Since the COVID-19 pandemic arrived in the US late last winter
and the economic recession it triggered starting in the spring, Congress has
passed 4 pieces of legislation, with strong bipartisan support, to respond to
its threats and adverse impacts on everyday people. These included:
Coronavirus Preparedness and Response Supplemental
Appropriations Act (HR 6704) on March 6th.
Families First Coronavirus Response Act (HR
6201) on March 18th.
Coronavirus Aid, Relief, and Economic Security (“CARES”)
Act (S.3548) on March 27th.
Concerning the health provisions in each of these laws,
CPRSA Act ($8.3 billion) provided funding for COVID-19 testing, treatment, and biomedical research, as well as for basic state and local public health functions.
FFCR Act ($190 billion) provided funding for free testing, a 6.2% increase in Medicaid funding to states with a “maintenance of effort” requirement, and created a new temporary program for paid family leave and sick days.
CARES Act ($2.3 trillion) provided funding for hospitals and health care providers, personal protective equipment (PPE), and grants to states and large cities.
PPPHCE Act ($500 billion) expanded CARES Act funding for hospitals and health care providers, for COVID-19 testing, and for various federal health agencies.
Since mid-April, Congress has taken no further action despite the clear need for continuing steps to help those in need. In mid-May, the House passed, on a mostly partisan basis, the HEROES (Health and Economic Recovery Omnibus Emergency Solutions) Act (HR 6800), a very comprehensive bill that would do many good things, costing about $3.4 trillion. However, Republican Senate leadership has refused to take it up. In late July, they announced their alternative HEALS (Health, Economic Assistance, Liability Protection, and Schools) Act (S. 1624), costing about #1 trillion, but never tried to take it to a floor vote. In early Sept., they instead put forward their Delivering Immediate Relief to American Families, Schools, and Small Businesses Act (S. 178), a slimmed-down version of HEALS (“Skinny HEALS”), costing only $500 billion, and it was enacted along a party-line vote.
Looking at the health care provisions of the HEROES Act, it
offered:
Increased federal Medicaid matching funds by 14%
above a state’s standard rate.
An exemption for New York from federal
requirements to maintain the breadth and depth of its Medicaid program
throughout the pandemic emergency, something vigorously opposed by health care
advocates here in New York and nationally.
Subsidies for unemployed people to afford “COBRA”
coverage.
Funding for COVID-19 testing, tracing, treatment,
including via Emergency Medicaid in order to cover all immigrants.
New OSHA standards for frontline health care
workers in hospitals and nursing homes.
Hazard pay for frontline workers.
General financial support for state, city, and
county budgets.
By contrast, the “Skinny HEALS” bill only offered additional funding for development of COVID-19 treatment and vaccines.
Since mid-Sept., negotiations between the Senate and House
have stalled. However, the bipartisan
centrist “Problem Solvers Caucus” recently introduced its “March to Common
Ground” framework, costing $1.5 trillion, that would, on the health care front,
provide increased funding for COVID-19 testing and treatment, workplace
protections, and aid to states and localities.
President Trump has also made a statement about being willing to
negotiate a package, but no further details were included.
With the recent death of Justice Ruth Bader Ginsburg, much political
and legislative focus has shifted to the matter of confirming her successor as
the final weeks of the election season approach, so prospects are slim and dim
for further action. Meanwhile, millions
of people across the US who are in desperate need because of the pandemic and
its economic aftermath remain ignored, and over 200,000 people across the
nation have died of COVID-19 illness.
It’s been an upside-down state legislative session this year because of the COVID-19 pandemic. Since the state budget was adopted in early April, the Legislature reconvened only three times for brief weeklong periods, and held a few public hearings on issues related to the pandemic. They were back in Albany in late July for what was being viewed by many as the likely last session period for this year. Like any “last week” in a typical legislative year (usually happening in mid-late June), lots of bills had piled up for consideration, including some on the health care front.
The health care bills included ones to:
Provide public health insurance coverage for COVID-19 treatment to all low-income New Yorkers regardless of immigration status. (S.8357/A.10474, Rivera/Gottfried)
Suspend any medical debt collection efforts by hospitals and third-party collection agencies against patients during the state’s pandemic emergency order. Interest rates on hospital patient medical debt would be limited to the U.S. Treasury bill rate, and no interest would be allowed on any COVID-19 treatment bills. Health insurers would be prohibited from cancelling coverage due to non-payment of premiums because of financial hardship, and from reporting such people to credit rating and collection agencies. (S.8365-A/A.10506, Rivera/Gottfried)
Require Medicaid health plans to inform patients about how to contact state-funded consumer assistance programs operated by non-profits when these plans deny coverage for a service. (S,7241/A.9538, Rivera/Gottfried)
In addition to these health-specific bills, health advocates supported broader bills to help the state keep its budget in balance during the current economic downturn, and to strengthen the State Legislature’s role in the state budget process, all with an eye toward protecting funding for health care programs by raising adequate funding for them . Since the adoption of the state budget in early April, projections are that, because of the recession, it will be out of balance by as much as $13 billion as budget year proceeds. Gov. Cuomo is threatening further across-the-board budget cuts unless Congress acts soon to provide financial assistance to states and localities (which now under debate in DC.)
