Now that the new Congress is settled in and humming along and the state budget process over, New York health care advocates are pivoting toward them and the Trump administration.  As we look southward toward Washington DC, several categories of focus have emerged   A good number of them carry over from the previous two years since the Trump administration came to power.  However, the legislative landscape has now changed significantly with the shift of balance of power in the House of Representatives.  These include:

• Rebutting the Trump administration’s ongoing moves to sabotage the Affordable Care Act (ACA), dramatically restricting access to Medicaid, and curtail family planning programs and reproductive rights.
• Opposing the Trump administration’s budget proposals for the 2020 fiscal year that begins on October 1^st, particularly those provisions that affect health care and related human services, overall spending priorities, and EVEN MORE tax cuts ultra-rich.
• Improving the Affordable Care Act.
• Expanding coverage under Medicare and Medicaid in various ways.
• Curtailing prescription drug prices.

Digging down into the first two of these areas with more detail in Part I of this series, here’s what’s been coming out of the White House that cause us great concern:

Undermining the ACA – Since taking office, the Trump administration has undertaken a whole variety of efforts to undermine the ACA, including:

• Canceling “cost-sharing reduction reimbursements” to insurers for low-income policyholders who enroll in silver-level ACA health plans.
• Drastically slashing funding for advertising and public-private education/outreach programs during annual ACA open enrollment periods, and for enrollment assisters year-round in states that rely on the federal government’s online ACA marketplace system.  Regional federal government staff were also banned from participating in any local outreach events.
• Canceling IRS enforcement of the “individual mandate” tax penalty for uninsured people who do not enroll in coverage but have no legal exemption.  Eventually, the mandate amount was zeroed out in the Trump tax cut bill of 2017, thereby making it functionally non-existent while still technically on-the-books.
• Loosening the formulas used to calculate premium subsidies for people who buy ACA coverage so that they get less.
• Removing useful information for consumers about the ACA from government websites and social media platforms, and replacing it with propaganda of consumers discussing how the ACA has harmed them.
• Reducing the annual open enrollment period by 50% from 90 to 45 days, and shutting down the online federal marketplace website for “routine maintenance” on Sundays during this period.
• Allowing employers with “religious objections” to refuse to offer coverage of contraceptive care and termination of pregnancies.
• Allowing insurers to sell “junk coverage” through Association Health Plans and Short-Term Limited Benefit Plans, thereby negating the ACA’s requirements for 10 Essential Health Benefits and pre-existing medical condition protections.  The short-term plans were also extended from 90 to 364 days.
• Refusing to defend the ACA against constitutional challenges brought by some states, and eventually openly siding with those states.
• Allowing states to lower standards for comprehensive benefits offered by insurers’ various health plans.

(See also:  https://www.cbpp.org/sabotage-watch-tracking-efforts-to-undermine-the-aca)

Restricting Medicaid – Aside from continuing to try to repeal the expansion of Medicaid created under the ACA, the Trump administration is trying to impose by regulation a variety of ways to restrict eligibility to and use of Medicaid.

• The main way is to allow and outright encourage states to impose a whole lot of red tape and paperwork requirements that require Medicaid applicants and participants to continually prove that either they are a) working at least half-time, or b) qualify for work exemptions based on age, disability, informal caregiving responsibilities, or higher education.
• Methods to discourage enrollment include imposing premiums and co-payments, limiting available drug lists, ending preventive services for children, and non-emergency transportation to hospitals and doctors.
• Methods to restrict eligibility include lock-out periods for non-compliance with various requirements, ending presumptive eligibility for sick patients at hospitals, and imposing lifetime benefit caps.
• Allow states to only do a limited ACA expansion, unilaterally change eligibility criteria without federal approval, exclude abortion care providers, end 90-day retroactive coverage, and end transitional coverage when a family increases its income.
• Urge states to apply for special “block grant” waivers.

 (See also: https://healthlaw.org/resource/sec-1115-waiver-tracking-chart-3-2/)

Many of these moves are being challenged in the federal courts as violating existing Medicaid law, and some rulings are putting them on hold.  However, some of these changes are going ahead in the meantime, and people are losing access to Medicaid and some covered services.

Limiting Reproductive Health Care – Once it became clear that Congress was not going to do so in law, the Trump administration is now moving by regulation to end “Title X” and Medicaid family planning funding to any health care entities that provide abortion counseling, referrals, or care.  This move will primarily effect Planned Parenthood facilities.  Once a final rule is published, there will likely be lawsuits challenging the new policy as illegal.  These steps are in addition to moves to allow employers to deny insurance coverage of contraception if they so choose, based on the religious beliefs of the business’ owners. Further, the administration is allowing any health care provider to refuse to provide reproductive health care services based on religious beliefs, and even to refuse to treat certain patients whatever their health care needs.

Trump budget proposals – As in previous years, looking at the health care provisions as a whole, they embody the general approach of the infamous “Graham-Cassidy” proposal rejected by the Senate two years ago, yet it goes farther.  The “big idea” is to lump all health care and human service funding coming into states (Medicaid, Children’s Health Insurance Program, the ACA, food assistance programs, housing subsidies, income assistance, other “categorical” programs, etc.) into ONE gigantic block grant while simultaneously drastically cutting the total dollar amount of such funding, and dramatically scaling back federal requirements and oversight, all in order to “let states innovate”.  Many fear that what will actually result is a real-world “Hunger Games” wherein states would be saddled to pick up the slack which they could not possible do or manage.  The results would be quite drastic, particularly in states like New York where we have a long history of robust health care and social programs to support struggling individuals and families.

