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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.”

Testimony on the New York Health Act before the New York City Council

Testifying before the NYC Council in support of its resolution endorsing the New York Health Act, December 6, 2018

Testimony of Assembly Member Richard N. Gottfried

in Support of the New York Health Act

Public Hearing: City Council Committee on Health

New York City Hall

December 6, 2018

I am Assembly Member Richard N. Gottfried.  I chair the Assembly Health Committee and I am the introducer, along with Senator Gustavo Rivera, of the New York Health Act, to create single-payer health coverage for every New Yorker.  I appreciate the Council Health Committee holding this hearing on Speaker Corey Johnson’s resolution endorsing the bill.  I support the resolution.

In both houses of the State Legislature, we now have solid majorities who have co-sponsored, voted for, or campaigned supporting the NY Health Act.  And Governor Cuomo supports single-payer health coverage, although he says he has questions about whether it can be done at the state level.

Every New Yorker should have access to the health care they need, without financial obstacles or hardship.  No one says they disagree with that.  And the New York Health Act is the only proposal that can achieve that goal.

In NY State, we spend $300 billion – federal, state, and non-governmental – on health coverage.  Nationally, we spend far more than any industrial democracy as a percentage of GDP.  But 18 cents of the insurance premium dollar goes for insurance company bureaucracy and profit.  Our doctors and hospitals spend twice what Canadian doctors and hospitals do on administrative costs, because they have to fight with insurance companies.  We pay exorbitant prescription drug prices because no one has the bargaining leverage to negotiate effectively with drug companies.

Just about every New Yorker – patients, employees, employers, and taxpayers – is burdened by a combination of rising premiums, skyrocketing deductibles, co-pays, restrictive provider networks, out-of-network charges, coverage gaps, and unjustified denials of coverage.  I know I am, and I bet everyone in this room is.

And those financial burdens are not based on ability to pay.  The premium, the deductibles – the insurance company doesn’t care if you’re a multi-millionaire CEO or a receptionist.

In a given year, a third of households with insurance has someone go without needed health care because they can’t afford it – and usually for a serious condition.

The number one cause of personal bankruptcy is health care — even for those who have commercial health coverage.

We’ve put control of our health care in the hands of unaccountable insurance company bureaucrats. Nobody wants insurance company bureaucrats deciding what doctor you or your family can see and when.

The health insurance system means massive cost increases for most everyone and better health care for hardly anyone. It’s a disaster.

But it doesn’t have to be that way.

The NY Health Act will save billions of dollars for patients, employees, employers, health care providers and taxpayers – while providing complete health coverage to every New Yorker.

Everyone would be able to receive any service or product covered by any of the following:  NY Medicaid, Medicare, state insurance law mandates, and the current state public employee benefit, plus anything the plan decides to add.

And there will be no premiums, no deductibles, no co-pays, no restricted provider network, and no out-of-network charges.

We’ll actually save billions of dollars because we get rid of insurance company bureaucracy and profit, doctors and hospitals will be able to slash their administrative costs, and New York Health will be able to negotiate much lower drug prices by bargaining for 20 million patients.

And this lower cost will be shared fairly, based on ability to pay.  NY Health will be funded by broad-based progressively graduate taxes.

There will be one tax on payroll.  At least 80% of it must be paid by the employer.

There will be a similar tax on currently taxable “unearned” income – like capital gains and dividends.

Because of the savings and the progressively graduated tax mechanism, 90% or more of New Yorkers will spend less and have more in their pocket.

Pumping this money back into our economy will create 200,000 new jobs in New York.

And there will be money to completely cover everyone, and make sure doctors, hospitals and other providers are paid fairly – and today, most of the time, they are not.

The vast majority of our hospitals get most of their revenue from Medicaid, Medicare, and uncompensated care pools – none of which fully cover the cost of care.  The NY Health Act requires full funding for all hospital care, and hospitals will save billions in reduced administrative costs.

Here are 3 basic numbers:  The savings from insurance company bureaucracy and profit, provider administrative costs, and drug prices will total $55 billion.  The increased spending for covering everyone; eliminating deductibles, co-pays and out-of-network charges; and paying providers more fairly will cost $26 billion.  So the net savings to New Yorkers is $29 billion.

The way our society deals with long-term care – meaning home health care and nursing home care – for the elderly and people with disabilities is a moral outrage.  NY’s Medicaid does a much better job than other states.  But today, New Yorkers spend $11 billion a year out-of-pocket for long-term care.  And family members – usually women – provide unpaid home care worth $19 billion.

