Hello readers, we are pleased to announce that the peer-reviewed journal, Progress in Community Health Partnerships, has published a piece about our campaign with Bronx Health REACH to end segregation in the delivery of health care services by teaching hospitals in New York. You can download a copy of the piece here. Feedback welcome! We are using every avenue at our disposal to get the word out about this urgent issue, including the very types of publications that health care providers and policy decision-makers are likely to peruse.
Tag Archives: community organizing
We are back in New York City after a productive weekend at the black, Latino and Asian legislators caucus in Albany, where we presented on a panel about the Governor’s Medicaid Redesign Team with Judy Wessler from the Commission on the Public’s Health System and Laray Brown from the NYC Health and Hospitals Corporation, among others. Our collective message was clear. In not so many words: the MRT process sucks. The proposals it is considering also, by and large, suck. And the hurt will be felt most acutely by black and brown and immigrant communities across New York State. (Here’s a link to our PowerPoint presentation. Judy presented an overview of the MRT and all its problems, which you can download here, and Laray discussed the impact of the MRT on the city’s public hospitals in particular – click here for her presentation.)
Everyone we spoke to was hella angry about these Medicaid cuts and the means by which they are being made. As one panel attendee said, “we need to go Wisconsin on them!” And, indeed, we are plotting our next moves in advance of the MRT’s announcement of the cuts that it is recommending on March 1. We will keep you posted on this blog, or you can email the Save Our Safety Net Campaign to get up-to-the-minute updates (firstname.lastname@example.org). In the meantime, here are some important dates to keep in mind:
- February 24 & 25: Next meeting of the Medicaid Redesign Team (open to the public): 10:30 a.m. in Meeting Rooms 2-4, Concourse, Empire State Plaza, in Albany.
- February 28: Meeting of the Medicaid Redesign Team (open to the public): 10:30 a.m. in the Hart Theater of the Egg in Albany
- March 1: Medicaid Redesign Team announces its recommendations
As many of you know, Governor Cuomo has created a “Medicaid Redesign Team” to help him cut New York’s Medicaid program by $2 billion and redesign it for the long-term. This 27-member team is made up of only one statewide community organization and has little representation from the public sector. It is primarily dominated by the hospital industry and is led by two men with ties to large, private hospitals. Given the imbalanced composition of the Redesign Team, we are concerned that the “savings” and “reforms” it will propose will also be imbalanced, resulting in cuts to Medicaid benefits, long-term and primary care services in the community, and safety net providers. In New York City, people of color are more than twice as likely to be publicly insured than whites. This means that cuts and bad decisions about reforms to the Medicaid program will have a bigger negative impact on immigrant populations and communities of color.
What can you do in response?
1. Make your voice heard! The Medicaid Redesign Team is hosting a series of public hearings across the state, including two in New York City on Thursday, January 27th. The focus of the hearings is to solicit input on how to achieve savings in the Medicaid program. Consumer advocates and allies must be out in full force at both of these hearings to provide testimony about how savings can be achieved without breaking the backs of low-income New Yorkers who depend on Medicaid for critical health benefits. Click here for more information about time & location for these hearings.
2. Join the campaign! The Save Our Safety Net-Coalition (SOS-C) is mobilizing to keep the voices of consumers and labor front-and-center during the redesign process. If you would like to get involved or simply keep informed about what is happening, please contact the Commission on the Public’s Health System at 212-246-0803 or email email@example.com.
3. Spread the word! Please tell your friends, colleagues and fellow fighters about the upcoming public hearings, encourage them to attend and provide testimony, and urge them to join SOS-C. Important public policy decisions should not be made without the active involvement of the people most impacted. Click here to download a flyer about the Medicaid Redesign Team hearings to share with your networks.
We look forward to working with all of you to ensure that New York’s Medicaid reform is humane, just and participatory.
Saturday morning, April 17th, the auditorium of Junior High School 22 in the Bronx was crowded with community residents who had gathered for a town hall meeting. Health care reform had passed, but these folks knew that their problems were not over. Ensuring that most Americans have health insurance, while important, will not be enough to eliminate the racial and ethnic disparities that have been dyed deep into the U.S. healthcare system and that reveal themselves, vividly, in the Bronx.
To save black and brown lives and to improve the vibrancy of those lives requires looking beyond access and focusing on quality. It requires, among other things, an examination of the practices of major health care institutions, which deny low-income people of color the highest quality of care they have to offer even when those people have health insurance.
