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City & State NY: Health Care Officials Offer Diagnoses for New York’s Funding Challenges – Richard Gottfried, Mitchell Katz and Carlina Rivera Weigh In

(mayamaya/Shutterstock)

By City & State | February 27, 2018

Thanks to a flu season that’s one of the worst in recent memory, it has been a tough winter to stay healthy. Influenza hospitalizations are up and thousands have died. The flu vaccine has proven to be less effective than in years past, and public health experts say the disease may have yet to reach its peak. The spread of the virus is likely to continue for weeks.

It has also been a tough winter for New York policymakers and government officials who rely on Washington for funding. While congressional Republicans failed to repeal the Affordable Care Act, they’ve taken incremental steps to undermine the law, such as eliminating the individual mandate. The federal government has also reduced funding for safety net hospitals and for the ACA’s Basic Health Program, both of which play a major role in New York. Some Republicans in Washington still hope to scale back Medicaid and Medicare as well.

So we checked in with a few of New York’s top health care officials to hear their diagnosis of the situation – and how to remedy it.

Assemblyman Richard Gottfried (Jeff Coltin)

RICHARD GOTTFRIED, Chairman, Assembly Health Committee

C&S: What are your health legislative priorities this year?

RG: Our first order of business is, of course, dealing with health care cuts in the budget. This is not the worst year, not the worst budget we’ve seen, nor the best. But there are still serious cuts in health programs and restrictions in Medicaid that I and the Assembly will be trying to reverse. Beyond that, not necessarily in any particular order, passing the Reproductive Health Act in the Assembly again, and hopefully helping to advance it in the state Senate. A particular budget agenda item which we hope to deal with in the budget, and if not we will continue to try to deal with after the budget, is protecting safety net hospitals. The state’s various aid programs for hospitals are not very well targeted to get money to the hospitals that have the most serious financial need. Next, again in no particular order, is strengthening the medical marijuana program. I will be focusing on three issues there. One is to repeal the list of specific conditions for which medical marijuana can be used. There is no other drug that I know of that the law lists the conditions it can be used for. Secondly, today, only physicians, nurse practitioners and physician assistants can certify a patient for medical marijuana use. I think it makes sense that any practitioner who, under law today, can prescribe controlled substances ought to be able to certify a patient for medical use of marijuana as long as the treatment for the condition is within that practitioners scope of practice. The third piece deals with the current business model of producing, distributing and retailing, or dispensing, of medical marijuana. Today, all the licenses that have been issued require the registered organization to grow, process, distribute and dispense the product. There is almost no industry where we allow that degree of vertical integration, and certainly no industry where we require it. The next item is the New York Health Act, my single-payer bill. We will, I hope, pass that again in the Assembly as we have in the three years before. And our goal will be to continue to build support for that around that state. The last item is the Medical Aid in Dying bill that would allow an adult patient with decision-making capacity who is dying from a terminal illness to get a prescription for medication that would end their life. I think that legislation is very morally compelling for New York and I hope we can at least get it to the Assembly floor and pass it.

C&S: How would you assess the state of health care in New York based on what you’ve seen?

RG: It’s mixed. We have some of the finest health care providers, some of the finest physicians and hospitals in the country, but millions of New Yorkers still every year go without health care because they can’t afford or they suffer financially to get that care. Many of our nursing homes provide care that is well below national averages and well below standard. Our systems for inspecting nursing homes are really lacking. We need to invest a lot more of our resources into primary and preventive care, which is very difficult to do in a world where health care is controlled by insurance companies.

C&S: You mentioned your single-payer bill you would like to pass through the Assembly again. Why is that the best way forward for New York to go in in terms of health care?