Advocates for a variety of health and human service issues joined together this year in the New York Budget Justice campaign to oppose ongoing budget cuts, and instead promoting raising taxes slightly on the ultra-rich to close the budget gap. They have developed over a dozen different proposals to do so (available here.) Legislative leaders say they will wait until Congress acts this summer, and then decide which if any of these ideas they might move forward later on.
The Budget Equity Act (S.8198/A.9100, Biaggi/Gottfried) has had some momentum. Many advocates support this bill as an important way to improve democracy in state government. It would restore the balance of power in the budget process between the Governor and Legislature that was voided by the state courts in the early 2000s. Since then, lawmakers have limited options to affect whatever a governor proposes with little opportunity to push their own budget ideas. Lots of rank-and-file legislators are sponsoring this bill and legislative leaders have made some positive noises about it, but they chose to not move it forward.
Unfortunately, by the time the final gavel came down on July 23, of the above-mentioned health bills, only the modest one requiring that Medicaid patients be given notice of how they can access consumer assistance programs was passed. Depending on
Whoever would have imagined we’d be in the situations we find ourselves in now a mere six months ago? A global life-threatening viral pandemic (that is still intensifying), a severe economic recession (that is still worsening), and social uprisings against racial injustice (that are long overdue.) So far, it’s clearly been a year like no other that is challenging all of us to our very core.
Going Bold:
As 2020 began, health advocates from major coalitions had
united behind a joint “Go Bold” agenda for the year’s legislative session. The groups involved were the Campaign for New
York Health, Coverage for All, Health Care for All New York, and Medicaid
Matters New York. (Metro New York Health
Care for All belongs to all of them, and helps to lead three of them.) Our joint policy agenda included:
Pushing the New York Health Act (S,3577/A.5248, Rivera/Gottfried) forward in the legislative process with an eye toward a) getting a floor vote in the Assembly, and b) getting it through the Committee process in the Senate and the number of co-sponsors to at least one-half of all members.
Covering all immigrants by expanding New York’s very successful Essential Plan to all low-income immigrants, benefitting up to 110,000 people (S.3900/A.5974 (Rivera, Gottfried.)
Making Affordable Care Act health plans more affordable by offering additional premium subsidies through the state budget, and opening up the Essential Plan for people to buy into. Augmenting this focus is additional funding for community-based outreach and enrollment programs through the state budget.
Preventing cutbacks to Medicaid, and instead funding it fully by raising taxes slightly on the ultra-rich in a number of ways as proposed by the New York Budget Justice campaign.
Raising new, additional revenue to fully-fund all health and human service needs by requiring ultra-wealthy New Yorkers to once again pay their fair share of taxes after decades of tax cuts they have benefitted from at both the state and federal level.
Defending Medicaid:
When Gov. Cuomo announced his budget proposals in
mid-January, he said the budget gap was around $6B (billion), and attributed
around $4B of it to a “Medicaid deficit”, particularly in the area of cost
growth for long-term care (nursing homes, home health care and personal
care.) He especially pointed to growth
of the state’s very successful Consumer-Directed Personal Assistance Program
(CDPAP) that allows people to stay in their homes and live in their communities
as opposed to having to enter very expensive nursing homes.
It is important to understand that the state’s so-called
Medicaid deficit exists only in relation to an arbitrary “global cap” that Gov.
Cuomo and the State Legislature imposed on annual Medicaid spending and growth
back in 2012. Otherwise, this year it has
no other reality other than as a reflection that demand for long-term care has
grown as the population has aged and the price of those services has gone up,
particularly for personnel given recent raises in the minimum wage. Since the cap was imposed, Medicaid spending has
grown 3-4% on average year-to-year.
Advocates characterize the use of this cap as a defacto “block granting”
of the program, a step Gov. Cuomo has always decried whenever similar moves
were proposed (but never adopted) by Congress.
Further exacerbating the situation, Gov. Cuomo has always
imposed an overall spending growth cap of 2% on the state budget as a whole,
and the Legislature has never challenged him over that. The sum total of these steps, along with
other types of spending caps he’s used, has been to put the state on an
austerity budget footing throughout his entire tenure, something that he has
insisted on. Complicating this situation
is a State Court of Appeals ruling from the early 2000s (Silver v. Pataki) that
affirmed a Governor’s supremacy over the state budget in relation to the
Legislature.
Rather than lay out any specific cuts to Medicaid in his
proposed budget that he released in mid-January, Gov. Cuomo simply entered a
line item number of $4B in “savings” to be achieved by a) $1.5B from Medicaid
cost-shifts onto local governments ($1B of which would fall onto New York City
and our public hospital system in particular) based on long-term care
utilization growth, and b) $2.5B in program changes to be developed by a
“Medicaid Redesign Team” (MRT), an unusual mechanism he used when he first took
office in 2011 to curtail Medicaid spending in the wake of the Great
Recession. When its membership was
announced in early February, it was comprised of 21 members, almost all of whom
were representatives of various industry stakeholders and members of Cuomo
administration. Sadly, only one (token)
consumer/community representative was included to represent the diverse
populations who rely on Medicaid, T.K. Small from Concepts of Independence.