The specific issue that community members had gathered about is this: in New York City, prominent private hospitals–facilities like New York-Presbyterian, Montefiore Medical Center, Mount Sinai–operate two different systems of care for patients with the same kinds of health problems but with different types of insurance. There are, for example, cardiology “clinics” for patients with Medicaid, a public insurance program, and there are cardiology “faculty practices” for patients with private insurance. Sometimes the clinics are right next door to the faculty practices, but Medicaid patients won’t be allowed into the faculty practices, and privately insured patients are not sent to the clinics.
What is more, the hospitals allow valuable and finite resources to be allocated unequally between the two systems of care. For instance, clinics often do not have enough financial support from the hospital to perform basic care coordination tasks like sending notes back to the patient’s primary care physicians, while faculty practices often receive administrative and other forms of support so that such tasks are routinely able to be done.
More significantly, board certified faculty physicians, the top docs, spend only a fraction of their time in the clinics–a mere half a day a week for four months out of the year in one case–even though they are required by law to spend the bulk of their time supervising resident doctors and caring for patients in the clinic setting instead of in the faculty practice. Hospitals do nothing to shift the balance and, as a result, Medicaid patients do not have a single, board-certified physician who is ultimately responsible for their care, whereas privately insured patients do. Here is a chart summarizing some of the main inequalities:
The impact of these differences are felt on the bodies and backs of low-income patients. At the town hall meeting, Medicaid beneficiaries spoke of being bounced from one doctor-in-training to the next within a fragmented clinic system, where fingers and toes were almost amputated and cancer remained undiagnosed until dangerously late. And they spoke of how these outcomes were not race neutral. In New York, people of color are far more likely to have public insurance than whites, which means that when hospitals create two systems of care based on insurance they are also perpetuating a de facto segregation based on race. (For more background and helpful stats on this issue, please see this excellent monograph on medical apartheid in New York City by the Bronx Health REACH coalition, the group that first brought this problem to light.)
Representatives of health care institutions have argued publicly that community residents are missing the point. The source of the problem, they claim, is with the Medicaid program and not with the hospitals. Doctors’ offices are reimbursed at extremely low rates through Medicaid and therefore can’t afford to see publicly insured patients in their faculty practices. The clinics have been set up to provide an avenue for care that otherwise wouldn’t exist.
But it is the hospital representatives who are missing the point. The provision of care to Medicaid patients is not something hospitals are choosing to do out of the goodness of their hearts. Under federal law, hospitals are required to open their doors to Medicaid beneficiaries, and provide them care without discrimination, in exchange for accepting millions of dollars of government funding to modernize and upgrade their facilities.
Moreover, while Medicaid reimbursement rates for doctors’ offices are very low, they are much higher for clinic-based services. In order to integrate care, hospitals could simply shift their resources to the clinic and ensure that all patients, public and private alike, are seen in that setting, instead of siphoning off the privately insured patients to the faculty practices. The increased resources and mixed patient population would help ensure that the quality of clinic care would improve dramatically and that this high-quality care would be accessible to all on equal terms.
Of course, hospitals are choosing not to do this and, given the dubiousness of the financial arguments, one is left to presume that their motives are more suspect: one cannot attract wealthy, white patients from the Upper East Side and Westchester if those individuals will have to sit in the same waiting room as people of a different class or race. The fight to integrate our health care system and to reduce racial and ethnic health disparities is therefore going to be just as messy as the historic battles to integrate our educational system or our housing. But fight is what Bronx residents will do, even in the face of uncertainty and resistance. As one faith leader said at the town hall meeting, quoting a song from the civil rights movement of deep South, we must “run on and see where it ends.”
By, Nisha Agarwal, Director of the NYLPI Health Justice Program.
Right now, five hundred thousand immigrants and their allies are rallying in Washington, DC, having traveled from across the country in caravans of buses to demand humane and just immigration reform. Also right now, the votes are being tallied and negotiated on the most comprehensive health reform package in two decades. For those of us who aren’t in DC ourselves, Twitter tracks the movement on the ground for the immigration march:
From @thenyic: ‘Senator Schumer on conference call with 220 buses (11000 people!) heading from NY to DC for the March for… http://fb.me/vlRfj4w5
Meanwhile, email lists and blogs are active, urging last minute phone calls and petition signatures to get Democrats to vote with their hearts on health care reform, and not from their fear.
