Tag health care

The Nation: “Richard Gottfried’s Health Care Crusade Is Paying Off”

Richard Gottfried’s Health Care Crusade Is Paying Off

The NY State Assembly member has spent 27 years advocating for statewide health care. Now, his colleagues in Albany are finally catching up.

By Raina Lipsitz

MARCH 1, 2019

New York Assemblyman Richard Gottfried speaks at a news conference at the Capitol in Albany on April 28, 2015. (AP Photo / Tim Roske)

Two posters hang on the door of New York State Assembly member Richard Gottfried’s Albany office. One has a picture of Dr. Martin Luther King Jr., underneath a quote: “Of all the forms of inequality, injustice in health care is the most shocking and inhumane.” The other says “Healthcare is a Human Right!” and urges the reader to “Pass the New York Health Act.”

First elected at age 23, Gottfried is now 71 and one of the longest-serving legislators in New York history. He has sponsored the New York Health Act in the Assembly since 1992. The Assembly has passed the bill, which would establish single-payer health care in New York, in the last four legislative sessions; now that the State Senate is also under Democratic control, it has a real opportunity to become law.

Gottfried is optimistic. After all, his Senate colleagues not only support the bill; many of them actively campaigned on it. While granting that there would be “nervousness” to move forward on the part of Senate leadership, he believes that, given the level and consistency of support for single-payer health care “not only among self-identified Democrats, but particularly among independents” and the number of senators who cosponsored the Senate version of the bill, “there will be vocal and negative voter reaction” if the Senate fails to “fulfill its promises.”

Still, even for those who say they support it, the bill isn’t as easy to sell constituents on as you’d think. In a recent interview, Assembly member Catalina Cruz told me she is for the bill, but shares concerns raised by “union colleagues,” like whether it would negatively affect certain contracts and whether retirees who have paid into the system will continue to benefit if they move out of state.

“First of all, a large part of labor in New York very strongly and actively supports the bill and has for some time,” Gottfried said when presented with these concerns. “The New York State Nurses Association was part of a group that, 28 years ago, persuaded me that I should be for single payer.”

Major unions that support the bill, he said, include 1199, the health-care workers; 32BJ, the building service employees; and RWDSU, the retail workers, as well as “a large part of” the CWA and the UAW. Some union leaders, however, argue that they’ve ceded wages and benefits in exchange for union health plans and the New York Health Act would take away a key bargaining chip.

To Gottfried, that “misses the point.” Nearly all health-care plans now, union or otherwise, have deductibles, co-pays, restricted networks, and out-of-network charges, he pointed out. In fact, he said, “I’ve never heard of any union health plan that is as good as the New York Health package.”

In New York City, Gottfried added, municipal employees have had a deal for more than 30 years under which the city pays 100 percent of the premium. Under the New York Health Act, the employer has to pay at least 80 percent of the payroll tax that will fund the plan. Gottfried tells public-sector union members in New York that if they can get their employer to pay 100 percent of about $20,000 in premiums, they should be able to get the city to pay 100 percent of $6,000 to $8,000, and push for the savings to be used to increase wages and non–health care benefits.

“Their answer…is often something like, ‘We’ve already negotiated for 100 percent of the premium; why should we have to bargain again?’” In a tone of mild frustration, Gottfried answered the hypothetical question: “Because it would put more money in your members’ pockets…and get them better health coverage.” Furthermore, he said, “Public employees who retire and move out of state still get their retirement benefits, including retiree health coverage…. we put that explicitly in the bill.”

Gottfried has spent nearly 30 years making the case for the New York Health Act; he can recite the pros and counter the cons in his sleep. The insurance industry’s claim that only 5 percent of New Yorkers lack coverage, and the problem can be solved simply by getting those people on Medicaid “completely ignores the reality that 95 percent of New Yorkers who have health coverage are constantly being knocked around and shortchanged and abused by that coverage,” Gottfried said. There is no way to fix the current system without eliminating insurance companies, because the money New York would save by doing so is “absolutely essential to delivering the full benefits” of single payer, such as expanding coverage, including long-term care coverage, and protecting patients from deductibles and out-of-network charges.