RG: I believe that no New Yorker should go without health care or have to suffer financially to get it. To use the president’s term, that only gets complicated when the system is focused on the care and financing of insurance companies. And as long as our system is rooted in insurance companies, we will be spending tens of billions of dollars on, necessarily, on insurance company and health care provider administrative costs. You will have insurance companies taking thousands of dollars out of families’ pockets for premiums and deductibles and co-pays without any relation to ability to pay. And insurance companies telling us which doctors and hospitals we can go to, and which services they will pay for. To me, that’s no way to run a health care system. And I don’t know any alternative to a single-payer system that can work.

C&S: And you have seen support for that grow since you first introduced it?

RG: Oh, enormous growth and support, particularly in the last several years, because people have seen that while the Affordable Care Act made a lot of improvements, it still leaves us in the hands of the insurance companies with enormous problems. So people who thought maybe reforming the insurance system would do the job, now see that that really still leaves us falling way short. And it’s also clear that whatever health policy comes out of Washington is going to make things worse in New York, whether it’s for insurance or Medicaid or Medicare. So more than ever, people realize that, whether you call it improved Medicare for All, or single-payer, is really the only answer, and that we have really no alternative but to pursue that at the state level because it’s clearly not coming from Washington any time soon. And so we are constantly picking up more community organizations. There are activists all around the state having meetings with their state senators, there are more unions supporting the bill than ever before, so the issue really is moving forward more than I’ve ever seen.

C&S: Do you have any concerns for what is happening on the federal level, such as cuts in spending or other kinds of legislation that might affect health care in New York?

RG: Their efforts to dismantle the Affordable Care Act will undermine insurance in New York. They are already implementing cuts that are hurting the program called the Essential Plan, which is a subsidized health care program for people whose incomes are a little above Medicaid. And there will be more devastation coming to Medicaid any day now. And their next target will be Medicare. Republicans have had their eye on trashing Medicare since it was enacted in 1965. And that will be coming next. And all of that will be ripping money out of our health care system and putting more burden on out-of-pocket spending by New Yorkers who can’t afford it.

Dr. Mitchell Katz (NYC Health + Hospitals)

MITCHELL KATZ, President and CEO, New York City Health + Hospitals

C&S: What are the problems you’re facing at Health + Hospitals and what are your plans to address them?

MK: I believe, like the nuns, that there’s no mission without a margin. And so while my career has been dedicated to taking care of people who don’t have insurance, I’ve always done that by billing insurance for people who do have insurance, and attracting insured patients to my systems. Currently in Health + Hospitals, in most of our centers, we are still sending away insured patients, not providing the services that are better remunerated. This doesn’t come from a bad place, it’s sort of the history of public hospitals, that public hospitals like ours generally started before Lyndon Johnson’s Medicaid and Medicare in the ’60s when nobody had insurance. And so nobody billed and that was fine. But gradually, public hospital systems have learned how to bill and how to attract and keep paying patients, so there’s a margin to provide the care to the people who don’t have insurance. Health + Hospitals has a long way to go in that area, but this is work I’ve done in two other municipalities, and it’s well-known how to do it. And it’s a lot easier than saving people’s lives in trauma, which I’m proud my system does every day. So if we can revive a pulseless person who’s lost most of the blood volume in their body, surely we can learn how to bill insurance the way other systems do, and we are.

C&S: Could the affordable health care program that you spearheaded in California, Healthy San Francisco, work in New York City?

MK: I think that the model could work. Like a lot of other questions, it comes to participatory democracy. One of the features of Healthy San Francisco was that employers who did not provide insurance for their workers were required to pay into a fund or provide benefits or pay insurance bills. So that’s a political question as to whether or not the city would want to do that. It would have been a lot harder, maybe not impossible, but certainly a lot harder to have had the success we had in San Francisco without the employer spending requirement.

New York City Councilwoman Carlina Rivera (Ali Garber)

CARLINA RIVERA, Chairwoman, New York City Council Hospitals Committee

C&S: What has been your experience so far heading this new Committee on Hospitals?

