medicare and private pay patients that have better profit margins.

The margins are not low enough to keep Benjamin Landa out of the business. He is one of the largest nursing home operators in the state. And there are other facility operators who manage to stay afloat.

Dr. Jeffrey Rubin is chief executive officer of Elderwood Care, a for-profit chain that operates several of Western New York’s best-rated homes. Rubin says that getting the right mix of revenue is complex, involving Medicare managed care and private pay patients. “Having the right mix allows us to create a stable environment,” Rubin said.

It would be nice if the federal government’s one-star ratings for the poorest performing nursing homes caused them to clean up their act, but it doesn’t always work that way. The Gottfried-Hannon bill would at least help state health officials to not allow the owners of poorly run facilities to keep popping up in new locations.

NY Post: Medical marijuana could soon be covered by New York health insurance

By Carl Campanile and Nolan Hicks, 11/22/18

Taxpayers could soon be on the hook to help low-income New Yorkers score medical marijuana, thanks to a bill that would force public health-insurance plans to cover it.

Patients in the state currently have to pay out of pocket for their prescription pot.

But state Sen. Diane Savino (D-SI/Brooklyn) and Assemblyman Richard Gottfried (D-Manhattan) and pushing a doobie-ous scheme that would require government health-insurance programs such as Medicaid, Child Health Plus, the Essential Plan, Elderly Pharmaceutical Coverage and workers’ compensation to cover weed as they would any other prescription.

“It’s unfair not to cover marijuana when opioids, OxyContin and Ambien are covered,” Savino told The Post. “We have to push the envelope.”

The lawmakers claim it will help battle the opioid epidemic ravaging the state.

“For thousands of patients, medical marijuana is a safer and more effective medication than other drugs, especially opioids,” Gott­fried argued.

But both lawmakers acknowledge the state would likely have to draw from the public purse to cover their plan.

The federal government likely wouldn’t provide financial support for the program because authorities in Washington still classify weed as an illegal drug.

The bill also wouldn’t require private insurers to offer coverage, although Savino says she would support an amendment to mandate that they do.

“Insurance companies are leery because the federal government still considers marijuana an illegal drug,” she said.

Medical marijuana in New York can come in a variety of forms, including tablets and oils that can be vaped, but it can’t be smoked under the current program, which was launched in 2016.

Public health experts are turning to marijuana to help cancer patients and others manage chronic pain as a nonaddictive alternative to opioids, which have fueled an overdose epidemic across the country.

Nearly 1,500 people died in the five boroughs last year because of overdoses — five times as many people who died in homicides — figures from the city’s Health Department show.

Opioids were linked to more than 80 percent of those overdose deaths.

There are 98,101 New Yorkers registered in the medical-marijuana program, but a study found one-third of the patients visited a dispensary only once for weed treatment.

New York lawmakers are under increasing pressure to act as New Jersey quickly moves toward full-scale legalization, which could be in place by next year.

Lawmakers in Trenton are expected to begin debating the matter on Monday, although Democratic lawmakers and Democratic New Jersey Gov. Phil Murphy are still at loggerheads over who would oversee the budding business — the executive branch or a five-person commission.

Meanwhile, Massachusetts began selling recreational marijuana earlier this week.

Gov. Cuomo has said New York will likely legalize pot for all adults in 2019.

Times-Union: As deaths rise, NY lawmakers push for addiction medicine in all state prisons, jails

By Bethany Bump, November 14

NEW YORK — A group of New York lawmakers are seeking support for a bill that would require all jails and prisons in the state to offer medication that has been proven to reduce death among individuals with opioid use disorder.

On Wednesday, members of the Assembly held a hearing on the effectiveness of “medication assisted treatment,” or MAT, in the state’s jails or prisons, and concluded the state falls woefully short when it comes to its use of the evidence-based treatment. Currently only six of the state’s 54 state-run correctional facilities offer MAT, which relies on one of three FDA-approved medications to help curb opioid cravings and stabilize brain function.

“It’s a start, but time is fleeting,” Assemblywoman Linda Rosenthal told state officials after they testified that New York has seen great progress implementing MAT in its correctional facilities in recent years.

“This is a recurring problem,” she continued. “People come into our facilities with a substance use disorder; others develop it while incarcerated. And when they leave, many go back into the neighborhoods they came from and overdose. So I think it’s incumbent on the state to take a giant leap and go for it in all our facilities.”

Roughly 78 percent of all inmates in New York have a diagnosed substance use disorder, according to the state Department of Corrections and Community Supervision. While state officials could not provide a figure for the segment that’s addicted to opioids, it’s safe to assume the number is high, as opioids remain a leading cause of overdose death nationwide.