“Anybody who tries to sell the snake oil that getting the last million New Yorkers into health insurance is all we need to do,” he said, “is deliberately or negligently missing the point.”

The point, to Gottfried, is that single payer is a moral imperative, which is why he sees many of the questions skeptics raise as nitpicky or irrelevant. But he doesn’t dodge one of the biggest: Can the New York Health Act be funded without raising taxes? “To do it, you need to convert premiums and other out-of-pocket spending into a smaller number that is paid through taxes,” he acknowledged. “If you focus on whether we’re spending more money on taxes, then you’ll say we’re spending more money on taxes. If you focus on how much New Yorkers spend, and how much of what they spend actually goes for health care, and how much they get to keep in their pockets, then [you’ll see that] we’re saving New Yorkers money, and getting them better health care.”

As for the fears of Democratic leaders like Governor Andrew Cuomo and Senate majority leader Andrea Stewart-Cousins, both of whom have publicly signaled that they won’t raise taxes, Gottfried said, “A pledge not to raise taxes should not prevent you from lowering the cost burden on New Yorkers…. If you can save New Yorkers billions of dollars by converting spending to the public sector, that shouldn’t violate anybody’s pledge.”

Asked how serious Cuomo is about supporting single payer—the governor says he likes the idea, but has hardly been a full-throated proponent—Gottfried remains optimistic. “Unlike about 48 other governors. Governor Cuomo says single payer is the right thing to do,” he says. But what about the difficult, practical work of making it happen? “I’d be surprised if the governor’s thinking evolves in the next couple of months,” Gottfried allowed, “but if and when the bill is on the floor of the State Senate, ready to be passed, I think we will start having serious conversations with the governor.”

For the bill’s critics, another sticking point is the Trump administration’s likely refusal to approve state waivers for single-payer health care. But, although it would “certainly be simpler to run the New York Health plan with federal cooperation, and it would even save the federal government money,” Gottfried said, “we can still run the New York Health Act by various mechanisms around or through Medicaid and Medicare and the Affordable Care Act.” The bottom line: “We can do it legally without federal waivers.”

What can be done to help get the bill to a vote? Gottfried said that he and Senator Gustavo Rivera, the bill’s Senate sponsor, need to continue answering questions and “explaining the merits of the bill,” as well as aggressively reaching out to groups that have questions about it and encouraging them to “come tell us” if there’s anything they think needs to be nailed down or changed. Gottfried cited productive discussions with labor unions, physicians, and the hospital community. Community organizations and grassroots activists also need to “keep up their advocacy,” he said, and “keep the fires lit under legislators.”

Given the national political climate, Gottfried believes it’s especially critical for states that can “move aggressively forward with a progressive agenda” to do so, in part because of the difference it can make nationally. The Children’s Health Insurance Program began in Minnesota; several years later, it was adopted by New York. “And in almost no time,” he said, “every state in the union had a children’s health-insurance plan.” New York can now do the same for single payer. If a couple of states enact single-payer legislation, “I think it’s only a matter of time before it becomes nationwide.”

Raina Lipsitz has written about gender, politics, and pop culture for a variety of publications, including Al Jazeera America, Jewish Currents, and the online editions of The Atlantic, Cosmopolitan, and Glamour.

VICE News: This Brewing Healthcare Battle Is a Preview of the Medicare for All War

By Harry Cheadle, 12/13/18

Last month, Democrats achieved an historic win in New York, flipping control of the state senate and thus taking control of the entire government, upending a weird status quo during which a group of breakaway Democrats allowed the Republicans to control the legislature’s upper chamber. Now that they actually have the power to pass laws in one of the most Democratic states in the country, the possibilities seem intoxicating for the left: Abortion access could be codified into law, the subways could finally be fixed, the state’s byzantine election laws could be updated, and New York could commit to fighting climate change.

But right near the top of any progressive wish list is the New York Health Act, the state’s version of Medicare for all—which is to say universal, government-provided—health insurance. Single-payer healthcare, as such systems are also called, has been a left-wing lodestar for generations. If the NYHA passed, it would make New York the first state in the union to guarantee free access to healthcare (and freedom from fear of health-related bankruptcy) to all of its residents, including undocumented people. 

