On July 28th, Medicaid Matters New York, Health Care for All New York, and The Legal Aid Society sent comments to the NYS Attorney General regarding the Affinity Health Plan petition to sell to Molina Healthcare, a national for-profit health plan.
The comments can be downloaded here.
Health Equity Assessment Bill Receives Final NYS Legislative Passage
Health advocacy groups across New York State today applauded state Assembly action Tuesday night giving final legislative passage to S1451a, the Health Equity Assessment Bill. The bill, which had previously passed the state Senate, was approved in the Assembly by a vote of 103 to 44. Assembly Health Committee Chair Richard Gottfried and Senate Health Committee Chair Gustavo Rivera championed the bill, which is a first step toward addressing inequities in access to health care that were starkly exposed by the COVID-19 pandemic. The groups called on Gov. Andrew Cuomo to sign the bill.
The bill would require state health regulators to consider the impact that proposed health facility projects would have on racial and ethnic minorities, low-income people and other vulnerable health consumers. The bill would introduce a new requirement into the Certificate of Need (CON) process through which hospitals, nursing homes and other health facilities seek state regulatory approval for proposed mergers, acquisitions, closings, downsizing, new construction or change of ownership. For the first time, CON applications would have to include an independent assessment of the likely impact of the transaction on access to timely, affordable care for medically-underserved New Yorkers, including those who are low-income, racial or ethnic minorities, women, LGBTQ people, people with disabilities, older adults, immigrants and rural residents.
“This law would protect people of color and low-income New Yorkers who have been the hardest hit by COVID-19 pandemic,” said Elisabeth Benjamin, Vice President of the Community Service Society of New York, which coordinates the statewide Health Care for All New York coalition. “The current process permitted unfettered hospital closures so that we now have only 1.5 beds per 1000 residents in Queens (which suffered the most severe impact of COVID-19) compared to 6.4 beds per 1000 in Manhattan, which had a much lower rate of COVID-19 cases.”
These inequities can be traced to two decades of hospital consolidation across New York State, with more than 40 acute care hospitals closing entirely and others downsizing by eliminating emergency departments, ICUs, maternity units, psychiatric units and other services vital to the consumers they serve. Many of these closures were safety net hospitals and rural hospitals that disproportionately provided care for medically underserved consumers. As a result, New York lost over a third of its hospital bed capacity.
“Communities have had little or no say when their hospitals are merging, downsizing or closing because the state CON approval process is not transparent or consumer friendly,” explained Lois Uttley, Women’s Health Program Director for Community Catalyst and coordinator of Community Voices for Health System Accountability (CVHSA). “This lack of meaningful oversight and consumer representation has allowed health systems to proceed with the consolidation in New York’s health care markets, leaving some communities without vital services or any hospital access at all. This bill will require meaningful engagement of affected communities and an independent assessment of how a proposed transaction would affect access to care for medically-underserved people.”
Currently, the New York State Department of Health and the Public Health and Health Planning Council (PHHPC) review and approve proposed health care industry transactions with no formal criteria requiring the examination of whether the project would improve or diminish health equity and address the needs of underserved communities. Moreover, there is only one consumer representative on the 24-member PHHPC, which has multiple representatives of health systems, hospitals, nursing homes and home care agencies, and there is no requirement for public hearings in affected communities.
“It’s especially important that this bill will require a close examination of the likely impact of health industry transactions on people who rely on Medicaid or who are uninsured,” said Lara Kassel, Coordinator of Medicaid Matters New York. “These are the people who have the least ability to seek care outside their own communities when local hospitals and other health providers close or eliminate services. We are grateful the Legislature prioritized this bill to help our systems move closer to greater health equity.”
Heidi Siegfried, Director of Health Policy for the Center for Independence of the Disabled, commented: “We especially appreciate that health facilities seeking an approval from the PHHPC would have to explain how the proposed project would improve access or reduce health disparities of people with disabilities, how it will reduce architectural barriers for people with mobility impairments, and how they will ensure effective communication with people who have speech, visual, or hearing impairments, and disclose the existence of any civil rights access complaints.”
Maria Alvarez, Executive Director of the New York StateWide Senior Action Council, commented that “For-profit companies have been buying up nursing homes, and making money for their owners and investors is more important to them than serving our community needs. This important legislation would require that the impact on access to care for disenfranchised communities is considered as part of hospital and nursing home requests to modify their businesses. On behalf of New York’s older residents, their families and their neighbors, we thank the Legislature for their support and urge the Governor to enact this bill.”
CVHSA is a statewide alliance of health advocacy groups, including the Center for Independence of the Disabled, Commission on the Public’s Health System, the Community Catalyst Women’s Health Program, the Community Service Society of New York, the Children’s Defense Fund, the Empire Justice Center, March of Dimes, Medicaid Matters NY, Metro NY Healthy Care for All, the NY Immigration Coalition and the New York StateWide Senior Action Council. HCFANY is a statewide coalition of more than 170 organizations working to improve health care coverage and access. Medicaid Matters NY is a statewide coalition working on behalf of Medicaid enrollees.