CR: Well, it’s been educational. It’s definitely been informative as to how nuanced the issues can be. We have two other committees that are tackling issues in the health field, but we’re focused on hospitals. So what I’ve been doing is trying to meet with as many stakeholders, groups, individuals, people who are advocates, people who are retired advocates who worked in hospitals and with patients, and really try to get a broad perspective of what’s going on, how the budget, the deficit is affecting patient care, and how best we can use this committee for oversight, for investigations. But also to push forward legislation that’s going to take care of all New Yorkers. My focus is to really dive deep into Health + Hospitals, but also bring in our private partners. This is a very big network, I say it’s the most important public system in the city, and I want to make sure we’re talking about the underinsured, the insured, the undocumented and all of the people who are so dependent on the system. So again, it’s going to be a focus on the public system, but bring in our private partners as well. And it’s been eye-opening. There are a lot of people working on different campaigns, local, citywide and of course statewide, so I’m trying to, again, meet with as many different people as possible, other elected officials who are chairs of their own committees in their own legislative bodies, and then of course labor and community leaders that do the work.

C&S: Based on some of these meetings that you’ve been having, what is the most pressing issue when it comes to Health + Hospitals?

CR: I would say that would be DSH funds, Disproportionate Share Hospital programs, and that’s the funding to hospitals that treat the poorest New Yorkers. And also the risks from Washington, the threats of cuts to this very important care, these programs, the charity dollars and the way they’re distributed amongst the public and private systems. But when I talked to people, undoubtedly, one of the first things that comes up is DSH. I think it’s also about how are we going to address a billion-dollar deficit and keep 11 major hospitals open? We have the mayor’s commitment that he will keep these facilities open, but how are we going to look at underutilization in terms the spaces in these brick-and-mortar facilities? And how are we going to generate revenue? I had a really great conversation with (President and CEO of Health + Hospitals) Dr. (Mitchell) Katz, along with some of the committee staff here at the Council, just to get a little preview of some of the issues that we’re going to be going over next week. And he has some basic, I think, fundamental outlook on how to make sure we’re getting the reimbursements that we’re not getting, and to implement a more efficient system, and getting paid for the services we’re providing.

C&S: Dr. Katz is also new to Health + Hospitals, and you’re the new head of a new committee. What is that like, to have everyone who’s now trying to tackle this problem be fairly new? Is that detriment or is it good to have a lot of fresh ideas coming in?

CR: I think that’s it, you took the words right out of my mouth. I think it’s great to have fresh ideas. I think it’s good to have someone with a different perspective. He’s coming from tackling a similar issue in another major city. I come from more of the community-based care perspective. My work in Healthy Aging has been working with seniors, with very low-income families in accessing health care and navigating the Affordable Care Act. Though my experience is limited and his is incredibly comprehensive, I’m really excited because it just allows for a clear break from past issues and mismanagement, and I think that’s going to be something that’s going to be important to looking at the health care system in a different lens.

C&S: Was this a chairmanship that you had wanted? And how did you feel when you received it?

CR: Yes, of course. I think I’ve said this before, that I think that making this its own standalone, full committee, it shows the needed urgency for such an important issue. I did mention my interest to the speaker. We’re very aligned when it comes to our beliefs and values and the things we want to achieve in terms of our agenda for the City Council. So we talked a lot about health. We talked about some of the work that he had done, how I wanted to continue that work in terms of the legislation and the policy he put forward, and then bringing my own ideas based on my experience. So this was something I was interested in, and when I was assigned to it, I was very, very excited. I know that I have him for support, I have a great committee staff here and lots of advocates throughout the cities.

Times-Union: Legislation would mandate coverage of prostate cancer screenings

By Matt Hamilton, 9/27

ALBANY — State legislation introduced last week would mandate that insurers cover in full prostate cancer screenings for men who are middle-aged and older, in the same vein as a state mandate for breast cancer screening coverage.

The bill from state Sens. Jim Tedisco, R-Glenville, and Kemp Hannon, R-Long Island, and Assemblyman Richard Gottfried, D-Manhattan, would bar insurers from charging an annual deductible or co-pay for prostate cancer screenings for men 40 and older with a family history of such cancer, and also men 50 and over regardless of whether they show symptoms of cancer.