If passed and smoothly implemented, NYHA could be not just a way to improve the lives of New Yorkers but a model for the rest of the country as it debates the merits of Medicare for all, a policy backed by Bernie Sanders and many other potential 2020 presidential contenders. But now that Democrats can actually pass the NYHA, single-payer supporters are facing a fight that could pit them against not just the insurance industry but a host of Democratic constituencies and leaders—a preview of the contentious debate over healthcare that might follow victories in 2020.

The foremost obstacle is the powerful medical industry lobby, which will likely deploy the usual counterattacks—think the “death panels” of the Affordable Care Act debate, or the fear-mongering “Harry and Louise” ads that helped scuttle reform in the 90s. Then you have Democratic lawmakers who may hesitate to back a transformative proposal that would raise taxes on a lot of people, a governor who doesn’t seem particularly warm to the idea, a hostile federal government, and potential lawsuits from employers. While the coming NYHA battle represents a possible turning point in the history of healthcare politics, it won’t be a pretty sight.

Yet if single-payer advocates could get past all that, they’d have a roadmap to victory in other states—and a model that could be replicated in DC.

Richard Gottfried, the chair of the New York State Assembly’s Health Committee and the chief architect of the NYHA, recently explained what it would look like. “It would create universal complete health coverage for every New York resident without premiums, deductibles, copays, or restricted provider networks,” he said over the phone. The bill would pay for this by pooling the money the state gets from the federal government for programs like Medicaid and Medicare, and also by raising taxes. “There would be one tax on payroll income, predominantly paid by employers, and a parallel on unearned income like dividends, capital gains,” Gottfried explained.

This would transform the way New Yorkers pay for healthcare—instead of giving premiums to insurers, they’d be getting taxed—and according to a recent studyby the RAND Corporation, overall health spending would drop by $80 billion, or 2 percent, by 2031, even as the roughly 1.2 million currently uninsured New Yorkers gained access to care. Gottfried said he didn’t necessarily agree with RAND’s report (for one thing, his bill as currently written does not specify tax rates, so RAND analysts made assumptions about what those rates would be) but NYHA backers have trumpeted the finding that the bill could drive costs down.

The arguments against the NYHA are echoes of the normal arguments marshaled against single-payer healthcare. Realities of Single Payer, an anti-NYHA organization made up mostly of business and health insurance interests, warns of high taxes, long wait times for care under a government-run system, and job loss in the insurance industry. (Through a spokesperson, Realities of Single Payer said in a statement that “rather than throwing out a functioning system for a very uncertain future, there should be a greater focus on covering the remaining uninsured New Yorkers.”) Katie Robbins, the director of Campaign for New York Health, a coalition of unions, doctors, and left-leaning groups, called these warnings “talking points that are used to create fear” and noted that this year’s election proved single-payer was popular statewide.

“There’s been a longtime narrative, a false narrative in my opinion, that this is an issue that only New York City liberals care about,” Robbins said. “But what we saw reflected in the results is that Senate candidates outside of New York City—Long Island, Hudson Valley, upstate in Syracuse—who ran on the New York Health Act, not just standing on it, but making it a priority of their campaign… handily won their elections.”

Those election results create pressure on Democrats, according to Hank Sheinkopf, a longtime Democratic consultant in the state who has worked for everyone from Andrew Cuomo to Michael Bloomberg to Bill Clinton: “They have to do something.”

The NYHA—which Gottfried has introduced into the Assembly every year since 1992—has passed the lower legislative chamber in each of the past four years. But even with increased support in the Senate, its path to becoming law is tricky to say the least. The top Democrat in the State Senate, Andrea Stewart-Cousins, seemingly embraced the NYHA last year, but after the election said Democrats wouldn’t raise taxes. And while Governor Andrew Cuomo said the NYHA was a good idea “in theory” during a debate against his left-wing primary challenger Cynthia Nixon, he was also skeptical of the cost and said he’d like to see single-payer healthcare be implemented on a federal, rather than state, level. (Neither Stewart Cousins nor Cuomo responded to requests for comment left with their offices.)