Every day I work at this meeting point between immigrant rights and health equity, but it is not every day that I can see these issues reverberate on a national scale. Today, however, they echo and re-echo, and I listen in awe and gratitude to my fellow activists and allies. This is a progressive moment, and it is because we have made it one. In all the bickering about the details of the legislative packages and the concern about the eventual outcome of HCR and CIR—important arguments and worries to have—we shouldn’t forget what has already been accomplished: Both the push for health care reform, which is nearing its end, and the fight for immigration reform, which is just beginning, are strong, durable movements that progressives have built, with massive ground operations and multiple, coordinated perspectives tightly networked through cyber-space. We have shown that power can be built from the ground up, even in the wake of decades of reactionary national government and the collapse of the global economy, and in the face of a deep blue hate. I am optimistic that we will win health care and immigration reform, and I am proud of the structures we have created to do so. We here at NYLPI’s Health Justice Program are in full solidarity with all of our friends in DC right now. Si se puede. Hal soo it dah. Yes we can.
This post is by Equal Justice Works Fellow Seth Cohen, an attorney at New York Lawyers for the Public Interest (NYLPI). Seth’s EJW Fellowship is sponsored by Johnson & Johnson and Patterson Belknap Webb & Tyler LLP.
As we have written about in previous posts, Southeast Queens is a low-income community of color that has long experienced some of the worst health outcomes in New York City across a variety of measures. Despite this, and despite the fact that this community—long designated a Medically Underserved Area—has experienced a continuing trend of healthcare disinvestment. Consider this: over the past year, three hospitals that served Southeast Queens have closed; there are only 48 full-time primary care doctors per 100,000 people in Southeast Queens, almost 2/3 less than in whiter neighborhoods in Queens. All the while, Southeast Queens has the unenviable distinction of having abysmal health outcomes, including some of highest rates of infant mortality, low birth weight, and diabetes in the City.
One might think that the New York State Department of Health (DOH), the state government entity that handles all things health, would move quickly to shore up health services in a community with such a critical shortage of services and such a critical need for them. To its credit, DOH awarded $30 million in HEAL NY grants to spur healthcare services development borough-wide. Southeast Queens United in Support of Healthcare (SQUISH), a community-led coalition, advocated for allocating part of those funds toward fundamental healthcare services that Southeast Queens needs most: primary care; emergency care; and inpatient beds. The DOH grant disbursements signaled a first step—over $5 million was awarded to two community health centers that serve Southeast Queens.
Nevertheless, the grants did little to directly address the community’s most critical needs. For an area that has seen a disproportionate share of hospital and clinic closures in the borough, Southeast Queens simply did not receive funding proportionate to the critical need and unacceptable health outcomes the community faces. Indeed, it ultimately received the least amount of HEAL funding as compared to other areas in Queens.
Part of the difficulty for Southeast Queens—or any low-income community of color in New York, for that matter—is the fact that New York lacks any meaningful, structured way for people who live in the community and who use healthcare services there to provide ground-level input to DOH as to what they see as the most pressing health concerns, and how to best address those concerns. As it currently stands, DOH seems to turn a blind eye to the very individuals who actually utilize healthcare services. This perspective, though, is questionable at best, and will certainly not lead to a reduction of health inequities any time soon.
According to the National Partnership for Action to End Health Disparities, an initiative launched by the United States Department of Health and Human Services, such ground-level input is essential to eradicate health disparities. Three of the primary actions the Partnership calls for include:
- Create opportunities to engage stakeholders from all sectors in discussions and actions to ensure community responsiveness and accountability toward ending existing health disparities;
- Create mechanisms for individuals (e.g., residents, advocates) who have been affected by, or concerned with, health disparities to share their stories with the public and decision makers at all levels
- Develop or support efforts to educate legislators and elected officials about health disparities and the determinants of health
Notwithstanding these recommendations, DOH has continued to take a hands-off stance, maintaining that it is merely a “neutral” government entity unable to actively engage in or commit to correcting the systemic health inequities that persist in the community. As dispassionate and impervious as this may sound, DOH has indicated, however, that it was up to community residents to work with elected officials and other stakeholders to locate and negotiate with healthcare providers who would be willing to serve the community. Only then might DOH get involved.
So, this is exactly what SQUISH has started to do.