An ad-hoc campaign dubbed “Protect Medicaid” was quickly
formed by a number of statewide health advocacy groups including the Campaign
for NY Health, Child Health Now, Consumer-Directed Personal Assistance
Association of NYS, Health Care for All NY, Medicaid Matters NY, NY Association
on Independent Living, NY Statewide Senior Action Council, and Save NY Public
Health. We played a key role in leading
this campaign which focused on keeping the state’s broader health and social
service advocacy community aware of the MRT process, coordinating efforts to
influence the MRT’s deliberations, engaging legislators on the issues in play, and
calling the media’s attention to what was at stake for people who rely on
Medicaid.
In the end, the MRT process proved to be very rushed and
perfunctory with some public engagement mechanisms that proved little more than
window dressing for ideas that the Cuomo administration had already developed
and just wanted rubber stamped. These
proposals were then taken into the final budget negotiations with the State
Legislature at the very last minute, a highly unusual procedure given how
significant the Medicaid portion of the overall budget really is, and was done
in a way that up to that point had completely cut the Legislature out of the
process of reviewing and developing a Medicaid budget. $2.2B in cuts were made, including very
significant changes to long-term care programs to limit eligibility and curtail
the recruitment and retention of home care workers.
The final budget deal was concluded just as the COVID-19 pandemic was hitting our state full force. In fact, during the last two weeks in March, much legislative activity moved online and the final agreement was almost exclusively negotiated between Gov. Cuomo, Senate Majority Leader Andrea Stewart-Cousins, and Assembly Speaker Carl Heastie, with little if any involvement of major committee chairs nor rank-and-file members. In addition, there were no one-house bills passed nor the usual (largely ceremonial) conference committee process invoked, both standard parts of a normal year’s budget process.
Other Aspects of the Final Budget:
The shift of some Medicaid costs for excess long-term care costs onto the counties was not approved. Instead, a portion of counties sales taxes will be held by the state and dedicated to support safety net hospitals.
Pharmacy coverage for people enrolled in Medicaid managed care plans will be removed from private insurers, and instead will be provided through the state’s existing program for fee-for-service Medicaid where it negotiates lower prices with drug manufacturers.
Concerning expansions of existing coverage programs, a new state-funded premium subsidy for Affordable Care Act private insurance plans offered on the state’s New York State of Health online marketplace was not created. In addition, opening up the state’s Essential Plan to all immigrants was not improved.
Funding for New York’s health insurance consumer assistance program was preserved, but was not increased. Unfortunately, no new funding for community-based outreach programs was created.
On the positive side, some consumer protections against medical debt were strengthened, the distribution of charity care funds to hospitals was improved to better target safety net providers who serve large numbers of Medicaid and uninsured patients, and a new prescription drug affordability board was created to moderate drug prices for those not on public insurance programs.
Insurers can no longer charge insulin-dependent people with diabetes co-payments higher than $100/month per prescription.
Gov. Cuomo was granted special power to propose periodic budget cuts at the end of April, June, and December. They would go into effect in 10 days after announcement unless the Legislature enacts a different set of cuts.
The Fight for More Revenue:
Since Gov. Cuomo took office nearly a decade ago, he has
consistently pursued conservative fiscal policies to limit any new taxes, cut
taxes whenever possible, and curtail spending growth to very modest
levels. The result has been that
existing health care and social programs have either been outright cut or not
allowed to grow to meet need, possible new ideas and programs were not
developed despite their merits, and state agencies have been unable to hire new
staff to carry out proper oversight and implementation roles.
With the change in the balance of power in the State
Legislature last year as progressive political forces gained ascendancy, there
was much optimism that the state could and would finally turn a corner away
from Gov. Cuomo’s longtime politics of austerity, and some health and human
service advocates came together under the “New Hope for New York” campaign. However, change did not happen then because
the new Senate Majority was not able to coalesce effectively behind an
alternative to his stance.
Starting last fall, a much broader array of social justice
and politically progressive activist groups and unions joined forces to form
the New York Budget Justice campaign, led jointly by Empire State Indivisible,
Fiscal Policy Institute, and Strong Economy for All. The campaign undertook a variety of
strategies and tactics since the start of this year to promote the overall call
for raising new revenues by slightly raising taxes on ultra-wealthy New
Yorkers, and developed more than a dozen different tax proposals (www.nybudgetjustice.com/initiatives.)
While Gov. Cuomo opposed these ideas, support began to grow
within the Legislature, and bills were introduced. Unfortunately, when the COVID-19 pandemic hit
our state full force in mid-March, the usual budget process immediately ground
to a halt, everything went behind closed doors for a fast wrap-up, and the
whole “new revenue” effort stalled out.
However, the campaign continues to live on and is significantly building
steam since then. Depending on how the
budget adjustment process plays out over the course of this year, there may be
new legislative opportunities that arise.
It was a festive evening on December 19th at our 2019 Health Care Justice Leadership Annual Gala when we all gathered at AFSCME District Council 37’s new Non-Profit Division to celebrate another year of “work well done”, prepare for the year ahead (which should be intense), and salute some worthy groups and individuals who’ve made significant contributions to the fight for health care for all.
After some opening remarks from our board chair Jeff Gold, our
Executive Director recapped what got done in and what still remains from 2019,
and looked forward into the crystal ball of 2020 when our “Vote for Health Care”
project will once again be critically important.