Meanwhile, unions remain a powerful force in state politics—especially in New York City—and some might oppose the NYHA because members generally have good insurance they won through negotiations and may not want to replace that with government-provided plans. Other barriers include the Trump administration potentially refusing to grant waivers to New York that some say would be necessary for the plan to be implemented (Gottfried disputed that such waivers would be needed) and potential lawsuits from employers under a federal statute called ERISA that protects employers who choose to pay insurance claims themselves.

It’s also not even clear the NYHA will pass the Assembly when the legislature goes back into session in January. “It’s like starting from scratch because the political dynamics changed so much,” Robbins said. In other words, now that everyone knows the NYHA may actually become law, some Democrats may have second thoughts about voting for it.

Gottfried, for one, seemed confident of the bill’s chances. “I fully expect the Assembly to pass the bill again,” he said. He added that he and NYHA Senate sponsor Gustavo Rivera were talking to stakeholders to flesh out the details of the bill and add “additional provisions” to speed its passage through the Senate. They were also “working to convince” Cuomo that the NYHA was the way to go, Gottfried said.

If Gottfried and his allies can pass the legislation quickly in early 2019, it will put Cuomo on the spot, former Assembly member Richard Brodsky—a frequent Cuomo critic—argued in a recent Albany Times-Union column: “Anything short of immediate support puts him under the same kind of statewide and national pressure, intensified by any presidential ambitions he may have.” It’s safe to say that reticence on Cuomo’s part will spark widespread progressive anger. “If Andrew Cuomo’s first appearance in 2019 is to put a bullet through the head of single-payer, it will have political consequences,” Brodsky said in an interview.

If the dynamics of passing the NYHA seem complicated, welcome to a preview of what national politics may look like in 2021. If Democrats can retake control of the federal government in the 2020 elections, they will have likely done so while promising single-payer healthcare, just as New York Democrats did. But passing a bill through Congress will require selling it to voters in the face of intense opposition from insurance companies and the medical industry, and also navigating the push and pull of other priorities like climate change. Medicare for all can seem like a common-sense solution to the country’s patchwork, inhumane, and overpriced healthcare system when advocates talk about it, and it’s popular in many polls. But history suggests the politics turn thorny when government-provided health insurance becomes a real possibility.

“You’re treading into unknown territory here. There’s no map for how to get this down the road.”
–Richard Brodsky

Recent single-payer pushes have come tantalizingly close in other states, only to fail, sometimes in dramatic fashion. In 2014, Vermont Governor Peter Shumlin pulled the plug on a single-payer bill, saying his state couldn’t pay for it. Two years later, a Colorado ballot measure that would have created a single-payer system was rejected by voters after a confusing election-season scrum—abortion-rights groups opposed the measure because the new system wouldn’t have covered such procedures. Last year, a California single-payer bill was effectively axed by Assembly Speaker Anthony Rendon, who said it was “woefully incomplete” and didn’t describe how the system would be paid for. (Single-payer advocates were so incensed they subsequently attempted to remove Rendon from office.)

Gottfried said that unlike the California bill, the NYHA clearly describes where the funding would come from, and unlike Vermont, New York has enough wealth to make paying for a single-system more practical. But other Democratic factions, including some unions and the governor, may not be persuaded by those arguments, setting up a fight between single-payer advocates and the rest of the party, with lawmakers caught in the middle.

As Robbins pointed out, six of the eight former members of the Independent Democratic Caucus—the rogue Democrats who gave control of the Senate to Republicans—lost primaries to grassroots opponents earlier this year, indicating the same base that is demanding single-payer has some teeth. “I would think that the folks who are in elected office now should really figure out how to deliver what they promised in their campaigns,” she said, “because clearly there is a motivated base with high expectations and now the electoral muscle to make them pay at the polls if they don’t deliver.”

