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NY Daily News Op-Ed: A Hit to Safety-Net Health-Care Providers We Must Prevent

New York Daily News, December 14, 2020

By Richard N. Gottfried, Brad Hoylman, Gustavo Rivera and Linda B. Rosenthal

Many of New York’s health-care providers are in crisis. COVID-19 has increased the cost of providing care and cut their income because people are postponing care. This is on top of the fact that many health-care providers that rely on Medicaid have been on painful austerity budgets for years due to government cuts. Then, in April, Gov. Cuomo’s state budget slashed Medicaid even more.

As if that was not enough, one little-noticed action in the budget changes how Medicaid pays for prescription drugs. It will financially cripple our most vulnerable safety net providers and leave their patients without care.

Here’s the story. The vast majority of Medicaid recipients are required to get their coverage, including prescription drugs, from a Medicaid managed care plan. Each managed care plan does its own price negotiating with drug manufacturers. A small number get their Medicaid coverage directly from the state, without a managed care plan, and the state pays directly for their drugs, through its “preferred drug program.”

This year’s state budget “carves out” all prescription drugs from Medicaid managed care coverage and requires all Medicaid patients to get their prescription drugs directly through the state.

Like many small business owners, local baker and trained chef Samantha Hamilton had to figure out how to keep her home-based business, The Sugar Shack Bakery, alive during a…

In many ways, this is a good idea. The state will be negotiating drug prices for a much bigger group of patients than any one managed care plan. This will mean lower prices. And the preferred drug program gives patients and their doctors more choice of drugs than managed care plans do. For years, we’ve advocated getting Medicaid managed care plans out of the picture for drugs. (The NY Health Act, our single-payer bill, would get all insurance companies out of the whole picture for all of us, but that’s for another article.)

However, there is a serious problem in this plan. Community health centers, HIV providers, sexual health clinics, many rural hospitals and other safety net providers currently participate in a federal program called 340B, which allows them to purchase prescription drugs at a significantly reduced price. These providers rely on their 340B savings to “stretch” their Medicaid funding to pay for health care for the people they serve. The catch is, under federal law, this only works for drugs purchased under Medicaid managed care.

340B was created in 1992 by Congress “to stretch scarce…resources as far as possible, reaching more eligible patients and providing more comprehensive services.” It guarantees dramatically lower drug prices for the providers that are covered. In New York, these providers are all non-profit groups.

The money trail is complicated (like almost everything involving prescription drugs), but the bottom line is: If New York State shifts Medicaid drug coverage away from managed care, the way it was done in the budget, these non-profit safety-net providers will lose hundreds of millions of dollars they now use for patient care.

If this change goes ahead, the state and the federal government will pocket the savings. The benefit will no longer help the safety net providers the 340B program was created to help. How the Cuomo administration will use the money is anybody’s guess.

We believe it’s possible to change the new carve-out law to protect the 340B providers and HIV health plans. But it will take time for the Health Department, legislators, health-care providers and HIV plans to develop, evaluate and implement a successful carve-out that does not diminish access and quality for programs and the vulnerable people they serve.

That is why we’ve introduced a bill to have the carve-out go ahead for the bulk of Medicaid, but to delay it for three years specifically for 340B providers. The Legislature and the governor have to pass this bill before the full carve-out goes into effect on April 1, 2021. Otherwise, vulnerable health-care providers that serve vulnerable New Yorkers will suffer serious financial harm, and many will not survive.

Gottfried, chair of the Assembly Health Committee, represents parts of the West Side and Midtown Manhattan. Rivera, chair of the state Senate Committee on Health, represents parts of the Northwest Bronx. Hoylman represents parts of Manhattan in the state Senate. Rosenthal, chair of the Assembly Committee on Alcoholism and Drug Abuse, represents the Upper West Side and parts of Hell’s Kitchen.

Spectrum News – Health Chairs to Lawmakers: Don’t Alter Bail Law

The top lawmakers on the Assembly and state Senate health committees, in a letter Tuesday, urged against making changes to the state’s bail law, which ended cash bail requirements for misdemeanor and non-violent felony offenses.

In the letter, Assemblyman Richard Gottfried and Sen. Gustavo Rivera warned that making changes could lead to more people in jails, creating an increase risk for people to contract the coronavirus.