MAT has been a proven treatment for opioid use disorder for at least three decades, with studies showing it prevents relapse and significantly lowers overdose rates. But it remains controversial, in part because the medications used to curb cravings are themselves powerful and because abstinence-only proponents view any reliance on drugs as a negative.

Supporters, however, note that abstinence-only policies don’t work for everyone and stigmatize those who have gone on to lead normal, productive lives thanks to drugs like buprenorphine and methadone. These so-called maintenance drugs, they argue, save lives by preventing overdose.

Those in the drug reform movement characterize disdain for these drugs as yet another example of how those suffering from mental and behavioral conditions are treated differently than those with medical conditions.

“I hope and I believe that in every correctional facility in the state our inmates with diabetes and high blood pressure and multiple sclerosis have treatment available to them,” said Assemblyman Richard Gottfried, a co-sponsor of the bill. “If there were only six prisons in the state that had diabetes treatment available, nobody would find that acceptable.”

The high rate of fatal overdoses among former inmates has made the rollout of MAT in jails and prisons a key issue for recovery advocates.

2007 study, for example, found that former inmates of Washington State prisons were 12.7 times more likely to die in the first two weeks after their release than the average state resident, with drug overdose the leading cause. And that was in the late 1990s and early 2000s, before the emergence of highly potent fentanyl in America’s drug supplies.

Today, public health experts believe the chances are much higher, as synthetic opioids like illicitly manufactured fentanyl are among the fastest-growing category of drugresponsible for overdose deaths.

Forced to detox before they’re incarcerated, inmates enter jail or prison without the physical dependence on a substance but continue to battle the underlying addiction. Illicit drugs smuggled into these facilities can further enable this addiction — or, if an inmate manages to stay clean behind bars but is exposed to drugs upon release, their lower tolerance greatly increases their chances of fatal overdose.

To help treat the underlying addiction, Sean Byrne, executive deputy commissioner of the state Office of Alcoholism and Substance Abuse Services, and Acting DOCCS Commissioner Anthony Annucci testified Wednesday that 53 of the 54 state correctional facilities offer psycho-social counseling services for inmates battling substance use disorder.

“They’re intense,” said Annucci. “They can last between six and 12 months.”

They also noted that while they’d like to expand MAT systemwide, it would be unwise to move too fast, as the programs currently in place downstate are only pilot programs. Obstacles, such as obtaining agreements with outside treatment providers who are licensed to provide the drugs, still have to be ironed out before a systemwide expansion is feasible, they said.

“I’ve been around a long time — 34 years — in this agency and the worst thing you can do is get excited about a pilot, rush it and then unfortunately have something happen where you lose buy-in from participants,” Annucci said.

Daily News: New York State bill to boost prisoner health care to be introduced following reports of treatment that led to 50 deaths

By Reuven Blau, November 12

Prisoner health care must be significantly improved and staffing levels should be regularly monitored, a state lawmaker said Monday following reports of horrific medical abuses that led to 50 deaths over the past five years.

State Assemblyman Richard Gottfried (D-Manhattan) will introduce legislation to give the state Department of Health more oversight power over prisoner medical treatment. Currently, medical treatment is largely handled internally by the Department of Corrections and Community Supervision.

“People in prison and jail, sort of by definition, are not looked at kindly by most New Yorkers,” Gottfried said. “We also have to realize they are human beings. They are in our custody, and we have a constitutional obligation to protect their health, whether they have done wrong or not.”

The Daily News on Monday reported that a state medical review board concluded 50 prisoner deaths may have been prevented had they gotten better health care.

Commission of Correction review panels repeatedly criticized prison medical staff for failing to complete basic checkups and mental health screenings. In multiple cases, doctors and nurses totally discounted prisoner complaints until they were too serious, according to the death probes.

Gottfried’s proposed legislation will also require state officials to study health care staffing in prisons and issue a report on the issue twice each year.

The number of health care practitioners employed by the department shrank by 3%, according to DOCCS. Some doctors are in charge of 500 or more prisoners.

Marijuana Moment: New York Bill Would Require Medical Marijuana Be Covered By Public Health Insurance

By Tom Angell, October 23

Public heath insurance programs would be required to cover medical marijuana in New York if a new Assembly bill is enacted.

“Cost is the primary barrier to patient access in New York’s medical marijuana program,” reads a memo attached to the legislation. “Medicaid, other public health plans, and commercial health insurance plans do not cover medical marijuana, forcing patients to pay out of pocket. Some patients begin treatment only to stop due to inability to pay, while others turn to the black market.”