That said, Robbins added that “there’s absolutely no guarantee” the bill will pass, and a lot could depend on pressure from activists. Brodsky suggested NYHA sponsors consider a “toned down” bill that is less costly and helps manage the transition so as to address criticisms about job losses in healthcare. He also said Gottfried had the “political shrewdness” to get it done.

“You’re treading into unknown territory here. There’s no map for how to get this down the road. It’s an enormous challenge,” Brodsky said, adding, “the political climate has changed from roughly unfavorable to roughly favorable. That’s not chopped liver.”

The battle over the NYHA will be a state-level political knife fight, but the stakes could be even higher than the future of healthcare in New York. The hope among advocates is that once a single-payer system gets a foothold in one state, it can be exported around the country. The passage of the NYHA would not be the end point of the movement, but the beginning of a new chapter.

“Social progress in this country historically, usually begins at the state level,” Gottfried said. “Our labor laws, a lot of our consumer protection laws, public support for healthcare for poor people, the child health insurance program—all began at the state level.”

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.”

City & State: Has single-payer health care’s time finally come?

By Rebecca Lewis, 12/9/18

With their new majority in the state Senate, Democrats are finally preparing to pass long-stalled progressive legislation. Perhaps the most expansive and expensive item on the 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 one study estimated it would cost $139 billion in 2022. Many incoming lawmakers campaigned on the promise that they would get it done, but even if it does pass, it likely won’t be implemented right away.

The Democratic-controlled Assembly has passed the legislation every year since 2015, but in that time it never came up for a vote in the state Senate thanks to the Republican majority. Now that the chamber will be in Democratic hands, the legislation seems far more likely to pass.

A single-payer health care 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 single-payer 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. In a recent interview on WCNY, he expressed doubt that the state would be able to finance the $150 billion program, since that would nearly double the state’s budget. “There will be rhetorical desire to do things,” Cuomo said. “Governmentally there will have to be a reality test to get all things to fit in the budget.”

Although this sounds like it could put a serious damper on the future of the legislation, Gottfried called the governor’s stance “a perfectly reasonable position for a governor,” noting that Cuomo is already far more progressive than other governors by simply supporting the concept of single-payer health care. Gottfried said he has been in talks with the administration and expects those conversations to accelerate now that passage is more realistic.

Gottfried said that stakeholders who have remained quiet in the past are coming forward to voice their concerns. Most recently, Gottfried and state Sen. Gustavo Rivera, the bill’s Senate sponsor, have been negotiating with New York City public unions over concerns that union members would pay more or have fewer benefits. “What we’re talking about is modifications just to accommodate concerns that people are raising now that it looks like it can easily pass both chambers this session,” Gottfried told City & State. “People who we haven’t heard from are starting to come forward and say, ‘Gee, could you add this nuts and bolts?’ or ‘Tighten it up here.’’”

Gottfried said making tweaks to the bill will continue at least a couple weeks into the session, which begins in early January. However, Gottfried said that he and Rivera will not make any major structural changes to the bill and said the Assembly is “well positioned” to pass the bill this upcoming session.

People who we haven’t heard from are starting to come forward and say, ‘Gee, could you add this nuts and bolts?’ or ‘Tighten it up here.’ – Assemblyman Richard Gottfried

Rivera expressed more caution, telling City & State that he feels confident that the chamber will engage in meaningful conversations about the bill, which it has never done before, but did not want to make any promises about a timeline for passage. “This is not a simple thing that we’re trying to do,” Rivera said. “We want to make sure that we don’t put anything up for a vote, to be signed by the governor, unless it’s ready to go.”

Bill Hammond, a health policy expert at the right-leaning Empire Center for Public Policy, argued that no amount of change to the New York Health Act would actually make the legislation viable. “I think (Gottfried and Rivera’s) posture right now is not to acknowledge the sacrifice, it’s to make it even more attractive to whatever interest group thinks they’re going to lose,” Hammond told City & State. He added that any changes would likely add to the already astronomical cost of the bill.