Simultaneously, the Trump administration proposes to reorient spending increases away from the full range of non-defense discretionary spending that funds many health and human service programs, and increase spending on defense and national security.  This change would break a decades-long bipartisan agreement that whatever overall spending increases or decreases happen on one side of the budget (e.g. defense) is comparable to what happens on the other side of the budget (e.g., domestic.)

In addition, the administration proposes to permanently extend the personal income tax cuts included in the Tax Cut and Jobs Act of 2017 (aka “Trump tax cut bill”), most of which benefited the ultra-wealthy.  That bill included tax cuts for large corporations and special interests which already are permanent, but the personal tax cuts were only put in place for 10 years (through 2026.)  Taken together, those cuts blew a whopping $2 trillion hole in the federal budget deficit over the next decade.  Making the personal tax cuts permanent will add another $3 billion to the deficit, leading to a total deficit increase of nearly $5 trillion.  The ONLY way to pay down a deficit of that big a size without raising any taxes of any sort will be to drastically slash spending on major social entitlement programs such as Social Security, Medicare, Medicaid, and SNAP/Food Stamps, as well as the whole range of health, human service, education, and economic development programs.

Advocates’ responses — All 12 Congressmembers from New York City belong to the new House Majority which, as a whole, is publicly opposing all these moves by the Trump administration.  Nonetheless, advocates have been meeting with them to voice our concerns, and support their efforts to lead our nation in a different direction.  In particular, we have been seeking to engage with the two new members of our city’s delegation (Rep. Max Rose whose district encompasses all of Staten Island and parts of southern Brooklyn, and Rep. Alexandria Ocasio-Cortez whose district encompasses parts of southeastern Bronx and western Queens), as well as Rep. Hakeem Jeffries who is now the fourth-highest member of the House Majority leadership.  Other congressmembers from New York of importance are those who serve on the relevant committees of jurisdiction (Ways and Means, Energy and Commerce, Education and Labor, Budget, Appropriations.)  In addition, New York’s senior US Senator, Charles Schumer, is the Minority Leader of the Senate, and our junior Senator, Kirsten Gillibrand, is a candidate for President, so there are lots of opportunities for us to take advantage of, and lots of bases to cover.

In addition to engaging with lawmakers directly, we are also reaching out to everyday New Yorkers to help them understand what’s at stake for them, their families, and our communities, and what they can and should do.  The statewide “Renew the American Promise” (RAP) campaign was established at the beginning of this decade to bring forces together from across New York State in a coordinated effort to defend the broad range of health care and human service programs, and support budget and tax policies that keep them strong.  Simultaneously, RAP is promoting policies to improve and expand these programs to help more New Yorkers in need.  (More on all that in Part II of this series.)  Metro New York Health Care for All helps to anchor RAP along with Citizen Action of New York, New York State Alliance of Retired Americans, and New York Statewide Senior Action Council.  The campaign fosters and guides loose coalitions of groups in strategic regions and congressional districts across the state to take action.

For the first time ever, the New York State Senate Health Committee is holding an official hearing on the “New York Health Act” (NYHA), a bill to create a fully-public universal health care program covering all New York residents. The hearing will be held on Tuesday, May 28th starting at 10 a.m. in Hearing Room A of the Legislative Office Building in Albany, and will be joint with the Assembly Health Committee.  The Committees chairs are encouraging all groups and entities with statewide scope to present testimony on the bill. Official information on this hearing can be found here.

Advocates for universal health care are mobilizing to turn out for the hearing, bear witness to the proceedings, and show support for this bill. FREE buses and car pools are being organized from across the state. People can learn more and RSVP for travel here. Earlier this decade, the Assembly held hearings around the state on the bill, and many everyday New Yorkers showed up for and testified at them, and they also organized press conferences for local media outlets, Now it is the Senate’s turn in the spotlight.

This hearing represents a signficant political step forward for NYHA and gives it further political and legislative legitimacy. Originally introduced in 1992 by long-time Assembly Health Committee Chair Richard Gottfried, it passed then in the Assembly as a symbolic one-house bill in advance of that fall’s statewide elections. It then languished for over two decades, typically getting voted out of his Health Committee and then not moving forward any further. With a new Assembly Speaker (Carl Heastie) coming to power in 2015, interest in the bill improved greatly because of his support, and it has since passed as a one-house bill in the Assembly every year since. However in the Senate, it was never even taken up and debated in the Health Committee by the former Republican Majority, and was typically sponsored by a Minority Democrat, first Eric Schneiderman, then Bill Perkins, and finally Gustavo Rivera. By the end of the 2018 legislative session, support had grown strongly, and all but one Democratic Senator was co-sponsoring the bill.

With the new balance of power in the Senate this year, prospects for the bill moving forward in the Chamber have increased greatly, particularly since Sen. Rivera is now chairing the Health Committee. So far, 30 Senators are co-sponsoring the bill, and another 2 are needed for a simple majority to be on board. Once that happens, it will be taken seriously by the body and its leaders. This hearing will begin that process, and hopes are that once this year’s legislative session ends in late June, the Committee will “take it on the road” to hold regional hearings across the state during the summer and fall, to hear from everyday people statewide, answer questions about it, and educate local media and the broader public. The strategy is to build up a head of steam heading into next year’s legislative session that will start in January.

The substance of the bill itself has evolved quite a lot since its introduction some 25 years ago, to reflect various changes in health care and coverage that have happened over the years, most notably the State Child Health Insurance program created by Congress in the mid-1990s, and the enactment of the Affordable Care Act (ACA) a decade ago, along with more modest incremental reforms enacted here in New York. The big change in the bill this year has been the inclusion of a new “Long-Term Care Amendment” to provide coverage for people who need nursing home care and/or health and personal care services at home or in the community. This new provision has generated much excitement and support in the senior citizen and disability rights communities, as well as from long-term care workers and informal family caregivers.