“This vital public health legislation will save lives by removing obstacles for prostate cancer screening which will encourage more men to take charge of their health before their cancer becomes worse,” Tedisco said in a statement. “This bill also will save taxpayers money in the long run by preventing unnecessary hospitalizations and burdensome medical expenses through early detection and treatment.”

In 2016, Gov. Andrew Cuomo sought and won similar coverage of breast cancer screenings. His advocacy came after his longtime partner, Food Network star Sandra Lee, was diagnosed with breast cancer in 2015. She underwent a double mastectomy and had multiple follow-up surgeries, though she said in September 2015 she was cancer free.

Cuomo spokesman Richard Azzopardi said the the administration would review the prostate cancer bill.

PRESS RELEASE – Assembly to Pass New York Health Act Today

Assembly to Pass New York Health Act Today

Single Payer System Guarantees Health Coverage
for all New Yorkers

(Albany, NY, May 16, 2017) Assembly Speaker Carl Heastie and Health Committee Chair Richard N. Gottfried announced the Assembly’s intent to pass the New York Health Act today. The universal “improved Medicare for all” single-payer health plan would cover every New York resident, regardless of wealth, income, age or health status (A.4738, Gottfried/S.4840. Rivera).

“While lawmakers in Washington debate giving tax cuts to the wealthy and cutting funding for health care for those who need it most, the Assembly Majority remains committed to ensuring every New Yorker has access to the care they need and deserve,” said Speaker Heastie. “The Assembly will once again pass this measure, but the recent action taken by Congress to strip more than one million New Yorkers of healthcare has proven it is time for our colleagues in the Senate to act as well.”

PRESS RELEASE – 6/1 Assembly Passes NY Health Universal Healthcare Bill

Assembly Passes “NY Health” Universal Health Care Bill

The New York State Assembly passed the “New York Health Act” universal health care bill (A. 5062A/S. 3525A) by an overwhelming majority on Wednesday, June 1, for the second year in a row.  New York Health would provide universal, complete health care coverage to every New Yorker without deductibles, co-pays, or limited provider networks.

“Health insurance plans have now asked the State for a 17% rate increase, with some plans as high as 45%,” said Assembly Health Committee Chair Richard N. Gottfried, lead Assembly sponsor of the bill.  “Year after year, the cost of coverage for families and employers goes up faster than wages and inflation.  Premiums, deductibles, co-pays, out-of-network charges, and uncontrolled drug costs undermine health care and family finances, and are a heavier burden on employers and taxpayers.”

Legislative Gazette: For second year in a row, Assembly passes universal health care bill

By Simon Rosenbluth, 6/2

The Assembly voted 86-53 Wednesday to pass universal health care legislation in New York, marking the second time in two years the bill passed the Democrat-controlled house.

The issue of health care has received increased attention since the passage of the Affordable Care Act in 2010. But some state lawmakers, physicians, nurses and patients say the federal program doesn’t go far enough and legal challenges are still threatening its full implementation.

The New York Health bill (A.5062-a) passed by the Assembly Wednesday would provide universal, complete health care coverage to every New Yorker without deductibles, co-pays, or limited provider networks.

“Health insurance plans have now asked the state for a 17 percent rate increase, with some plans as high as 45 percent,” said Assembly Health Committee Chair Richard Gottfried, lead Assembly sponsor of the bill. “Year after year, the cost of coverage for families and employers goes up faster than wages and inflation. Premiums, deductibles, co-pays, out-of-network charges, and uncontrolled drug costs undermine health care and family finances, and are a heavier burden on employers and taxpayers.”

Capitol Pressroom with Susan Arbetter (Audio)

January 13, 2016

Gov. Andrew Cuomo hosts his 2016 State of the State Address, which will also include the annual budget presentation.

Christine Quinn, the President and CEO of Women in Need, will weigh in on the Governor’s plan to address issues of homelessness in the state.