But Gottfried maintained that a single-payer system will lead to lower overall health care spending despite the introduction of a new payroll tax because the average New Yorker would no longer pay insurance premiums and copays. He cited the Rand Corp. study, commissioned by the New York State Health Foundation, which found total health care spending could be lower under the New York Health Act than under the status quo. “To me, the issue is not about where your check goes,” Gottfried said. “What people really care about is how much are they going to have to spend, and how much they will be able to keep under the New York Health Act.”

However, Hammond pointed out that since there is no precedent for the system in the country, the details of the new tax plan have not been worked out yet and it is hard to accurately predict the cost of the program, so the Rand study could be wrong. He added that it also hinges on the federal government providing waivers to in order to divert Affordable Care Act, Medicare and Medicaid funding into the single-payer system, an unlikely prospect with the current administration. “There’s all kind of doubt and uncertainty about who’s going to pay more and who’s going to pay less,” Hammond said.

Rivera dismissed the idea that the New York Health Act depends on receiving those federal waivers, saying they would be helpful, but not necessary. “We believe, both my colleague and myself, believe that there are ways within the system that we could actually extend the New York Health Act as a wraparound service that would ultimately not require waivers,” Rivera said. He added that since the single-payer system would take years to put into place, he remained hopeful that a different, more sympathetic administration would be in the White House by then.

Another sticking point in evaluating and passing the New York Health Act is the fact that the previous legislation contained no specific language on tax rates for the proposed payroll tax, forcing Rand to use a hypothetical tax schedule. Gottfried said no language about tax brackets will be added to the legislation that he and Rivera will introduce and that it will be worked out after the bill’s passage since the program will take years to implement. He added the absence of this information will not pose an impediment to passage and that it could be easily added in if it becomes necessary.

Despite the many obstacles the legislation appears to face, Gottfried said that he and Rivera have learned from their previous mistakes, such as not including a revenue stream, and they remain confident New York will lead the country in single-payer health care. “Anything has to start with somebody,” Gottfried said. “And New York is ideally suited to be the state that begins single-payer coverage.”

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.

Crain’s: At hearing, City Council gives warm reception to single-payer

By Jonathan Lamantia, 12/7/18

The City Council seems likely to pass a resolution endorsing a state single-payer health care bill after a hearing Thursday in which health committee chair Mark Levine fervently supported such a system and criticized its detractors.

Levine derided the status quo in health care, which costs more per capita in the U.S. than in other developed countries without better outcomes. He said that while he supports a national approach, it is unlikely to be taken up by the Trump administration.

“New York need not and must not stand still in the face of inaction at the federal level,” he said.

The bill would create a statewide public fund to cover all New Yorkers with no out-of-pocket costs. It received broad support at the hearing from nurses, physicians, social workers, immigrant advocates, disability rights activists and community groups.

The New York Health Act has passed the Assembly four consecutive years, and with the Democrats taking control of the Senate in January, there is an increased chance of the bill’s passage next year. Gov. Andrew Cuomo has said he believes the federal government is best positioned to take up the issue.

Assemblyman Richard Gottfried and state Sen. Gustavo Rivera plan to reintroduce the bill in January to address fiscal concerns. One new wrinkle, which Gottfried previewed Thursday, is that it will incorporate long-term care, such as nursing home and home care.

“No New York family will have to wipe out their savings, and no family member will have to give up a career to provide long-term care for a loved one,” he said at the hearing.

A coalition called Realities of Single Payer, which includes the state Health Plan Association, state Conference of Blue Cross and Blue Shield Plans, and the Business Council, said in a statement that the hearing was “nothing more than political theater” and a single-payer system would result in higher taxes and decreased access to care.

An analysis in August by Rand Corp. estimated that the state would need to raise $139 billion more in taxes by 2022 to fund the program, an 156% increase above expected levels. The research organization proposed one possible tax structure, as the current bill lacks one. Under its proposal, households earning up to $290,000 would pay a smaller percentage of their income toward health payments, including the new taxes.

The analysis assumed the state would receive a waiver from the federal government to deliver Medicare and Medicaid benefits through its own program while still receiving federal funds. Centers for Medicare and Medicaid Services Administrator Seema Verma has said she wouldn’t approve such a waiver.