Advocates view this bill as a template to work from to craft the best possible legislation that can pass through both houses of the Legislature and be signed by the Governor, a process that often takes a bit of time. Then the state will apply for waivers from the federal government to use the many current health care funding streams from it that come to the state to help fund the new program, as allowed under the ACA. Simultaneously, a process will begin here to craft all the necessary rules and regulations, followed by a transition process to phase-in the new system, hopefully by the middle of the next decade if not sooner. All that said and done, New York will be a model for the nation on “what’s next for health care”, and continue our proud, decades-long tradition as a “leader state” on health care issues.

Despite health care being a top-tier issue for voters in last fall’s elections, no major new initiatives were included in the final New York State 2019-20 budget enacted by the Legislature and Governor at the end of March.  The only significant actions taken were to codify provisions of the federal Affordable Care Act (ACA) in state law (up to now it’s existed merely under an Executive Order), and rejecting a proposed cut to a scheduled increase in Medicaid reimbursement rates to hospitals for in-patient services (a move long overdue since rates hadn’t increased in almost a decade.)  While both these steps were sound, much else was left undone.  Otherwise, it was pretty much just a maintenance of the status quo.

Here’s a run-down of what did and didn’t get included:

Expanding and Improving Insurance Coverage:

Most disappointing was the fact that no major initiatives were included to offer new health insurance options to a) immigrants who lack them, b) make health insurance more affordable to buy and/or to use, and c) reach out to those who remain uninsured and get them enrolled.  In particular, advocates were promoting the ideas of 1) expanding the state’s very successful Essential Plan to undocumented immigrants using state-only dollars (the program’s current funding is mostly federal), 2) allowing moderate-income people to buy-in to the Essential Plan if they want, and 3) offering additional premium subsidies to people who currently receive federal ones and/or to those who don’t qualify for federal ones because their income is too high.

Consumer Assistance and Outreach:

ACA Navigators –The program was reauthorized for another 5 years, but with no increased funding to provide a cost-of-living increase since it was set up 5 years ago.  Consequently, community-based, non-profit organizations who comprise the program are now having to raise separate funds from private sources to account for cost increases such as raises in the state’s minimum wage.  This program enrolls people into coverage through Medicaid, the Essential Plan, and private Qualified Health Plans offered on the state’s New York State of Health exchange marketplace.

Community Health Advocates (CHA) – Funding for the state’s officially-designated consumer assistance program was also flatlined, again with no cost-of-living increases since its creation at the beginning of this decade.  CHA is a wildly successful and well-respected ombuds program that helps consumers and patients with all kinds of health care and insurance problems.  Like the Navigator program, CHA is comprised of a statewide network of local community-based non-profit groups, and is anchored by the Community Service Society, Legal Aid Society, Medicare Rights Center, and Empire Justice Center.  (Got a problem?  Contact them!)

Enrollment Outreach – New York has done remarkably well in implementing the ACA, such that our uninusrance rate is now less than 5% generally, and less than 2% for children and adolescents.  Those who remain uninsured are either a) immigrants who have few options beyond Emergency Medicaid, b) eligible for current coverage programs but for some reason who are not yet enrolled, or c) believe they cannot afford to buy coverage given their family income and don’t qualify for public programs.  One good way to help all these people out is to reach them through trusted grassroots community groups who are often small and operate on subsistence budgets.  Unfortunately, the Legislature and Governor rejected calls to create a funding stream for these groups to undertake basic community outreach and education, and help get those still-uninsured to Navigators and other enrollers.

Health Care Delivery:

Charity Care Funding – Since the enactment of the ACA, the state has been required to revamp the formula by which it allocates funds from its Indigent Care Pool (ICP) to hospitals that treat large numbers of uninsured and Medicaid patients, because the pool includes funds from the federal Disproportionate Share Hospital (DSH) program.  Previously, a lot of this money went to some hospitals that treated few such patients or outright refused to admit them other than in an emergency room during a medical emergency.  A transition has been underway, but the final stage of complete changeover has been delayed for several years now. 

In last year’s budget, a multi-stakeholder workgroup was created by the Department of Health to develop proposals to complete the transition.  A subset of the group’s participants comprised of consumer and community advocates and public hospitals produced a set of recommendations, but nothing official was recommended by the Department.  In this year’s budget, absent any positive action, the last vestige of the old formula was scheduled to automatically sunset, and the Governor’s initial budget proposal was silent on the matter.  However, in the final budget, the status quo was continued for another year with no phase-out.

Public Health Services – Article 6 of the state’s Public Health Law provides funding to cities and counties for core public health services for populations with special health care needs.  This year, out of nowhere, a $60 million cut was imposed just on New York City, but no similar cuts affecting any other localities.  These cuts will mean less state funding to New York City for prevention and treatment programs for HIV/AIDS, hepatitis, tuberculosis, sexually-transmitted infections, maternal and child health programs, children’s health clinics and school-based health programs, and public hospital clinics.

Safe Staffing — For years, unions representing nurses in hospitals and nursing homes have called for the state to mandate minimum staff ratios per patient, by department, to assure adequate care and quality of care.  The budget calls for the Department of Health to convene a multi-stakeholder workgroup to study the issue and develop recommendations, with a formal report due by the end of the calendar year.

Other relevant issues:

Tax Revenue – Time after time, year after year, advocates on many issues push for good ideas, only to be told by lawmakers that “there’s not enough money.”  Meanwhile, over several decades now, taxes have been cut at both the federal and state level for large corporations, special industries, and wealthy individuals and families.  With the new political landscape in Albany this year, many health and social service advocates were hopeful that these trends could be significantly reversed to provide more funding for needed programs, restore funding cuts from previous years, and to improve overall “tax fairness”.  Ideas promoted by economic justice advocates included an “ultra-millionaires” tax, a “pied-a-terre” tax, a “mansion tax”, and a “carried interest” tax.

