The Roundtable: Healthcare
Q: You have been scrutinizing the state’s new healthcare exchange, which was set up as part of the federal healthcare reform. How is it being rolled out? Do there need to be any changes, or is it working well?
KH: We had an oversight hearing with the chairman of the state Senate Insurance Committee, Jim Seward, and the idea was not to be critical, not to poke holes or anything like that. In fact, we waited until after the whole Obamacare act began, after the 1st of January, 2014. We really wanted to get a sense of where the exchange was going, how well they felt they had done, challenges they were facing—and we did that. We had a number of the interested parties come forward. We had the insurance companies explaining how [for] many of the applications they had received, and the notice of the applications, they were only received in their companies by about the middle of December. So to get them coverage within a couple of weeks was very difficult. But we did have patients and doctors talking about the confusion on who was in a given network, which doctors were in the network, which insurance companies were actually covering, because given the name of one company, it may have been one subsidiary or the other, and then whether they had the ability as a patient to go out of network. And so the whole concept—which some people have said, “Well, companies, to get into the exchange, had to reduce the amount of doctors or hospitals and how much they’re paying them,” and patients are saying, “Wait, we expected to have things the way they were. We expected to keep our own doctor.” So there’s a considerable difference. My conclusion is, it’s really created by the federal law, and there is a considerable difference between expectation on the part of patients and reality in terms of delivery by doctors and hospitals.
Q: What are the other key healthcare issues that you will be prioritizing in the Legislature this year?
KH: There is a considerable amount of healthcare issues, it begins and ends with A to Z. We started a task force on Lyme disease because we want to look for an action plan by the state in terms of how we can prevent it, what we can do to foster research about it, what are appropriate treatment vehicles, what are insurance rules. It’s become very prevalent from the tip of Long Island and it is working its way west, and we’re now at least into Schoharie County, but the whole Hudson Valley is just rife with ticks. A number of other initiatives with regard to public health, a number of initiatives on the structure of the healthcare system, what are hospitals doing, and interestingly, a number of doctor delivery systems. There has been a discussion of mini-clinics in pharmacies. There’s been a discussion of what do you do, if anything, about urgent care centers, which are springing up all over. There’s questions about should we have free-standing emergency rooms or even part-time free-standing emergency rooms. There’s questions about the role of nurse practitioners. And it’s all the delivery of service aimed at primary care, how do we keep track of who’s been treated, what do we know about who’s been vaccinated, so there’s a lot of intermediate steps that need to be taken.
Q: What are your expections for the 2014 legislative session, especially on healthcare?
RG: One issue that I know is on everyone’s mind at this point is the medical marijuana issue. I think it is very exciting that Governor Cuomo has put his stature in support of the proposition that there is legitimate, important medical use for marijuana, for patients with very serious health conditions. What he is going to be doing by executive order, I think, is a very important interim step that he can do with existing law, although that law from 1980 is very limited and very cumbersome. State Sen. Diane Savino, who is the Senate sponsor of the bill that I have been carrying—she and I have been talking with the governor’s office, and I would say that we are very hopeful that this legislative session we will be able to work out a comprehensive and strong piece of legislation that hopefully the governor will support. And I think with his support, enacting it is almost a sure thing.
Q: Is it the right approach to start out with a small program and see how it works?
RG: First of all, we’ve had experimentation with how to do it in 20 states. Our legislation reflects lessons that we have learned from all of those states. I don’t think New York needs to reinvent that wheel. I think the interim step that the governor is taking is important because it can be begun to be implemented now without waiting for legislation. But very clearly there will tens of thousands of patients who ought to have access to medical marijuana who will not under the 1980 law, and I think the governor’s staff understands that. So I hope that we will be able to work out a comprehensive bill this session.
Q: You have been a longtime proponent of a single-payer health system for New York, and you have had legislation introduced each year for quite some time. Will you be introducing that bill again, and what are its chances this year?
RG: I have been sponsoring a state single-payer bill for a long, long time. I am hopeful that we may be able to get that bill to the Assembly floor this year for a vote. If we get it to the floor, I think it will pass. What gives me optimism at this point is really bad news. With the Affordable Care Act, I think we have gone about as far as we can go to try to make the insurance-based system workable for people. We are finding that you still have outrageously high deductibles and co-pays and restrictions on what doctor you can go to and employers who more than ever are going to be dropping health coverage and putting their workers at the mercy of the marketplace, where they have no negotiating power at all. I think it is becoming more and more clear to people that if you want to deal with those issues, if you want to deal with the financial burden on working families and the restrictions that insurance companies impose, you’ve got to go to a single-payer system. The traditional Medicare product that was invented in 1965 has been justifiably one of the most enormously popular things left, right and center, that this country has. President Obama said a year or so ago that no American in their golden years should have to live at the mercy of an insurance company. I would say, “Why do we have to wait for our golden years?”
Q: What do you see as the biggest public health crisis the city will face over the next five years?
CJ: The continued loss of hospital beds is a crisis of untold magnitude, and this Council will work with the new administration to fight to stem the closure of community hospitals. The prevailing hunger gap in our city is also significant, and affects all in our communities, particularly our most vulnerable—children and seniors. We need to work to expand access to free school lunch and institute universal breakfast in classrooms for our children. For seniors we need to expand the sites that offer congregate meals, ease the qualification for home-delivered meals, restore funding for a “sixth congregate meal” for seniors to take home on the weekends, and work to increase enrollment opportunities for SNAP while continuing to push for fresh foods and access to healthy food.
Q: With several city hospitals in dire financial straits, will you try to establish more community health centers?
CJ: Federally Qualified Health Centers and the District Public Health Offices maintained by DOHMH are important aspects of a well-rounded approach to health, irrespective of the state of our hospitals. St. Vincent’s was tragically lost in my own district, and I will work with my colleagues to fight against the closures of Interfaith and LICH. For too many people, their first point of entry to the medical system is through the ER bay. Through local access to care, and comprehensive services including education in their communities, these trends can be curbed. This commitment to primary care will in no way abate our zeal to maintain critical hospital services and trauma centers throughout the city.