“For thousands of patients, medical marijuana is a safer and more effective medication than other drugs, especially opioids.”

The bill, filed on Monday by Assemblyman Richard Gottfried and 17 cosponsors, would add medical cannabis coverage to four publicly funded health programs—Medicaid, Child Health Plus, workers compensation and EPIC, as well as the largely publicly funded Essential Plan.

“For Medicaid and Child Health Plus, there would presumably not be federal matching funds until the federal government changes its policies, but New York’s Medicaid and Child Health Plus programs have always covered people and services for which we do not receive federal match,” the Assembly memo says.

The bill also clarifies that while commercial health insurance programs are not required to cover medical marijuana, they are free to do so. And it would allow state regulators to certify medical marijuana dispensaries as Medicaid providers solely for the purpose of dispensing cannabis.

If enacted, it would be the latest in a series of steady expansions to the the state’s medical cannabis program. Earlier this year, for example, regulators moved to allow medical marijuana to be recommended for any condition for which opioids would normally be prescribed.

Meanwhile, the administration of Gov. Andrew Cuomo (D) is considering more broadly legalizing marijuana. Officials are conducting a series of listening sessions around the state on the topic, and the governor created a task force to draft legalization legislation that lawmakers can consider in 2019.

Gay City News: Legal Pot Movement on Two Fronts This Week

By Nathan Riley, October 19

The Albany County district attorney made an impassioned plea for taxing and regulating the sale of marijuana to adults at a State Assembly hearing October 16, saying ending the war on pot is a logical next step in the process that began in 2004 with the repeal of the draconian Rockefeller era drug laws.

David Soares, who is also the president of the New York State District Attorneys Association, said there is disagreement on this issue within that group but that “several” DAs had similar views. Soares has intensively studied Colorado’s example as the first state to permit adult use of marijuana and emphasized that the new tax revenues from legalization must restore “vulnerable” communities where residents have been arrested by the tens of thousands while pot use by white New Yorkers was overlooked by law enforcement.

“Real Courage,” he told a joint hearing of several Assembly Committees on adult use of marijuana, is about addressing the “aftermath” of the war on drugs, winning the peace with a plan for “reconstruc­tion” of neighborhoods unsettled by mass incarceration. Simply closing the illegal market for pot could have grim consequences; dealers could replace what is on their shelves with opioids.

“If you don’t recycle the money, you’re buying yourself a bigger problem,” Soares warned.

Proposed legislation creating a tax and regulate system provides for community reinvestment. Sponsored by Manhattan Democratic Senator Liz Krueger and Assemblymember Crystal Peoples-Stokes, a Buffalo Democrat, the measure creates a marijuana revenue fund from tax receipts — net of administrative and oversight costs — that would funnel 25 percent to the State Education Department, 25 percent for drug treatment and public education, and 50 percent for community reinvestment.

Specific regulations implementing the legislation would be drafted by a new bureau in the State Liquor Authority, which was established in 1933 to create from scratch a system of legal liquor sales following the repeal of Prohibition. The SLA would repeat this mission by licensing and managing the production and sale of legal marijuana.

A cornerstone of the SLA is a system favoring small business ownership of retail outlets, Krueger told a conference, also held October 16, organized by Capalino+Company, which is recruiting clients that would benefit from a regulated market. Under this approach — which represented a persistent theme touched on at the event that drew roughly 200 people — residents of low-income neighborhoods would be given an opportunity to go into business as retail sellers of legal marijuana.

Billed as the “Cannabis Summit: Developing a Sustainable Cannabis Economy in New York,” the Capalino event featured a keynote addresses by Melissa Mark-Viverito, the former City Council speaker who is now a senior official at the Latino Victory Fund, and Melissa Moore, the deputy state director of the Drug Policy Alliance, a leader in the movement to end drug prohibition.

Krueger’s bill would permit people with marijuana convictions to petition for a review of their criminal justice records. Marijuana convictions complicate the abiity of some to access jobs and scholarships for which they are otherwise qualified.

In his hearing testimony, Soares strongly supported this objective, saying, “We must work to seal and reclassify” previous convictions and “move from stigma to opportunity.”

Krueger voiced particular pride that her bill would respect New Yorkers who object to second-hand smoke. Tenants in smoke-free buildings would be prohibited from smoking pot at home. Doctors, she said with a sly grin, believe that inhaling a burning leaf of any kind is dangerous.