In the final budget, the current millionaires tax was renewed but not expanded, an internet sales tax was created, along with a new “congestion pricing” tax for driving into lower Manhattan (begins in 2021), and a new tax on purchases of luxury residential real estate (valued at $25 million or more.)  Also, annual local property tax increases outside of New York City were capped at 2%.

Overall spending growth – Since taking office in 2011, Governor Cuomo has aimed to limit year-to-year budget increases to 2%, a figure which is totally arbitrary.  The Legislature has always accepted his policy and never challenged it, despite higher trends in overall economic growth and tax receipts.

Fair Elections – The budget authorized the creation of a public financing of elections program.  The program will fund a “small donor matching” system for all statewide and legislative offices (Governor, Comptroller, Attorney General, Senate, Assembly.)  A formal commission was created to develop proposals regarding eligibility thresholds, financing limits, contribution limits, large donor limits, and fusion voting rules.  Commissioners will be appointed by the Governor and majority and minority legislative leaders.  Their recommendations are due by December 1, 2019 and will go into effect within 20 days unless amended or rejected by the full Legislature.

This new campaign finance system will dramatically transform who runs for office on what issues and promises, and who is able to get elected.  New York City has had such a system for two decades and many more community-based and community-focused officials have been elected.  They have enacted many progressive policies on health care and other human service and social justice issues.  In recent years, Suffolk County has also created such a program.

What’s next:

The Legislature will remain in session through late June before adjourning for the year, so there’s still a chance that some of the “left undone” measures could still pass as stand-alone policy bills, with an eye toward teeing them up for next year’s budget process in terms of actual funding.  These issues include:

• protecting and expanding coverage for immigrants.
• codifying the CHA program in statute.
• finishing the transition to a new and better/fairer formula for distributing charity care funding to hospitals.

Other issues we’ll be promoting concern:

• strengthening the state’s “Certificate of Need” oversight process for hospital mergers, downsizing, curtailing of specific services, and outright closures.
• expanding consumer protections against out-of-network surprise medical bills.
• requiring health insurers to maintain existing provider networks and prescription drug formularies during a given plan year.
• requiring pharmacy benefit managers (PBMs) to disclose subcontracts and possible conflicts of interest
• advancing the New York Health Act along the legislative process.

We invite you to join in with us and our Health Care for All New York partners on one or more of the above matters.  Please contact us about any you might be interested in.

It’s the annual “budget season” in Albany right now, and advocates, lobbyists, and others are crowding the halls of the State Capitol and the Legislative Office Building to plead their cause and the money needed for the programs they care about. As part of our statewide coalition Health Care for All New York (HCFANY), we too are working the shoe leather and bending the ears of legistors and their staff. Our key priorities include:

1.  Expanding and preserving health coverage options for immigrants. Of those who are still uninsured across our state, immigrants are the largest group. While many have benefited from the Affordable Care Act (ACA), others remain without any options other than Emergency Medicaid. Also, some low-income immigrants who qualify for Medicaid because they have Temporary Protected Status (TPS) or Deferred Action for Childhood Arrivals (DACA) status may lose it because of anti-immigrant moves by the Trump administration.

What NY can do: Open up the state’s very successful (and public) Essential Plan to low-income immigrants who don’t otherwise qualify for Medicaid. The state should continue Medicaid coverage for people who may lose their TPS or DACA status.

2.  Making coverage more affordable to buy and use. While the ACA has moderated health insurance premium growth significantly in New York, policies still remain expensive and deductibles and co-pays can be quite high depending on the metal-level plan one selects. When people move from public programs for the low-income into the private market, the financial shift can be quite dramatic and stressful, and many are living paycheck-to-paycheck.

What NY can do: Allow moderate-income people to “buy-in” to the Essential Plan at a modest premium price if they’d like. Also, augment existing federal premium assistance with additional funding to make premiums more affordable.

3.  Reaching out to the still-uninsured to help them enroll in coverage. Surprisingly, there are a significant number of people who already qualify for public programs and financial assistance, but for a variety of reasons they have not yet enrolled in coverage. They often are among the hardest to reach because the “live in the shadows.”

What NY can do: Provide modest funding to trusted, grassroots community groups to go out and locate the uninsured, answer their questions, allay their fears, help them understand their options, and get them to enrollers.

4.  Expanding consumer counselling and ombuds services. One of our state’s crown jewels resulting from the ACA is the Community Health Advocates (CHA) program. It is a statewide network of non-profit organizations which helps people and small employers who have all kinds of insurance. CHA helps them to use and solve problems with their coverage and accessing services, often saving them significant amounts of money and cutting through red-tape and hassles. As more people get enrolled in coverage and seek the care they need, demand for CHA’s free services is significantly increasing. (Find a CHA group near you at www.communityhealthadvcoacates.org or call their hotline at 888-614-5400.)

What NY can do: Increase funding for the program to help more people solve insurance issues and get and afford the care they need.

5.  Distributing indigent care funding in a fair and just manner. New York has always provided robust amounts of funding to hospitals to provide care to the uninsured and low-income people. However, those funds have often not been properly distributed to those facilities that actually care for large numbers of uninsured and Medicaid patients. Because of provisions in the ACA, the state has moved to (mostly) fix this problem, but a once-temporary transition period has been inordinately extended, and our safety net and public hospitals still do not get the full funding they deserve.

What NY can do: End the transition period, and fully support safety net and public hospitals.