David Rich, executive vice president of the Greater New York Hospital Association, spoke in opposition to the bill at the hearing. He noted the coverage gains New York has made to lower its uninsured rate to 5% from 10% in 2013 and said there were other ways to insure the remaining 5%. He said he worried a single-payer system would provide lower reimbursement to hospitals than the current system.

“Yes, we must cover the remaining 5% of New Yorkers who are uninsured. Yes, we should make health care affordable,” he said. “We can do this without the disruption we think would be caused by a single-payer system.” 

New York Times: 2 New Yorkers Erased $1.5 Million in Medical Debt for Hundreds of Strangers

By Sharon Otterman, December 5, 2018

Carolyn Kenyon, left, and Judith Jones, both of Ithaca, N.Y., raised $12,500 and sent it to a debt-forgiveness charity, which then purchased a portfolio of $1.5 million of medical debts on their behalf. Credit Heather Ainsworth for The New York Times

If a slim, yellow envelope with a Rye, N.Y., return address lands in your mailbox this holiday season, don’t throw it out. It’s not junk.

Some 1,300 such envelopes have been sent to New Yorkers around the state, containing the good news that R.I.P. Medical Debt, a New York-based nonprofit organization, has purchased their medical debt — and forgiven it.

Last spring, Judith Jones and Carolyn Kenyon, both of Ithaca, N.Y., heard about R.I.P. Medical Debt, which purchases bundles of past-due medical bills and forgives them to help those in need. So the women decided to start a fund-raising campaign of their own to assist people with medical debt in New York.

Over the summer months, the women raised $12,500 and sent it to the debt-forgiveness charity, which then purchased a portfolio of $1.5 million of medical debts on their behalf, for about half a penny on the dollar.

Ms. Jones, 80, a retired chemist, and Ms. Kenyon, 70, a psychoanalyst, are members of the Finger Lakes chapter of the Campaign for New York Health, which supports universal health coverage through passage of the New York Health Act.

“The way sort of opened,” Ms. Jones said. They cast a wide net for donations, she said, explaining to people that the campaign was only a short-term fix for the larger problem of out-of-control medical costs.

Many people take on extra jobs or hours to afford health care, and 11 percent of Americans have turned to charity for relief from medical debts, according to a 2016 poll conducted by The Times and the Kaiser Family Foundation.

The 1,284 New Yorkers who had their debts forgiven live in 40 of the state’s 62 counties, from Westchester to Chautauqua. The sources of the debt were some 130 hospitals and branches that had provided medical services, R.I.P. Medical Debt said.

“I like doing this much more than I liked doing collecting,” Mr. Antico said.

R.I.P. Medical Debt had its first star turn in 2016, when John Oliver did a segment on his HBO show “Last Week Tonight,” in which he paid $60,000 to forgive $14.9 million in medical debts through the charity. About 9,000 people received the yellow forgiveness envelopes as a result.

Since then, other high-profile efforts to forgive debts through the charity include fund-raisers sponsored by NBC and Telemundo affiliates.

In all, the organization says its donations have forgiven $434 million in medical debt so far, assisting some 250,000 people. That remains only a fraction, though, of the more than $750 billion in past-due medical debt that it says Americans owe.

“It is a drop in the bucket,” Mr. Antico said.

R.I.P. Medical Debt specifically seeks to buy the debts of people who earn less than two times the federal poverty level, those in financial hardship and people facing insolvency.

It purchases the portfolios at a steep discount, a penny or less on the dollar. These bills have typically passed through several collection agencies and months or years of collections. The people, who do not know they have been selected, receive the debt relief as a tax-free gift, and it comes off their credit reports.

Mr. Antico said he thought of his charity as a “resolutionary, not a revolutionary” effort, one that offers people relief, but that cannot solve underlying issues like high medical costs. Through personal data associated with the debt accounts, they are able to target specific classes of people, such as veterans, to relieve their debts.

“I do like the idea that people do not have to ask for help,” he said. “The random act of kindness is kind of a cool thing.”

The envelopes from Ms. Jones and Ms. Kenyon’s gift went out in November, but new letters are going out all the time. And don’t worry. Even if you throw your yellow letter out, your debt is still forgiven. You just might not know about it until the next time you run your credit.