Next up was our keynote speaker Barbara Berney, Professor Emerita at the CUNY School of Public Health. She spoke about some lessons learned from the civil rights era of the 1960s when health care across the U.S. was formally desegregated as Medicare came into being. Her terrific documentary “Power to Heal: Medicare and the Civil Rights Revolution” reveals that untold story. Dr. Berney also reflected on what those lessons mean for us in our current times when racism in health care still remains a crucial issue to be addressed in order to successfully move toward universal health care.
Our first honoree of the evening was Dr. Mitchell Katz, President and CEO of New York City Health + Hospitals, for his Governmental and Political Leadership. He was introduced by Karen Jarrett of the New York State Nurses Association.
The next honoree(s), for Trade Union Leadership, were GM Workers from across New York State who are members of the United Auto Workers who went on strike this past fall to defend workers’ rights to health care benefits, among other key issues. Beverley Brakeman, Region 9A Director for the UAW, accepted the award since the relevant UAW Locals are all located in Western New York. She was introduced by Robert Score of Local One of the International Association of Theater and Stage Employees.
Our final honorees, jointly recognized for Community Leadership, were Alice Berger, recently retired Vice President for Health Care Planning at Planned Parenthood of New York City, and Terry Mizrahi, recently retired from the Silberman School of Social Work at Hunter College of the City University of New York and a longtime leading figure in the field of community organizing and health care.
This event was also our major annual fundraiser. If you haven’t already done so, we ask that you make a contribution in one of the following ways (see below.) Your support enables us to carry our work forward into 2020 when the future of our shared effort for universal health care will definitely be “on the ballot” here in New York and nationally.
Mail a check to us – 420 West 45th Street,
DC 37 Non-Profit Div., New York, NY 10036.
We want to thank the following groups and unions for financially supporting our Gala:
AARP New York
Anthony DiMarco Fund for Health Care for All of
US
Associated Musicians for Greater New York, Local
802 AFM
Callen-Lorde Community Health Center
Center for Independence of the Disabled New York
Children’s Defense Fund of New York
Chinese-American Planning Council
Citizen Action of New York
Coalition for Asian-American Children and
Families
Commission on the Public’s Health System in New
York City
Committee of Interns and Residents, SEIU Healthcare
Communications Workers of America, District One,
and Locals 1102 and 1180
Community Health Care Association of New York State
Community Healthcare Network
Community Service Society of New York
District Council 37, AFSCME
Doctors Council, SEIU Healthcare
Doctors for America, New York Chapter
1199 SEIU United Healthcare Workers East
1199-GNYHA Healthcare Education Project
Greater New York City Laborers and Employers
Cooperation and Education Trust
Hudson Center for Health Equity and Quality
International Cinematographers Guild, Local 600
IATSE
Make the Road New York
Medicare Rights Center
New York City Central Labor Council
New York Gray Panthers
New York Professional Nurses Union
New York State Nurses Association
New York Statewide Senior Action Council
Open Door Family Medical Centers
Organization of Staff Analysts
Peace Action of Staten Island
Physicians for a National Health Program, New
York Metro Chapter
Planned Parenthood of New York City
Primary Care Development Association
Professional Staff Congress, CUNY
Project Hospitality
Public Health Solutions
Raising Women’s Voices, New York
Ryan Community Health Network
Retirees Association of DC 37
Theatrical Stage Employees, Local 1 IATSE
United Auto Workers, Regions 9 and 9A
United Federation of Teachers, Local 2 AFT
West Side Federation of Senior and Supportive
Housing
Workers Circle
We thank everyone for all you do all year long to further the cause of universal health care here in New York and across the US. We look forward to our continuing partnership with you throughout 2020.
You’re invited! Please join us for our always-inspiring 2019 Health Care Justice Leadership Annual Gala to celebrate our accomplishments of the past year, look ahead to our work for the coming year, and raise the resources needed for our ongoing work to foster community and labor collaboration in the fight for universal health care and health care justice in New York and across our nation. Our Gala will take place on Thursday evening, December 19th, from 6 to 8:30 p.m. at District Council 37 AFSCME, Non-Profit Division, located at 420 West 45th Street in Manhattan.
We’re delighted to be honoring the following people and groups:
For governmental leadership — Mitchell Katz, MD, President and CEO of New York City Health + Hospitals (our city’s public hospital system.) NYC H+H is the crown jewel of our city’s health care system that offers culturally and linguistically competent services to all comers, regardless of ability to pay or insurance status . We are SO lucky to have it! Under Dr. Katz’ leadership, the system’s finances have been stabilized, and a strong emphasis on primary care has been developed. In addition, Dr. Katz has led the effort to establish our city’s new “NYC Care” program for the still-uninsured that aims to enroll people in coverage (if possible), and get them into regular primary care that also includes mental health and substance use treatment. Dr. Katz has also been an outspoken supporter of the New York Health Act, a universal health care bill now before our State Legislature. He is also a primary care physician at Gotham Health/Gouverneur, an H+H community health center located on Manhattan’s Lower East Side.
For trade union leadership — GM Workers, United Auto Workers Region 9 and 9A,Locals 686, 774, and 1097,completed a nearly six-week strike this fall that resulted in a successful contract negotiation. It was the union’s longest strike in nearly a half century. One of the key issues in dispute concerned maintaining strong health care benefits, which was achieved.