One question that may likely come up as you promote one or more of these ideas is “how to pay for it?” As we indicated in our previous email, the overall answer is to raise the revenue needed by requiring those who’ve economically benefited so much in the last decade (or longer) to now pay their fair share of taxes. Our colleagues at the Fiscal Policy Institute have a menu of good ideas for the Governor and Legislature to choose from, and we can push them forward.  (See: www.fiscalpolicy.org.)

Among the key revenue options are:

• An “Ultra-Millionaires Tax” to create additional marginal tax rate tiers above current levels.
• A “Carried Interest Fairness Fee” to tax the incomes private equity and hedge fund managers at a rate equivalent to normal earned income.
• A “Pied-a-Terre” tax on unoccupied luxury apartments that merely serve as investment vehicles for real estate speculators.
• A “Stock Transfer Fairness Fee” on high volume sales of stocks.
• A “Stock Buy-Back Transfer Tax” on corporations who buy back their own stock from investors instead of using their excess profits and tax windfalls to create jobs, invest in research and development, or increase wages and benefits for their workers.

While all the issues discussed above may seem overwhelming, we urge you to take up those of them you feel comfortable and confident about, and reach out to your state legislators with your views on them. Some people will cover some of them, and others will do others, so that in the end, they all get raised and it’s all good. Thanks for taking on whatever you can do!

It’s that time of year again in Albany: “Budget Season”. Since health care is always one of the biggest items in the annual state budget, there’s always a lot of specifics to pay attention to and advocacy to do.

But first, it’s time to “change the game!” for the overall budget process so that we’re no longer at the mercy of powerful special interests, and no longer fighting over the leftover crumbs when it comes to the health care needs of everyday New Yorkers.

What needs to happen now, and what’s in play:

#1: Creating “Fair Elections” – Our coalition was founded 26 years ago to foster community and labor coalition in New York to fight for universal health care. The reality is that we would have achieved our goal YEARS AGO were it not for the inordinate influence of the vested special interest and big donor money in our political process. NOTHING would make more of a difference to advance our cause than combating, rebalancing, and ending that influence, BY FAR. If we want universal health care, we have to have major campaign finance reform — it’s that simple.

In his budget proposals released in mid-January, Gov. Cuomo called for a) drastically limiting the amount of election campaign donations that corporations and large donors can contribute to any candidate, and b) the creation of a “small donor matching” system of public financing of elections. You can read more all about it here: www.fairelectionsny.org. We’re proud to be part of the Fair Elections for New York campaign, and serving as a liaison to the broader health advocacy community about it.

A Fair Elections system has been in place here in New York City for two decades now, and it has dramatically transformed our city government in terms of who gets elected and what issues are taken up and acted upon. We now have a government that is much more reflective of the residents of our city, and that focuses on the needs of everyday New Yorkers when it comes to health care and so many other of our shared concerns. We can now do the same statewide in our elections for Governor, Attorney General, Comptroller, State Senate, and State Assembly.

#2: Creating “Shared Prosperity” – For nearly a decade now, Governors Paterson and Cuomo and the State Legislature have intentionally limited spending in and the annual growth of the state budget. While this may have made some fiscal sense in the immediate wake of the Financial Crisis of 2008 and the subsequent Great Recession of 2009-10, things have clearly changed in our state’s economy since then so that such strategies are no longer needed, yet they continue to be invoked by Gov. Cuomo year after year. New York can now easily afford to raise more and sufficient revenue and spend more on many public programs to benefit everyday people struggling to get by, particularly for those who are still suffering from the ramifications of the Great Recession. Further, the economic growth and assistance that has occurred over the past decade has been VERY skewed toward the already-very-well-off, so our tax and spending priorities now need to be significantly recalibrated to assist people and communities in need, and raise enough money to do so.

Accordingly, the “New Hope for New York Budget Principles” campaign was launched late last fall to lead the charge for our state government to change direction with regard to overall budget policy and take a new, more socially-just path. It is being jointly led by the New York State Council of Churches, the Fiscal Policy Institute, and Strong Economy for All, and many public interest groups and faith communities have joined in to support it. You can read more about this campaign and join in its efforts here: https://bit.ly/2SJ8knj   We are proud to be participating in this campaign to help provide leadership and guidance to it as concerns health care issues such as coverage for all immigrants and universal health care.

Unfortunately, Gov. Cuomo continues to adhere to his budget austerity approach, and says he does not want to ask the ultra-wealthy to pay their fair share of taxes in order for the state to have enough money to meet the health and human service and other needs of struggling people, families, and communities which exist in every corner of our state. He claims the rich will up and leave the state, despite the fact of evidence to the contrary throughout this decade since the state instituted a “millionaires tax: on upper-income people. You can reach more all about that here: www.fiscalpolicy.org.

What’s happening now, and what you can do:

Right now, each house of the State Legislature is crafting their one-house budget bills which they will be releasing and voting on next week. These bills reflect changes each house wants to accept, change, or delete from what the Governor has proposed. We need to make sure that each of their bills contains provisions to a) create a “Fair Elections” program (so that we can move forward toward a universal health care program), and b) adopt a “Shared Prosperity” budget framework that promotes just economic recovery and growth to meet the broad range of human and community needs, including health care.

We urge New Yorkers to reach out to your State Senators and Assemblymembers now about these matters, and to share these ideas with friends, family, neighbors, and colleagues. Make a call, send an email, do a tweet! The state budget process will wrap-up by the end of this month, so NOW is the time to act.

We’re celebrating our 25th anniversary on Thursday evening, December 6th, and we want all our friends and colleagues “in the house” with us!  Our fete will be held from 6 to 8 p.m. at District Council 1707 AFSCME, located in the Hell’s Kitchen area of Manhattan, just west of the Theater District.