Download a PDF of the press release here.
Several advocacy groups, along with NYC Health + Hospitals and labor unions, continue to push for redistribution of the Indigent Care Pool (ICP). Over $1 billion in Medicaid funds are allocated to hospitals across the state, and advocates believe the funding should be targeted to true safety-net hospitals.
Find linked here Medicaid Matters’ memo in support of the bill to redistribute ICP funds, along with a revised joint statement (linked here) endorsed by dozen of organizations in support of this effort.
Like our partners across all sectors, we are relieved after the verdict of Derek Chauvin, while also embracing the notion that true justice requires structural change. As health justice advocates, we will do our part to fight systemic racism. Our thoughts are with the family of George Floyd and the many families who have lost loved ones to racism.
Medicaid Matters New York and Health Care for All New York – the two major statewide health care consumer advocacy coalitions – applaud the State Legislature for several historic additions to the adopted state budget for 2021-22 related to funding for public schools and universities, rental and mortgage assistance, assistance to undocumented essential workers and small businesses, and taking some first steps toward restoring progressivity to the state’s tax system. Millions of low-income New Yorkers who rely on our state’s public health insurance programs will benefit from these improvements to the Governor’s initial set of budget proposals.
However, our State leaders failed to break ground in health care, which is disappointing in light of a decade of austerity budgets and the ongoing nature of the COVID-19 public health crisis. Medicaid Matters and HCFANY are specifically concerned about the following issues:
- The arbitrary Medicaid global spending cap was extended for another year. As a consequence, Medicaid continues to be approached with an austerity mindset. For ten years, Medicaid has suffered from unnecessary cuts, impacting access to services for low-income people, families, people with disabilities and communities.
- Public health insurance coverage was not expanded to low-income immigrants who have had COVID-19. Instead, those who are undocumented remain reliant solely on Emergency Medicaid for acute care and charity care programs for ongoing treatment. As a consequence, many will likely forego seeking necessary care, thereby prolonging illness and suffering, risking death, and incurring medical bills they cannot pay.
- The home care crisis and institutional bias remain unaddressed. Home care workers play a vital role in serving and protecting disabled New Yorkers and seniors living independently, a role that became even more critical and evident during the pandemic. However, New York’s failure to invest in home care has created a “worst in the nation” workforce crisis that prevents meaningful access to home care services for thousands of people and results in greater institutionalization.
- This is the first time in decades that New York State has adopted a discriminatory maternity coverage policy. Instead, only citizen and lawfully residing immigrant women will enroll in free (state-funded) Marketplace coverage after their Medicaid ends—continuing a system that allows for disruptions in care.
- No new initiatives were created to address inequities that are wide-spread throughout our state’s public health, health care, and health coverage systems, despite significant federal pandemic-related funds the state has received over the past year to address these disparities. The pandemic has revealed them clearly, and they can no longer be ignored.
On the positive side, we thank both the Governor and Legislature for these new initiatives:
- Eliminating all premiums in the state’s Essential Plan that provides insurance coverage to low-income people and families who are not eligible for Medicaid. This move will enable them to keep medical, dental, and vision coverage in place without financial barriers, an important step during the ongoing pandemic.
- Protecting the financial stability of community health centers and other safety net providers by delaying the implementation of the planned pharmacy carve-out from the state’s Medicaid Managed Care program.
We also acknowledge and appreciate restorations in funding cuts initially proposed by Governor Cuomo that made no sense given our ongoing pandemic:
- An across-the-board Medicaid rate cut that particularly threatened safety net hospitals that serve large numbers of Medicaid and uninsured patients.
- Elimination of Indigent Care Pool funding to public hospitals.
- Cuts to the state’s Vital Access Provider Assistance Program that keeps certain safety net and rural hospitals financially afloat.
- Additional cuts to Article VI public health funding to New York City.
- Allowing insurers to impose restrictions on the ability of doctors to prescribe certain drugs to Medicaid patients (elimination of the provision known as “prescriber prevails”).
- Another 25% cut to home care workforce recruitment and retention money that would have further harmed community-based long-term care.
- Cuts to programs serving adult home residents.
While as a whole and on the surface it may appear that New York continues to meet the needs of those enrolled in our state’s public health insurance programs and the providers they rely on, the 2021-22 adopted budget fails to make needed investments to turn away from austerity politics, protect all immigrants, expand community-based long-term care, and promote health equity. A lack of harm must not be confused with a budget that provides for what New Yorkers need. We can do better, and we must.
You may download a PDF of this statement here.