For community leadership —
Alice Berger, former Vice President for Healthcare Planning, Planned Parenthood of New York City from 1997-2019 where she focused on strategic advocacy to expand the agency’s services and defend reproductive rights. She has long been a leading voice calling attention to the intersection between the fights for health care for all and comprehensive reproductive health care.
Terry Mizrahi, Professor (1980-2019), Silberman School of Social Work at Hunter College, City Univeristy of New York; has been on the faculty of the Silberman School of Social Work at Hunter College for nearly 30 years, where she founded and developed their innovative program in community organizing and social welfare policy, and also expanded it to be an official minor program at the undergraduate level. For many years, she co-led the Health Care Policy and Practice Network of the New York City Chapter of the National Association of Social Workers, and has represented the Chapter to our Steering Committee since our founding in the early-mid 1990s.
Our special keynote speaker is Barbara Berney, DPH, Professor Emerita, School of Public Health, City University of New York, and Producer of “Power to Heal: Medicare and the Civil Rights Revolution”. Dr. Berney’s terrific documentary tells the story of how the implementation of Medicare 50 years ago was leveraged to desegregate hospitals across the United States in (literally) just a few week’s time. This accomplishment was the result of the civil rights movement combining forces with public health activists, hospital workers, and government civil servants. She will speak to us about lessons to be drawn from that era that inform our work ahead to bring about true universal health care in the U.S.
We invite everyone to support our Annual Gala by making as generous a contribution as you can. There are several options:
mail us a check (Metro New York Health Care for All, 420 West 45th Street, New York, NY 10036.)
give at the door.
Our requested minimum contribution is $75 for individuals, but all are welcome at whatever level you can donate. If you cannot attend in person, we will miss you but will still welcome your support.
We also ask that you approach your own organization or union for their support. Options for them include joining the Host Committee, and/or placing an announcement in the commemorative journal. Package deals are also available upon request, as are groups of tickets. Contact us directly at metrohealth@igc.org or 646-887-0305 for further information.
Throughout this year, the New York State Senate and Assembly Health Committees are holding a series of joint hearings across the state that are focusing on the New York Health Act (S.3577, A.5248)., a bill to create a fully-public universal health care program for all New York residents The first hearing was held in Albany late last spring — it was jam-packed and lasted over 13 hours, and garnered much local media attention. The second was held in early October in Western New York, at the Memorial Art Gallery in Rochester — it too was well attended, lasted most of the day, and got covered by local media. The third took place in New York City in late October at the Bronx Library Center– over 40 people testified over the course of a full day. A final hearing is planned for November in the Hudson Valley — the date and location are to be announced.
Below is the testimony we presented at the New York City hearing on October 23rd.
“Since our coalition’s founding 26 years ago, we have supported various proposals and legislation that both fully embody and incrementally move our state and nation towards a universal health care program. We do not believe either approach to be in opposition to the other, but rather they are complementary – one reinforces and advances the other both policywise and politically. We therefore call on the Legislature and Governor to do the same: that is, to push for a unitary bold and comprehensive program, while at the same time taking other strategic interim steps forward to lay groundwork.
“It is in this vein that we understand and support the New York Health Act, as we have since our very first days as a coalition. This bill, should it be enacted by the Legislature and signed into law by the Governor, will have to be put in place in phases, so it’s helpful for us to think of it in that way. In sum, this bill lays out a journey that we will all be embarking on, and a framework we will be working from. first crafting and enacting legislation, next crafting and adopting rules and regulations, and finally implementing it as law over a defined period of time.
“As this bill moves forward in the legislative process, we recognize that changes will be made, both for policy and political reasons, so that the public in all our variety is behind the effort in every step in the process. Several of our coalition’s union partners, while certainly supportive of the bill’s goals and principles, have expressed legitimate concerns about some aspects of the bill that they worry may leave their members less well off. We commend your efforts as chairpersons to engage with them to address their concerns, and urge you to continue that process. We also thank the New York State AFL-CIO for taking leadership to bring our state’s trade union community together to help forge resolutions.
“With that in mind, we call for your committees and all stakeholders to focus on the following goals as we proceed:
“Universality – When all is said and done, ALL New Yorkers must have good health coverage in place in coverage that they can rely on when accessing care. We believe that public programs are the best foundations to build upon, and we believe that a unitary program is best to create.
“Affordability – ALL New Yorkers must be able to afford the care they and their families need and receive. We believe a system of progressive taxation with little to no payment at the point of service is the best way to finance the provision of services.
“Accessibility – As universal coverage comes in place, ALL New Yorkers must have a place to go to get the care they need in their local communities, from culturally-competent providers they know, trust, and freely choose. An insurance card alone is not enough, and requiring people to travel long distances will not work.
“Comprehensiveness – ALL services deemed necessary by patients, their families, and their providers must be covered, including medical, dental, mental health, reproductive health, substance use treatment, and long-term care for people with chronic illnesses and disabilities.
“Simplicity – The terms “byzantine” and “Kafkaesque” don’t even begin to describe the nature of our state’s health care system, and an average patient’s experience of seeking and paying for services. If this bill does nothing else, it must make our state’s health care system vastly easier for the everyday person to understand and use.