 Our 25th Anniversary and 2018 Health Care Justice Leadership Annual Gala will feature some inspiring speakers looking back over 2018 and forward to 2019, and we’ll be saluting some worthy groups and individuals for their health care justice leadership.

Our distinguished honorees include:

— Mary Bassett, MD, MPH, former Commissioner of the New York City Department of Health and Mental Hygiene for her political and governmental leadership.  During her tenure, Dr. Bassett prioritized advancing health equity across all neighborhoods in our city, and revolutionized the Department’s entire approach to public health by focusing on the social and economic determinants of health for low-income and immigrant communities.

 — Lourdes Rodriguez-Dox, Director of the Retirees Division of 1199SEIU United Health Care Workers East for her trade union leadership.  She has helped lead the union’s retirees for over 3 decades, and involved them in many advocacy campaigns in support of Medicare, Medicaid, Social Security, children’s health care, and the Affordable Care Act.  In addition, she has been a leader in the New York City Chapter of the New York State Alliance for Retired Americans.  ARA is the national retiree program of the AFL-CIO.

— Broadway Cares/Equity Fights AIDS and The Actors Fund for their community service leadership partnership.  These two entertainment industry non-profits have collaborated over the years to provide specialized health care and health insurance services to our city’s entertainment community workers.  Most recently, they opened a new community health center in the Theater District.

— Coverage for All, a statewide campaign for immigrants rights and access to health care, for their community organizing leadership.  The campaign is a project of Health Care for All New York, and is co-led by the New York Immigration Coalition and Make the Road New York.  Since it’s founding in 2015, it has led efforts to protect and expand health insurance programs for immigrant New Yorkers.

Our keynote speaker will be Margarida Jorge, Co-Executive Director of Health Care for America Now, and veteran of the Jobs with Justice movement and the Service Employees International Union.  HCAN was formed in 2008 as a national community-labor umbrella campaign out-in-the-states to fight for comprehensive health care reform proposals in Congress, and was instrumental in passage of the Affordable Care Act (ACA).  Starting in 2017, HCAN led successful efforts to build and manifest grassroots support for the ACA, Medicaid, Medicare, the Children’s Health Insurance Program, community health centers, reproductive rights, and related social programs such as SNAP/Food Stamps. 

We’re counting on all our individual supporters and union and community partners to support our 25th Anniversary Annual Gala by joining the Host Committee, placing announcements in the commemorative journal, and reserving blocks of tickets. Please contact us for information about these options.

Individuals and groups/unions can make your contributions here:

— $75 and $100 for individuals (suggested donation)

— $250 for a small group/union Host Committee membership, or a quarter-page journal announcements (includes 2 tickets)

— $325 for a group of 5 tickets

— $500 for medium-size group/union Host Committee membership, or a half-page journal announcement (includes 4 tickets)

— $650 for a group of 10 tickets

–$750 for a large group/union Host Committee membership, or a full-page journal announcement (includes 6 tickets)

— $1,000 for a special page journal announcement (includes 8 tickets)

— $1,250 and $1,500 for special packages of a Host Committee membership, journal announcement and/or group of tickets.

— If you’re an individual with limited resources, we welcome whatever you can contribute. No one will be turned away.

You can use our fundraiser page here to make an online contribution, use the donate button here on our website, or send a check to: Metro New York Health Care for All, 420 West 45th Street, DC 1707 AFSCME, New York, NY 10036.  f you can’t join us at our Gala, we’ll miss you, but welcome your financial support regardless.

Your generous a contribution will enable us to “keep on, keeping on” even better next year. With our new Congress and State Legislature, and the groundswell of grassroots support emerging for universal health care, we’re very excited about the possibilities!

It’s a new day for health care politics and policy, and more generally our fundamental democracy, across our state and nation in the wake of yesterday’s midterm elections. There is now a check on unlimited one-party power in Washington, and immediate threats to existing health care programs are not very likely for the foreseeable future. We now have a chance to improve and build on them instead, and not just defend them.  That said, we will also have to keep our eye on moves by the Trump administration to undermine the Affordable Care Act’s marketplaces and consumer protections (such as pre-existing condition coverage, and 10 Essential Health Benefits), and it’s efforts to limit reproductive rights, and to transform Medicaid into a welfare-style program.

Nationally, three “red” states voted to expand their Medicaid programs under the Affordable Care Act:  Idaho, Utah, and Nebraska.  In addition, changes in state goverment leadership in several other states will likely lead them to expand Medicaid too:  Wisconsin, Kansas, Illinois, Michigan, New Mexico, Nevada and Maine …and possibly Georgia.

Turning to New York State, there’s a dramatic shift in the balance of power in the Legislature, particularly in the Senate. This new politcal landscape will provide new opportunities for our state to continue our long tradition as a “leader state” on health care, and build on our succeses.

Here in NYC, we have a new member of Congress for Staten Island and southwest Brooklyn. The victor, Max Rose, has a background in running a network of community health centers that specialize in addiction treatment, so he knows and understands health care issues. We welcome him to our city’s congressional delegation, all of whom are strong champions for health care.

Even given all this good news, we still have much work ahead to bring true universal health care to our city, state, and nation. We look forward to working with all of our coalition partners in that endeavor and all struggles for health care justice.

Finally, we thank and salute everyone who participated in our “Vote for Health Care!” project which worked to elevate the health care issue for the public and voters.  Joining with our partners in the NY-11 for Health Care coalition, we distributed approximately 5,500 non-partisan, issue-focused leaflets about what was at stake for health care in the elections.  We centered our efforts in the 11th Congressional District, the only one in NYC with a contested race.  We focused on outreach at transit hubs, community events, churches, social service program sites, community health centers, and public housing campuses.  We also held a Community Town Hall on Staten Island to present speakers on health care topics relevant to the elections, hear from residents about their own health care concerns and experiences, and answer questions.