Soares — responding to questions from the Assembly panel chaired by Dick Gottfried from Manhattan, the Health Committee chair, Joe Lentol from Brooklyn who heads the Codes Committee, and Manhattan’s Linda Rosenthal, chair of the Committee on Alcoholism and Drug Abuse — devoted a lot of time to addressing the risks of drivers being stoned. Currently, the police bring charges as soon as they smell pot, but with legalization that trigger would disappear. The Albany prosecutor said police would have to be trained in drug detection, and if a reliable blood test were developed police labs would need additional funding. He recommended that anyone refusing a blood test have their license suspended.

In any discussion of plans for legalizing pot, Krueger acknowledged, the elephant in the room is a proposal from Governor Andrew Cuomo that is likely to be part of the budget he unveils next year. The governor’s wishes would hold center stage in Albany.

PRESS RELEASE: RAND study confirms NY Health expands coverage, net savings

RAND CORPORATION STUDY CONFIRMS: NEW YORK HEALTH ACT “COULD EXPAND COVERAGE WHILE REDUCING TOTAL HEALTH SPENDING”

Think tank concludes: New York Health would cover all New Yorkers with net health care savings

Bill sponsors Senator Rivera and Assembly Member Gottfried will continue to push for the passage during the next legislative session

            State Senator Gustavo Rivera and Assembly Health Committee Chair Richard Gottfried, sponsors of the New York Health Act in the New York State Legislature, welcomed the findings of a study of the bill by the highly-regarded, independent, non-profit RAND Corporation. The study confirms that New York Health would reduce total health care costs, while increasing spending on actual care rather than administration and insurance company profit; provide full health coverage to every New Yorker; save substantial money for almost all New Yorkers; and generate a net increase in employment due to increases in disposable income.

El Diario: Vientres de alquiler al banquillo en Nueva York

By Pedro Frisneda, May 24

Las leyes que rigen los “contratos de madres sustitutas”, conocidos más popularmente como “vientres de alquiler”, son muy antiguas, estrictas y punitivas en el estado de Nueva York.

Por esta razón, miembros de los comités de Salud y Judicial de la Asamblea estatal de Nueva York realizaron una audiencia pública este jueves para analizar estas leyes que datan de casi 30 años atrás.

En 1992, el estado de Nueva York aprobó el Artículo 8 (Secciones 121-124) de la Ley de Relaciones Domésticas, que establece que los “contratos de crianza sustituta” con compensación (pago a la mujer que queda embarazada) son contrarios a la política pública de este estado, y son nulos e inaplicables.

Este artículo fue promulgado luego de un caso judicial muy publicitado y polémico en Nueva Jersey, conocido como “Baby M”, el cual involucró a una mujer casada que firmó un contrato por $10,000 con una pareja casada por el que aceptó quedar embarazada a través de inseminación artificial. El acuerdo estipulaba que, luego de nacer el niño, ella renunciar al mismo para entregarlo a la pareja. Sin embargo, después del nacimiento, la mujer se negó a renunciar al bebé.

Aunque originalmente un tribunal de primera instancia de Nueva Jersey decretó que la mujer cumpliera con lo exigido en el contrato de subrogación, una apelación ante el Tribunal Supremo del Estado Jardín declaró “inaplicable” el contrato frente a la política pública de ese estado.

Por antecedentes como éste, los participantes en la audiencia pública, encabezada por los asambleístas Jeffrey Dinowitz y Richard Gottfried, examinaron las formas en que la práctica de la maternidad subrogada o vientre de alquiler ha cambiado desde la aprobación de la prohibición estatal de los contratos de subrogación compensados en 1992.

Chronogram: Can New York Pull Off Single-Payer Healthcare?

By Wendy Kagan, June 1

About 10 years ago, when she was 44, Eve Madalengoitia had a hunch that something was wrong. She was experiencing concerning symptoms of the lady sort, and her doctor said it’s probably nothing, but let’s get you an MRI to be sure. At the time, she was working as a consultant from her home base in Poughkeepsie, writing grants and fundraising for nonprofits; her husband was a self-employed artist. They didn’t have health insurance. The expense of an MRI (ballpark $2,600) was so daunting that Madalengoitia convinced herself that her symptoms were nothing to worry about. She was young and healthy, wasn’t she?

A few months later she got insurance through a new job, so she went ahead and scheduled the exploratory test. Soon after, she received some news that no one expected. “I had aggressive, high-grade uterine cancer, which was not common in women my age,” she says. “I needed immediate surgery, chemo, and radiation.” Thankfully, her insurance paid for it, and now she is NED (no evidence of disease). But she is keenly aware of the what-ifs. “Without health insurance, I probably wouldn’t have gotten the test and the cancer would have spread,” Madalengoitia says. “I wouldn’t be here to tell my story.”