Thebody.com – New York State May Soon Finally Eliminate Explicit Consent From HIV Testing in Care Settings

By Tim Murphy, November 29

Laws about HIV testing have created decades-long controversy in New York State, pitting health officials who want virtually universal HIV testing against advocates — especially those who remember a darker, more discriminatory time — concerned about the privacy and protection of patients. It was that concern, after all, that in 1988 led to a stringent law requiring that health providers obtain from patients signed consent for HIV testing separate from consent for all other routine tests. And it was that same concern that, in the mid-2000s, led to mighty pushback from advocates when then-NYC health commissioner Tom Frieden tried to downgrade the law from written consent to mere oral consent, with the provider noting as much in their chart. That change did not occur until 2014.

But now, more than a decade later, there is solid evidence not only that early HIV detection and treatment means better long-term health outcomes, but that steady treatment makes people unable to spread the virus. It appears that most of the HIV advocacy community in New York City and the state at large now agree that the current law still obstructs testing for health providers — largely because they find it awkward asking patients if they can test for HIV.

These advocates agree that levels of testing high enough to truly end the state’s HIV epidemic cannot be achieved unless everyone who walks into an emergency room or primary care setting is routinely tested, with no notice to patients except for a sign on the waiting-room wall telling them they can opt out if they speak up and say so. And they are ready to lobby for that change with the state legislature in Albany next year.

On October 31, at the Brooklyn offices of Housing Works, representatives from that agency, Montefiore Medical Center, the large LGBTQ health provider Callen-Lorde, Bronx and Brooklyn Legal Services, the Latino Commission on AIDS, the National Black Leadership Commission on AIDS, Harlem United, the LGBT Center, Boom!Health, and other organizations met. According to Housing Works cofounder Charles King, “I think we came to a working consensus that we want to move HIV testing forward in a routine way.”

King said that the next step would be another meeting in which constituents write a rough draft of proposed bill language that would mandate that health facilities do routine HIV testing and that they post that information clearly in waiting or other public areas, letting patients know they must explicitly refuse HIV testing in order to not be tested.

More than a decade ago, Housing Works was among the leading voices against such a move, engaging in a sustained public protest against Frieden’s efforts that created acrimony between the city health department and much of the city’s HIV/AIDS services community. Thirteen years later, says King, “Less than 10% of all HIV-positive people in New York State don’t know their status,” and many of them are those whose only point of contact with health care is a visit to the emergency room — hence the need to test everyone in those settings.

“It’s imperative that we identify these folks and get them into care if we’re going to not only save their lives but stop all new infections of HIV in New York State,” says King.

He is part of the state’s Ending the Epidemic initiative, which aims to get new HIV infections in New York to 750 or below by 2020, as well as to make sure that the vast majority of all New Yorkers with HIV are both in regular care and virally suppressed on treatment. These are all necessary factors to effectively end the AIDS epidemic in New York State, historically the nation’s worst.

“In recent years, we’ve learned that the sooner someone with HIV starts on treatment, the better their outcomes,” King says. “We’ve also learned that someone who’s virally suppressed can’t pass on HIV. Those are huge game-changers that have tipped the balance in terms of whether it’s worth intruding on someone’s privacy.”

Donna Futterman, M.D., longtime director of the Adolescent AIDS Program at Montefiore, agrees. She’s long called for getting rid of requiring explicit consent from patients to HIV-test them. “The current stipulations are a proven barrier to more people knowing their status,” she says. “We want it to be part of a routine blood panel. Why do we still need HIV exceptionalism when it comes to testing? No one says, ‘Oh, we’re screening you for cancer,’ but often, routine tests are how you start to find cancer.”

She continues: “With HIV right now, a lot of nurses use unverbalized judgment on who they ask to be tested, based on race, age, or who they think is gay. They shouldn’t have to make that call. Thirty-five years into this epidemic, it’s time for us to let go of some of our old notions, especially now that we have the blueprint to ending this epidemic, and testing is the first piece of that.”

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.