“Patient-at-the-center – At the end of the day, any and all changes and reforms of our health care system must be centered around the concerns and priorities of the patient, and not the systemic priorities of any entities providing and financing care. The patient comes first, and the system must adapt to meet their needs even if deemed by elements of the system to be “inefficient.”
“Accountability – Given that our state’s resources for health care are not limitless, all aspects of our health care system must be subject to rigorous oversight by state authorities to assure the highest quality and scope of care for the investments we make, and to hold the components of our delivery and payment systems accountable for all patients’ access, costs, care experience, and treatment outcomes.
“Equity – Like all aspects of our society, there is a long and shameful history of disparities and inequities in treatment throughout our health care and coverage systems based on race, ethnicity, nationality, spoken language, gender and gender identity expression, disability, sexual orientation, and other demographic factors. Whatever gets created and changed by the New York Health Act must mitigate and ameliorate this history, as well as address its historic impacts in the manner of restorative justice.
“Government in the driver’s seat – Overall, what is most hopeful about the New York Health Act is that it envisions taking health care out of the for-profit sector and placing it firmly in the public and non-profit sectors. To the extent any for-profit entities would continue to play any role in the provision of and payment for services, they should be highly regulated. We strongly support these changes. We believe that health care is a public and social good, a human right, and it should no longer be subject to the vagaries and cruelties of the free market with its consequent winners and losers.
“Promoting health – The proper role of a health care system is to, as best as possible, restore people to well-being in the event of illness and injury, and to keep them healthy. Doing so also contributes to the public health of our state, so a universal health care program needs to explicitly affirm and embrace such a responsibility.
“In closing, we thank and salute both of you and your committees for putting forth the New York Health Act as the next step in our state’s long and proud tradition of addressing the health care needs of all New Yorkers. Among states, we have the among the most robust Medicaid, Child Health Insurance, and Affordable Care Act marketplace programs. It’s now time to take the next step and move toward a full universal health care program as envisioned by your bill. Our coalition stands ready and willing to work with your committees, your colleagues in the Legislature, and the Governor to sort it all out and get the job done.”
As Congress has returned to work this fall, here’s an assessment of where various health care initiatives stand, and prospects for the rest of this year heading into 2020:
Appropriations bills – While a 2-year overall budget framework was adopted by Congress in late July (running until mid-2021), the spending bills for FY 2020 (which started on this past October 1st) have yet to be enacted, including the one for the Dept. of Health and Human Services. Before Congress recessed at the end of last week for a 2-week period, they passed a “Continuing Resolution” to keep the federal government open and operating at FY 2019 levels until Nov. 21st. Overall sticking points are funding for a wall on the southern border, and maintaining parity between increases in defense vs. non-defense spending.
Affordable Care Act defense and improvement bills – Earlier this year, both the House and Senate developed bills to push-back against Trump administration moves to weaken or outright undermine the ACA, as well as to improve some aspects of the bill that have needed fixing. In the House, their bill is the “Protect Pre-Existing Conditions and Making Health Care More Affordable Act” (HR 1884/Pallone), and 5 Representatives from NYC: Jeffries (NY-8), Rose (NY-11), Maloney (NY-12), Espaillat (NY-13), and Engel (NY-16) are co-sponsors. The bill has been jointly referred to the Education and Labor, Energy and Commerce, and Ways and Means Committees for mark-up, but nothing has yet moved out of any of them.
In the Senate, the main bills are the “Protecting Americans with Pre-Existing Conditions Act” (S. 466/Warner) which is co-sponsored by Sen. Gillibrand, and the “No Junk Plans Act” (S. 1556/Baldwin) and is cosponsored by both Sen. Schumer and Sen. Gillibrand. In addition, the Health Education, Labor, and Pensions (HELP) Committee passed the “Lower Health Care Costs Act” (S.1895/Alexander-Murray) and sent it to the floor in late June – it is an omnibus bill with a variety of provisions dealing with a range of health care issues and problems.
Surprise medical bills legislation – Both the House and Senate have been developing bi-partisan bills to provide new consumer protections for patients who are unexpectedly and unfairly hit with out-of-network bills from doctors, hospitals, and other medical facilities. The two main approaches that have emerged both remove patients from being caught in the middle of such disputes between insurers and providers: one approach creates an arbitration system (like we have here in NY for insurers subject to state jurisdiction); another approach creates a benchmark payment based on the average in-network charge for a given service in a given geographic area. Up through this summer, everything was on track to move forward this fall. However. since the August recess period, “dark money” forces and venture capital/hedge funds have launched an aggressive campaign to stop any such bills, as they seek to defend independent medical group entities that they own who profit handsomely from the current status quo where they can “balance bill” patients. Congressional leaders’ goal is to get a bill done by year-end. They are working their way through the Energy and Commerce and Education and Labor Committees in the House, and the Health, Education, Labor, and Pensions Committee in the Senate.