As New Yorkers ponder who to vote for on Election Day and why, our “Vote for Health Care!” campaign is organizing health care advocates and activists to reach out to the public about “what’s at stake” for health care in this fall’s elections (Hint: A Lot!)

Our next Congress and State Legislature and Governor will set the course for health care for all Americans and New Yorkers.  On a national level, Congress will determine the future of Medicare, Medicaid, Children’s Health Insurance, the Affordable Care Act, pre-existing condition protections, reproductive rights, drug prices, the VA health system, Social Security, SNAP/Food Stamps, and a whole slew of other health care and related social programs.  They will also decide whether or not all these programs will properly funding by making large corporations and wealthy people pay their fair share of taxes.  

On a state level, while New York is very much a “leader state” on health care, we will need to protect our existing health care programs from moves by the Trump administration to undermine them and our insurance markets.  In addition, there may be new opportunities to move forward toward a universal health care program as embodied in the New York Health Act or other approaches.

 Health care is a red-hot issue for the public (and getting hotter by the day), and our “Vote for Health Care!” campaign’s goal is to leverage that concern to motivate people to show up to the polls on November 6 to support candidates who will champion health care issues in our next Congress and State Legislature.  Our campaign is non-partisan and neither supportive of nor opposed to any particular candidate or political party.  Its aim is to help voters understand the claims and counterclaims and candidates’ positions so that they can vote intelligently when it comes to health care.

Our campaign’s major elements are distributing leaflets about the key health care issues in public settings and at candidate and community events, convening meetings and town halls on these issues, public speaking at meetings and events organized by other groups and unions, and posting relevant new stories and commentary on social media platforms.  (We urge everyone to like and follow our Facebook page for all the up-to-date developments!)

While our campaign aims to help all New Yorkers understand health care issues at stake in all races, given our limited resources, much of its work centers on New York’s 11^th Congressional District, the only one in NYC that is in serious contention this fall.  The district comprises all of Staten Island and parts of southwest Brooklyn (Bay Ridge, Dyker Heights, Bensonhurst, Bath Beach, and Gravesend.)

The district’s current Representative (Dan Donovan) is the only member of the current House Majority from NYC.  Last year, he voted against the American Health Care Act which would have repealed the Affordable Care Act, radically cut and changed Medicaid, and defunded family planning services provided by Planned Parenthood.  He also voted against last year’s Tax Cut and Jobs Act that gave huge tax cuts to large corporations and wealthy individuals/families, and meager cuts to everybody else, and against a bill last month to make all of those tax cuts permanent.  Unfortunately, he has not been very supportive of comprehensive reproductive health care rights, according to women’s health advocates.  He is being challenged by Max Rose, a former military veteran and executive with Bright Point Health, a network of community health centers here in NYC that specialize in addiction treatment.

How YOU can join in and support “Vote for Health Care!”

1. Help us leaflet commuters at the Staten Island Ferry terminal in lower Manhattan (adjacent to Battery Park.)  We’re there on selected evenings from 4:30-6:30 p.m., including Thurs. Oct. 4, Wed. Oct. 10, Thurs. Oct. 11, Thurs. Oct. 18, Wed. Oct. 24, Thurs. Oct. 25, Thurs. Nov. 1, and Mon. Nov. 5.  Let us know when you can participate by RSVPing on our Facebook page, or using the links on our Action Alerts page of this website.

2. Attend a special “Community Town Hall: What’s at Stake for Health Care in This Fall’s Elections”. It’s taking place on Monday evening, October 29 at Nation Builders/Edificiadores de Naciones church on the North Shore area of Staten Island, in the West New Brighton neighborhood, at 947 Castleton Avenue.  The formal event is from 7 to 9 p.m., with an informal reception beforehand starting at 6:15 p.m.

3. Make a financial contribution to support our campaign – just use the donate button here on our website.

Poll after poll shows that health care remains a top concern for the public as this fall’s election season approaches. We’re going to leverage that concern to urge New Yorkers  to show up and “Vote for Health Care!”

Health care IS on the ballot this fall, and New Yorkers can make a big difference in which way our country and state proceed. Our next Congress and next State Legislature and Governor will determine the future of health care in the U.S. and here in New York, so everyone’s vote really matters this fall.

Our Vote for Health Care! project has three goals:
— Register people to vote.
— Help people understand the key health care issues at stake in the elections.
— Mobilize people to get to the polls.

It was a full house at the United Federation of Teachers on Aug. 9 as we all came together to celebrate the anniversaries of Medicare, Medicaid, and Social Security which are happening since late July through mid-August. We committed ourselves to joining forces to preserve, improve, and expand these three bedrock programs of our nation’s social contract, which support millions of New Yorkers and protect our families. We also reaffirmed our commitment to fighting for universal health care nationally, particularly a universal Medicare program. We were delighted to be joined by Sen. Kirsten Gillibrand (NY) and Rep. Yvette Clarke (NY-9) as they inspired us for our work ahead. We want to thank our partners at the UFT and with the New York State Alliance for Retired Americans’ New York City Chapter for their crucial behind-the-scenes support.

On Aug. 8, we met with leaders and representatives of grassroots groups in southwest Brooklyn to plan how to roll out our Vote for Health Care! project in their congressional district, which is a crucial one for New York City. It was a follow-up discussion to one we held in on July 23 in the other part of the district over on Staten Island.

All of this activity is only possible because of the active engagement of concerned New Yorkers, and especially their financial support. We invite everyone to make a contribution!

Here’s how to join on our 2018 “Vote for Health Care!” team:

— Make a contribution on our Action Network page:

— Make a contribution using the donate button here on our website.