In January, Senator Rivera and I will be announcing that the NY Health Act will cover long-term care.

Now, that will use up $19 billion of the net savings.  But it means no NY family will have to wipe out lifetime savings, and no family member will have to give up a career, to provide long-term care for a loved one.  That’s profoundly important.

How much tax revenue will we need?  With the net savings, we’ll need $129 billion from the NY Health taxes.  When we add home care and nursing home care, we’ll need $159 billion.

How do we know the NY Health program will treat us – and our doctors and hospitals – fairly?  Two ways.

First, the legislation explicitly requires that provider payments be reasonable, related to the cost of providing the care, and assure an adequate supply of the care.  No coverage today has that guarantee.

Second, we’ll all be in the same boat; rich and poor.  Every New Yorker – every voter – will benefit from the program.  And every voter will have a stake in making sure our elected officials keep it as good as possible.

Remember where we started:  Every New Yorker should have access to needed health care, without financial obstacles or hardship.  We’re not there today.  The NY Health Act will get us there.  If anyone doesn’t like the NY Health Act, they should either put on the table another plan that will get us there, or admit that they’re OK with depriving millions of New Yorkers of health care or family financial stability.

Concerns have been raised by many of NY City’s municipal labor unions.  They are justifiably proud of the good deal they have won for their members over the years.  Good scope of coverage.  The City pays the full premium.  And the contract says that if there are savings in the health benefit, the savings go into a stabilization fund to pay for salaries and benefits.  As they remind us: at the bargaining table they have given up wages and benefits to protect this deal.

Under NY Health, by law, every municipal employee, like every New Yorker, would have an even broader scope of benefits, and without deductibles, co-pays and restricted provider networks and out-of-network charges.

Under the bill now, collective bargaining could continue to have the City pick up the whole tab for the payroll tax and pass on the savings to the stabilization fund.  But Sen. Rivera and I have offered to add bill language that by law would require the City to do that, without the need to bargain for it.

Our parents didn’t raise us to screw workers.  Period.  Sen. Rivera and I are determined to make sure that labor’s concerns are protected under the NY Health Act.  We are continuing the dialogue with them.

Thank you for letting me testify.

Assembly Health Committee Year in Review

Assembly Health Committee Year-End Update

The Assembly Health Committee wrapped up 2017 with 34 bills signed into law and 19 vetoed, including four which were vetoed with specific agreement for further administrative actions. Some bills were signed or vetoed based on agreements to enact changes in 2018. (A governor often raises concerns and wants changes in a bill after it has been passed by the Legislature. This usually happens after the Legislature has adjourned for the year. It is not widely known to the public, but in New York it is common for a governor to insist that the leaders of the Legislature agree to changes in a bill as a condition of the governor signing it. If the legislative leaders and the bill’s sponsors agree, the governor then signs the bill and the Legislature enacts the changes early in the following year.)

The Assembly Health Committee also held public hearings including:

  • Home care workforce adequacy.
  • Adult home oversight and funding.
  • Health care services in state prisons and local jails.
  • Nursing home quality of care and enforcement.
  • Water quality budget implementation.
  • Immigrant access to healthcare.

Below are summaries of bills acted on by the Governor as well as the public hearings.

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: Safe Staffing for Quality Care Act Passes Assembly

PRESS RELEASE

“Safe Staffing for Quality Care Act” Passes Assembly

Bill Sets Standards for Adequate Hospital, Nursing Home Staffing

(6/14/16 – Albany)  The New York State Assembly today passed the “Safe Staffing for Quality Care Act” (A8580A/S782) with bi-partisan support.  The bill would set a maximum number of patients that nurses and other “direct care staff” can care for in hospitals and nursing homes (staffing ratios) and was based on peer-reviewed academic and evidence-based recommendations.

“Safe staffing is a critical step to ensuring the safety of patients and the safety of nurses,” said Assembly Member Aileen Gunther, the lead sponsor of the bill. “Study after study has shown that investments made in nurses are good investments – whether it’s ending mandatory overtime, requiring safe patient handling policies, or setting safe staffing ratios. As our system of care is evolving, patient outcomes are a key factor in determining provider payments. Safe staffing will improve outcomes, save money, and save lives.”

“Safe staffing saves lives, improves outcomes and reduces avoidable patient injuries,” said Assembly Health Committee Chair Richard N. Gottfried.  “Research published in the Journal of the American Medical Association (JAMA) determined the odds of patient death increased by 7% for each additional patient the nurse must care for at one time.  The ratios and hours specified in this bill are based on peer-reviewed and evidence-based recommendations, and will ensure that hospitals and nursing homes are safer and provide higher quality care.”