Prescription Drug Pricing bills – House leadership recently introduced their new “Lower Drug Prices Now Act” (HR 3/Pallone) to a) create a system of government price negotiation with manufacturers for high-priced drugs, b) moderate annual price increases for all drugs, and 3) cap annual out-of-pocket costs for drugs for people on Medicare. They want to try to move this bill to the floor by the end of October. Its co-sponsors from NYC include Reps. Meng (NY-6), Rose (NY-11), and Engel (NY-16.) The “Medicare Negotiation and Competitive Pricing Act (HR 1046/Doggett), a bill that is more robust in scope, was introduced earlier this year, and is co-sponsored by NYC Reps. Velazquez (NY-7), Jeffries (NY-8), Clarke (NY-9), Nadler (NY-10), Rose (NY-11), Maloney (NY-12), Espaillat (NY-13), Ocasio-Cortez (N-14), and Serrano (NY-15). Advocates are supporting both these bills as good first steps. In the Senate, S.377/Brown is similar to HR 1046, and another bill, the Prescription Drug Pricing Reduction Act (S.2543/Grassley-Wyden), has passed out of the Finance Committee.
Medicare-for-All bills – A
variety of such bills have been introduced in the House and Senate, ranging
from modest to comprehensive in scope.
In the House, the most progressive one is HR 1384 (Jayapal-Dingell), and
all NYC Reps. are co-sponsors except for Rep. Rose (NY-11).
The other ‘building on Medicare”
bills are:
“Medicare Buy-in and Health Care Stabilization
Act” (HR 1346/Higgins) – NYC co-sponsors: Meeks (NY-5), Jeffries (NY-8), Rose
(NY-11)
“Medicare for America Act” (HR 2452/DeLauro) – No
NYC Reps. have yet co-sponsored.
Over on the Senate side, the main
Medicare-for-All bill (S.1129) has been introduced by Sen. Sanders (similar to
HR 1384) and is co-sponsored by Sen. Gillibrand. Other Medicare-based bills are S.981/Bennet
(same as HR 2000), and S.470/Stabenow (“Medicare at 50 Act”) which Sen.
Gillibrand is co-sponsoring.
The Bigger Context:
Looming over all these legislative proposals and actions are three major concerns that will affect what moves ahead and when, if at all:
Impeachment Inquiry – There is much speculation that further developments in the House’s new impeachment inquiry process could easily eclipse and derail any of the above discussed bills either because it becomes an overall distraction and/or because hyper-partisanship may intensify.
ACA Repeal court case (“Texas v. US”) – The Fifth US Circuit Court in New Orleans is expected to issue its appeal ruling soon on the constitutionality of the ACA in response the initial Texas District Court ruling early this year that struck down the law yet staying its decision pending appeals. The Trump administration has actively sides of the plaintiffs (various Republican State Attorneys General led by the one from Texas) rather than defending the law (as is typical in such situations), and the House on the side of the defendants (various Democratic State AGs led by the one from California.) Whatever the 5th Circuit decision, its ruling will be appealed to the US Supreme Court by whichever side loses. It’s not clear if the lower court’s stay will be continued, nor if and when SCOTUS would take up the case and hear arguments, either in their 2019-2020 session that will begin next week, or its 2020-21 session. In either scenario, the whole matter will likely continue to stoke hyper-partisanship around the law and health care issues in general, particularly in an election year context. Should an adverse decision come down from the 5th Circuit, advocates nationally will be mobilizing to voice opposition, help the public understand the implications, and pressure Congress to develop legislative reactions. It is important to place this case in context as part of the larger effort of the Trump administration and its Congressional allies to get rid of the ACA, either legislatively (which failed in 2017), legally (now underway in this case), or by Executive Order and/or regulatory changes (various efforts since Inauguration Day in 2017.)
…and of course, as the 2020
election process proceeds with primaries during the coming winter and
spring, conventions over next summer, and general election campaigns a year
from now, health care is once again poised to be a top-tier issue for
voters. Candidates are coming forth with
a variety of proposals and making claims and counter-claims about them. While we do not engage in any direct
electoral work for any candidates nor recommend who people should vote for or
against, we do plan to, as always, help people understand the health care issues
in debate, the various candidates’ positions and records, and fundamentally
“what’s at stake”, so that New Yorkers can make informed decisions when they go
to vote.
Thank you, everyone! With your generous support, we have exceeded the goal for our 2019 Annual Dues Campaign, raising the most resources ever.
We’re already putting all your contributions to work this fall with our “Getting Ready for 2020” initiative. It will lay the groundwork for a variety of policies to keep moving toward comprehensive, quality, affordable health care for all during the coming legislative year, and continue to elevate universal health care as a top-tier issue for voters and helping everyone understand all the claims and counterclaims from various quarters.
We salute the following organizations and individuals for joining our 2019 Health Care for All team!
Organizations:
Actors Fund
Citizen Action of New York
Center for Independence of the Disabled in New York
Commission on the Public’s Health System in New York City
Committee of Interns and Residents, SEIU
Communications Workers of America, Local 1102
Communications Workers of America, Local 1180
Community Healthcare Network
Community Health Care Association of New York State
Community Service Society of New York
District Council 37 Retirees
District Council 1707 AFSCME
El Centro del Immigrante
Healthcare Education Project
Hudson Center for Health Equity and Quality
Housing Works
International Cinematographers Guild, Local 600 IATSE
Medicare Rights Center
National Association of Social Workers, New York City Chapter
It was a packed house on Fri. morning Aug. 2nd at District Council 1707 AFSCME in midtown Manhattan when community and trade union activists celebrated the 54th anniversary of Medicare and Medicaid. Thank you to everyone who showed up, far exceeding our expectations. New Yorkers really love and care about these programs!