We want to thank the following groups and individuals who’ve stepped forward so far:

Organizations and Unions:
Actors Fund
Associated Musicians of Greater New York, AFM Local 802
Center for Independence of the Disabled of NY
Citizen Action of NY
Communications Workers of America, District 1
Communications Workers of America, Local 1102
Community Service Society of New York
District Council 37 AFSCME
District Council 1707 AFSCME
Doctors for America, New York Chapter
Healthcare Education Project, 1199SEIU & GNYHA
Hudson Center for Health Equity and Quality
Greater New York LECET
New York City Central Labor Council, AFL-CIO
New York Gray Panthers
New York Professional Nurses Association
New York State Nurses Association
Organization of Staff Analysts
Physicians for a National Health Program, NY Metro Chapter
Project Hospitality
Social Service Employees Union, Local 371 DC 37
1199 SEIU United Healthcare Workers East

Individuals:
Carmelita Blake
Anne Bove
George Carter
Melinda Dutton
Pat Fry
David & Ronda Kotelchuck
Terry Mizrahi
Chuck Mohan
Jim Perlstein
Alec Pruchnicki
Lou and Sara Levitt
Edwin Webber

April 26 — Remarks of Mark Hannay, Director, Metro New York Health Care for All, at a rally ouside Harlem Hospital Center in upper Manhattan.

We’re all excited to be here with everyone today outside Harlem Hospital, one of our city’s most important health care facilities and a key pillar of the Harlem community.

We are all joining forces here today for 7 major reasons:

• Reason #1:  We’re here today to celebrate the eighth anniversary of the Affordable Care Act, and all the advancements made under the law that have benefited millions of New Yorkers.   Nearly 400,000 New Yorkers have gained coverage through the state’s “New York State of Health” marketplace, and 60% of them have qualified for premium subsidies to help them purchase their coverage.  Over 700,000 New Yorkers have gained coverage under our state’s new, low-cost “Essential Plan” for low-income people who don’t qualify for Medicaid.  Nearly 350,000 children in New York now have coverage under our state’s Child Health Plus program.  Over 2.5 million New Yorkers have gained coverage under Medicaid. In total, nearly 6.5 million New Yorkers now benefit from Medicaid, fully one-third of our state’s population.  In total, New York’s uninsurance rate is now less than 5%, and less than 2% for children.  In New York State, scores of new community health centers opened because of the ACA, serving over 700,000 new patients. About 750 centers now provide care to nearly 2.25 million New Yorkers.  In sum… the ACA in New York is a smashing success because our political leaders have implemented it robustly, and taken full advantage of all its provisions.

• Reason #2:  We’re here today to call out President Trump and his congressional partners for all they are STILL trying to do to take health care away from millions of New Yorkers and other U.S. residents.  Last year they did it openly, this year they’re doing it sneakily.  President Trump in particular is doing everything he can to sabotage the ACA by destabilizing our insurance markets, cutting back on the law’s Essential Health Benefits, undermining vital consumer protections for those with pre-existing health conditions, and negating important civil rights guarantees under the law.  He’s also attacking Medicaid by proposing new work requirements, drug testing, and the like.

• Reason #3:  We’re here today to recommit ourselves to continuing to work together to take action to stop Trump and Congress from attacking and undermining Medicaid, Medicare, the ACA, reproductive health care, and the whole range of federal health care and social programs that millions of New Yorkers rely on.  They’re taking these steps in order to pay for the huge tax cut bill they passed last December that increased the federal budget deficit by $1.5 trillion, all to benefit large corporations and the super-rich.  Last year, everyday people came together across New York and the U.S. to fight back against a full-out legislative assault on the ACA, Medicaid, and family planning services.  Beyond our wildest expectations, we succeeded in stopping Trump and Congress.  We want to thank everyone here today who took an action then to contribute to our victory.  You – We – made it happen.  Now we have to do it again.

• Reason #4:  We’re here today to support our health care safety net, particularly our city’s public hospitals.  They have long served all New Yorkers regardless of their immigration status, ability to pay, or lack of insurance, and provided them excellent care.  Harlem Hospital is one of the crown jewels of the system.  As more people may lose coverage because of what Trump and Congress are doing to undermine our nation’s health care programs, places like Harlem Hospital, is where they will turn for care.  We call on our city and state officials to fully-fund our public hospital system to that its able to handle the additional burdens.

• Reason #5:  We’re here today to call on our political leaders, both at the national and state level, to move toward a truly universal health care program covering everyone, including all immigrants.  Despite the progress made under the Affordable Care Act, the U.S. still remains the ONLY industrialized democracy without a national, universal health care program.  Rather than trying to take away our health care, President Trump and Congress should be working to build on Medicare, Medicaid, the ACA, and CHIP to assure that health care finally become a human right across for all.  The ACA also allows and can support states like New York to move ahead on our own to create a universal health care program.

• Reason #6:  We’re here today to call on all our politicians, public health leaders, and health care institutions and professionals to launch an aggressive effort to address health disparities across our city, state, and nation.  We need to develop and advance policies that promote health equity for all New Yorkers, regardless of socio-economic class, race, ethnicity, age, spoken language, gender and gender expression or identity, disability or health status, sexual orientation, and geographic location.

• And finally, Reason #7:   We’re here today to commit ourselves to reach out to the public to inform them about what Trump and his allies are still trying to do to health care and social programs that all of us everyday people rely on, and what they can do working together to stop it.  We’re also going to help our fellow New Yorkers understand how incredibly important it is for people to register to vote and turn out to vote this fall, so that starting next year, we have political leaders who are committed to protecting, improving, and expanding all of our health care and social programs, instead of trying to destroy them.