PRESS RELEASE – Expanding Medical Marijuana Providers

Contact: Mischa Sogut, (518) 455-4941, SogutM@assembly.state.ny.us
5/26/16

Expanding Medical Marijuana Providers

The Assembly yesterday passed two bills to improve patient access to medical marijuana under the 2014 “Compassionate Care Act.”  Today, patients are struggling to find health care providers authorized to prescribe medical marijuana due to changes to the bill made by the Governor in order to secure his support.  These bills bring the law closer to the original bill as passed by the Assembly and supported by patients and their doctors.

A9510 (Gottfried): Authorizes nurse practitioners and physician assistants (NPs and PAs) to certify patients for medical marijuana. “New York law allows NPs and PAs to prescribe the strongest and most dangerous controlled substances, but not medical marijuana,” said Assembly Member Gottfried. “Patients in need should not be denied access to critical medication just because they are treated by a PA or NP.”

A10123 (Peoples-Stokes): There are only about 600 New York physicians registered to certify patients for medical marijuana, but no public list of them. As a result, patients are forced to cold-call doctors in hopes of finding one, or go through social media or other potentially unreliable sources. This bill would require the contact information of registered practitioners to be on the Department’s website (practitioners who do not wish to be listed could opt out). “I believe that current law – both the Compassionate Care Act and the Freedom of Information Law – requires that this list be public, as was the legislative intent. But apparently it needs to be spelled out.” said Assembly Member Gottfried.

###

Pro Publica: NY Lawmakers Discuss Tougher Oversight for Nurses

by Rosalind Adams, Jessica Huseman and Daniela Porat, 4/26

New York legislators say they are discussing how to tighten regulation of nurses after a recent ProPublica investigation found dangerous gaps in the state’s oversight of the profession.

Deborah Glick, who chairs the Committee on Higher Education in the state assembly, said she has asked the education department to determine what powers it needs to better oversee the profession. Nurses are regulated by the Office of the Professions, which is part of the state’s education department.

 “We’ve been having conversations about background checks and fingerprinting,” she said, adding that the changes, along with other potential solutions, would require a legislative fix, though she did not specify what might be proposed.

Assembly Health Committee Update, 1/21/16

Assembly Health Committee Update

The Assembly Committee on Health favorably reported 22 bills at its first meeting of the 2016 session on January 21.

The Committee reported the bill to establish safe staffing requirements in hospitals and nursing homes (A8580, Gunther). The evidence is clear that having enough nurses on staff has a direct impact on the quality of patient care. Research published by the American Medical Association estimates five additional deaths per 1,000 patients in hospitals with an 8-to-1 patient-to-nurse ratio compared to those with just a 4-to-1 ratio. More nurses per patient means fewer deaths and improves patient outcomes. It is well documented that hospitals with better staff ratios have lower rates of problems such as pneu­monia, shock, and cardiac arrest.

The ratios in the bill are based on academic and evidence-based studies. The Health Department could also set more demanding and specific ratios. California was the first state to mandate nurse staffing ratios and it has seen significant improvements in outcomes for both patients and staff.

For more information on a particular bill, please contact the sponsor listed after the description. For the text of a bill, supporting memorandum, and information on its status, go to: http://public.leginfo.state.ny.us/menuf.cgi

Genetic Disease Screening and Counseling – Authorizes grants for familial dysautonomia, Canavan’s and Tay-Sachs disease screening and counseling. (A126, Dinowitz)

Adult Home Residents Right to Sue – Lets adult home residents go to court for a court-appointed receiver to operate the adult home when the operator has endangered the health, safety, or welfare of the residents. (A154A, Weinstein) 

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.

Times-Union Commentary: Patients should be bottom line of care

The commentary by the Business Council‘s Lev Ginsburg on universal health care continues to rely on rhetoric and mistruths rather than the facts in an attempt to scare people. The health insurers and their allies use fear and labels like “socialized medicine” to attack a truly universal system, like Medicare but for everyone, that will give every New Yorker access to the doctor of their choice without premiums, deductibles or co-pays because the facts just aren’t on their side and are actually indefensible.

It’s reminiscent of how when Medicare was first proposed, the special interests who opposed it described it as “socialized medicine” and a threat to freedom and liberty. Now, Medicare is overwhelmingly popular and nobody would imagine getting rid of it.

Fact, a recent report from the independent Commonwealth Fund found that over a third of people forego care because of cost and another third get care but have trouble paying their bills — and this is considered good news, because those numbers have gone down.