Our opening panel featured New Yorkers sharing their own personal stories about what Medicare and Medicaid have meant to them personally, grounding our event in everyday reality. Carl Ginsberg told the story of his recently-deceased uncle Max Fine who served on President Kennedy and Johnson’s Medicare Task Force back in the early 1960s, and how they pushed the law through Congress. United Federation of Teachers retiree member Millie Glaberman spoke about what Medicare means for her as an union activist. Mario Henry of New York Statewide Senior Action told the story of caring for his mother in her final years. Nurse Judith Cutchin and New York State Nurses Association member spoke of how important Medicare and Medicaid are to our city’s public hospital system where she works. Home care worker and 1199 member Patricia McAlmont described how important Medicaid is for the frail patients she cares for daily. Finally, Disabled in Action leader Nadina LaSpina told the story of how both programs have enabled her and her late husband Danny Robert to live full lives in the community despite shortcomings that Congress still needs to address.
Our second panel let us know what is happening in Congress this year with regard to Medicare and Medicaid bills and proposals. The speakers were Derek Ayeh from the Medicare Rights Center, and Ben Anderson with the Children’s Defense Fund of New York.
The final section of the forum showcased activist leaders sharing information about various Medicare and/or Medicaid advocacy campaigns underway here in New York.Doris Welch from the New York State Alliance for Retired Americans reminded us of the importance of telling our own personal stories as a very powerful tool with lawmakers. Beth Finkel with AARP-New York discussed “common sense” efforts to bring down the costs of prescription drugs. Heidi Siegfried from the Center for Independence of the Disabled spoke about protecting and improving Medicaid long-term care provided at home and in the community. Darius Gordon with the Center for Popular Democracy told us about new efforts to advance Medicare-for-All bills in Congress. Before we broke for cake and ice cream, Metro’s Director Mark Hannay wrapped things up by sharing information about public hearings slated for this fall about the New York Health Act, and called for everyone to help the public understand the health care claims and proposals of candidates as the 2020 elections approach so that people can affirmatively “vote for health care” when they go to the polls.
As New York State’s annual legislative session heads toward its conclusion in late June, advocates and everyday activists of all stripes have their eyes on the State Capitol to push their priorities over the finish line. Below is a rundown of what health advocates are pushing forward, how you can help, and an important meeting in Albany next week that community and union advocates are invited to attend on June 6th.
But first off, kudosto everyone who turned out earlier this
week in Albany for the historic joint Senate and Assembly public hearing on the
New York Health Act, a bill to create a fully public universal
health care program for all New Yorkers. Buses, vans, and car pools of
supporters came from all corners of the state to witness the proceedings and
give testimony. We packed the room with 250-300 people, and the hearing lasted
well over 14 hours, ending just before midnight. Clearly, everyday New Yorkers
care about this issue (a LOT), and are demanding action for “health care for
all!” Because of YOU, this bill has now crossed over into the mainstream of
political debate, and lawmakers are sitting up and paying attention.
Next steps are that we are hoping
for another one-house vote in the Assembly for a fifth year in a row, and over
the coming summer and fall, regional hearings on the bill will be held across
the state, including in New York City, Long Island, and the Hudson Valley.
Watch for future details on dates and locations! They will set us up and give
us needed momentum going into next year’s legislative session.
But in the meantime, here’s
what’s up next for the month ahead:
We invite representatives from community groups and trade unions to join us in Albany next Thurs. June 6th for the Annual Spring Meeting of Health Care for All New York (HCFANY), taking place from 10:15 a.m. to 3:30 p.m. at 1199 SEIU (155 Washington Ave.) We’ll be discussing our end-of-session legislative agenda (see below), showcasing the exciting new “We the Patients” project to empower everyday people to address the systemic causes of much medical debt, and recognizing Sen. Brad Hoylman with our “Consumer Champion of the Year” award. We’ll also be holding workshops on online and social media organizing, health system accountability, expanding coverage options for immigrants and other uninsured New Yorkers, and reining in sky-high prescription drug costs. Click here to RSVP for this meeting.
We urge people to contact their own state legislators to express support for HCFANY’s short-term agenda for 2019, including:
Expanding coverage for uninsured low-income immigrants, and preserving it for those losing the Temporary Protected Status under new policies of the Trump administration.
Making sure that our state’s precious charity care dollars only go to those hospitals that treat large numbers of poor and uninsured patients, and not to those that don’t.
Stopping insurers from dropping doctors and hospitals from their provider networks and drugs from their formulary lists in the middle of a plan year without just cause.
Expanding the scope of our state’s landmark “surprise bills” law to include charges for out-of-network emergency services.
Regulating and licensing Pharmacy Benefit Managers so that they stop gaming the system behind their own closed doors to rake-in shady profits.
Strengthening community and public oversight of hospital downsizing, closures, and mergers, and requiring all hospitals to establish community advisory boards that are given meaningful roles in local needs assessments and service plan development.
Putting the state’s very successful independent consumer assistance program (“Community Health Advocates”) into law so that it is permanent, and is no longer subject to the vagaries of the annual budget process.