NY Post: Cuomo panel recommends $400M in hospital cuts as coronavirus pandemic rages

It’s unclear whether the Legislature or even the governor, who must approve the changes as part of the state budget, have the stomach to cut spending to medical facilities grappling with an expected wave of COVID-19 patients and a potential health catastrophe, as well as rolling back Medicaid services to patients.

“It’s never a good time to cut health care, especially when the only rationale is to fit into an artificial limit. It’s even more wrong in the midst of a growing epidemic,” said Assembly Health Committee Chairman Richard Gottfried (D-Manhattan).

Legislative Gazette – Health Committee chairs: Now is the time to keep people out of jails

“Everyone is pointing out that jails and prisons are a hotbed of spreading contagion,” said Assemblyman Richard Gottfried, chair of the Health Committee. “Our bail reform has [kept] more people out of that pot of bumbling contagion.“Coming in and out and infecting other inmates, infecting personnel, and when they come out, infecting their neighbors,” Gottfried said.

Gottfried and Senate Health Chair Gustavo Rivera sent a letter to every fellow lawmaker on Tuesday denouncing efforts to rollback bail reform during a health emergency.

January-February Health Committee Update

The Assembly Health Committee favorably reported 31 bills at its January and February meetings.  The Committee reported bills to extend Medicaid coverage for new mothers; reform the distribution of indigent care pool funds for hospitals serving low-income patients; create an emerging contaminants monitoring list in order to ensure that all water systems in New York are tested for potentially dangerous chemicals, lower lead levels in school water, and provide insurance coverage for medical marijuana.

Evening Observer: Assembly approves bill to aid blood drives

“This bill would create a program of grants to help community groups and schools run blood drives,” Assemblyman Richard Gottfried, D-New York City and legislation sponsor wrote in his legislative justification. “When community organizations or schools conduct blood drives, the blood bank generally pays for the cost of the blood collection itself. But the blood banks do not pay for promotional activities such as mailings to an organization’s members, or the cost of the space if this cost exists.”

Press release: Protecting Maternal Health

(Albany, NY) State Senator Gustavo Rivera, Assembly Member Richard Gottfried, advocates, and health care provider associations gathered today to call on the Legislature to pass the “Beyond the Fourth Trimester” bill, S.7147-A/A.9156 which would extend postpartum coverage for mothers from 60 days to one year after giving birth. The bill recently passed both houses’ Health Committees and has the support of physicians, midwives, hospitals, and advocates for improving reproductive health and reducing health care racial disparities.

Gothamist: New Bill Would Prevent NY Patients From Getting Stuck With Hidden ‘Facility Fees’

A new bill in Albany known as the Patient Medical Debt Protection Act (A. 8639/S. 6757) would prohibit New York hospitals from sticking patients with these extra charges. Facility fees would be banned altogether for preventive care and insurers would be required to negotiate with hospitals over any remaining facility fees, so they don’t fall on the shoulders of patients like Ryan.

This restriction on facility fees is among the most ambitious pieces of the legislation, which, incidentally, seeks to address several of the issues patients have brought to the attention of Gothamist, WNYC, and ClearHealthCosts in recent months through our joint health care cost transparency project, #PriceCheckNYC.

Daily News: ‘Nothing more than political theater’: Lawmakers raise doubts about Cuomo’s $6 billion Medicaid budget gap

ALBANY — Skeptical lawmakers skewered state health officials Wednesday as they sought details on Gov. Cuomo’s plan to tackle New York’s projected $6 billion Medicaid-induced budget deficit.

“It is a little bit concerning, scratch that, a lot, very concerning that you are coming to a public hearing on Jan. 29 and you’re telling us that by April 1 we have to just accept something that’s put together by a magical crew of folks,” Sen. Gustavo Rivera (D-Bronx), the chairman of his chamber’s health committee, said as he peppered state Health Department commissioner Howard Zucker and state Medicaid Director Donna Frescatore with questions about the proposal.

WSKG: Tensions Surface At Hearing On Proposed Cuts In Medicaid

ALBANY, NY (WSKG) – A lack of information on how Governor Andrew Cuomo plans to cut billions out of state-funded health care programs led to some tense moments at a legislative budget hearing Wednesday.

Cuomo, in his budget address, said he will convene a commission to decide how to cut $2.5 billion in Medicaid spending to help close a $6 billion budget gap without harming recipients.

But that commission, known as the Medicaid Redesign Team, won’t report back until sometime in March, potentially just weeks or even days before the state budget is due, leaving the Legislature little time to analyze the proposals.