We will hear which healthcare issues are at the top of the Assembly’s list this session from Assembly Health Committee Chair Richard Gottfried (D – Manhattan).

Mark Dunlea, Chair of the Green Education and Legal Fund, previews the State of the Climate, a rally at the Capitol for clean energy and a sustainable future.

Bruce Gyory of Manatt, Phelps & Phillips looks at key issues the Governor is likely to propose.

Elmira Star-Gazette: Let doctors negotiate with big health insurers

By Dr. Michael Herceg, 10/22

The recently proposed consolidation of health insurance giants Anthem and Cigna, and Aetna and Humana, is cause of great concern to the medical profession in New York. It should be of greater concern to patients.

The move comes amid a time when medical practices are already struggling with greatly increased practice costs and administrative hassles. More and more physicians are finding they have no choice but to become absorbed into large health care systems to deliver quality patient care.

Times-Union: Cuomo urged to sign bill giving doctors final say in Medicaid Rx disputes

By Claire Hughes, August 4

Supporters of a bill that would ensure doctors have the final say in prescription disputes with Medicaid managed care plans are urging Gov. Andrew Cuomo to sign the measure into law.

The measure, one of about 700 bills passed by the state lawmakers this year and under review by counsel, has not reached the governor’s desk, according to Cuomo spokesman Rich Azzopardi.

Given the administration’s past stance on language in the bill, however, supporters are concerned over the chance of a veto.

“The Health Department opposed this language when it was raised during budget discussions,” said Assembly Health Committee Chairman Richard Gottfried, D-Manhattan, a bill sponsor.

Times-Union: Patients, medical groups call on Albany to limit ‘fail first’ insurance policies

By Claire Hughes, May 29

Patient advocates and medical groups on Thursday were at the state Legislative Office Building to support a bill that would curb so-called “step therapy” or “fail first” policies among health insurers.

Groups representing patients with cancer, mental illness and chronic pain appeared with lawmakers to call for a clear and concise appeals process, and limits to health insurers’ right to require that less expensive treatments be used before more expensive ones are approved.

Health insurers oppose the bill. Step therapy encourages the use of effective medication, while keeping a check on the rising cost of prescription drugs, said Paul Macielak, CEO of the New York Health Plan Association, a trade association.

“Without efforts to control rising drug costs, consumers and employers would not be able to afford prescription drug coverage,” Macielak said.

The problem with the current appeals process, said bill sponsor Assemblyman Matthew Titone, is that the insurance companies control the process. Some delay approving the proper treatment indefinitely. The bill would not eliminate step therapy, but require insurers to make their appeals process transparent and easy to follow, and limit the length of time it takes to complete, he said.

Assembly Health Committee Chair Richard Gottfried, D-Manhattan, who supports the legislation, acknowledged that step therapy can be appropriate and effective under many circumstances. These include times when doctors are not sure which remedy might work best for a particular patient and the most prudent action is to try something inexpensive first.

Capital NY – Health chairs predict problems with coming ‘Cadillac’ tax

By Katie Jennings, 5/18/15

State legislators from both sides of the aisle are concerned that a soon-to-take-effect Affordable Care Act tax will have a “devastating effect” on health plan coverage for both public and private employees.

The so-called “Cadillac tax” provision of the Affordable Care Act isn’t set to kick in until 2018, but Assembly health committee chair Richard Gottfried and Senate health committee chair Kemp Hannon both raised concerns over its impact during a event on Friday organized by the fiscally conservative Manhattan Institute.

The controversial Cadillac tax, or excise tax on high-premium insurance plans, imposes a 40 percent tax on health premiums above a threshold of $10,200 a year for individuals and $27,500 for families. It is expected to bring in $87 billion in federal revenue by 2025, according to the most recent Congressional Budget Office analysis.

Gottfried, a Democrat from Manhattan, said “the approach of the Cadillac tax ought to be regarded by almost everybody as an oncoming train or worse.”