SQUISH has initiated conversations with Addabbo Family Health Care to prepare for leveraging any future federal dollars from healthcare reform to bring additional Federally Qualified Health Clinics (that serve predominantly Medically Underserved Areas like Southeast Queens) to the neighborhood.
SQUISH also recently met with elected officials—including Assembly Members William Scarborough, Michelle Titus, Barbara Clark, and New York City Council Member Leroy Comrie—to begin to hammer out a plan to effectively address healthcare needs in the near-term and also to craft a long-term plan to ensure quality healthcare delivery in Southeast Queens.
There is also the matter of figuring out how to influence next steps at the site of Mary Immaculate Hospital, the now-defunct hospital in Jamaica that went bankrupt and shuttered its doors approximately one year ago. The current owners of the site have indicated they “envision several options for redeveloping the Mary Immaculate site, including an educational facility, nonprofit organization use, government operations or a religious facility.” No doubt you can see what redevelopment option is curiously absent from this list: reusing the site to provide health services to the community. While reopening a hospital may prove a challenging enterprise, it is not unheard of. The communities of Watts and Willowbrook, low-income communities of color in Los Angeles, California that are similarly medically underserved, were recently successful in forging a pact with various stakeholders to reopen their community hospital, the King/Drew Medical Center, using federal stimulus funds. As put by one community resident affected by the lack of local healthcare services put it,
“The fact that we are in the richest and most affluent society in the world yet don’t have health and medical infrastructures in key urban cities to take care of potentially life-threatening situations is the reason we should have hospitals in communities, particularly underserved communities with large populations of uninsured.”
Three thousand miles from Watts, this sentiment is equally applicable in Southeast Queens as SQUISH continues to advocate for healthcare for its community.
Below is an email about federal health reform circulated to the comm-org listserv by Peter Dreier, a very thoughtful scholar of urban inequality and community organizing, that is right on as far as our mission as progressive health advocates is concerned. Please share this with your networks and do all you can in the coming weeks and months to ensure that we see meaningful health reform in the country and in our communities.
Friends and Colleagues:
I’ve posted this column, Go Out and Make Me Do It, on Huffington Post last night. It is an analysis of Obama’s speech on health insurance reform. I said it was a call to action, emphasizing that he opened the door for activists to mount a ground war to take on the insurance industry and push Congress — especially the handful of recalcitrant Democrats — to support a public option. The title is one of my favorite political quotes: FDR’s request, said to activists who lobbied him to be bold, to go out and make me do it.
Here’s the link to the article:
Also, here’s an op-ed column that Marshall Ganz and I wrote for the Washington Post two Sundays ago: We Have the Hope. Now Where’s the Audacity??
You will probably get lots of emails in the next few days from various organizations urging you to contact your Senators and Congressmembers, support organizations mobilizing people to push for reform, and spread the word among your friends and other contacts.
I encourage you to ramp up your activity in the next few weeks and months.
A great source of information about the grassroots campaign for health care is the website of Health Care for America Now (HCAN), the key coalition spearheading the organizing work. http://healthcareforamericanow.org. They will be looking for people to join the effort in many ways, from donating money, to contact Congress, to participating in rallies and vigils.
Please do what you can. We have an historic opportunity to bring about progressive change and make decent, affordable health insurance a right, not a privilege.
A recent article in the American Prospect about the De-Facto Segregation of Health Care has been getting a lot of attention, at least in the media that we read, and for good reason. It points out the uncomfortable truth that race matters in health care, which means, in part, that place matters too. As the article notes:
Ongoing de-facto segregation has a profound effect on the quality of care to which people of color — insured or otherwise — have access. While the health-care bills being debated in Congress would expand access to and quality of care for people of color, ultimately racial health disparities can’t be eliminated without better distribution of health resources.
This is a slice of Queens that represents the dividing line between the Northwest and the Southeast of the borough. The darker an area is shaded, the higher the percentage of people of color living in that area. De-facto segregation, anyone? Now check out those little plus signs, which represent hospitals. Notice how few–i.e. none–of them are actually located in the darker-shaded portion of the map. And, in fact, one of the hospitals right on the border recently closed — a common occurrence in communities of color across the country.
Now compare the availability of hospitals and the demographics on the Southeast side of Queens to the east side of Manhattan:
The absence of hospitals in Southeast Queens, and their over-abundance in white communities of the city, would be less of a problem if people in the area could actually access the primary or preventative care they need to prevent hospitalizations and trips to the emergency room. But, of course, the lack of hospitals isn’t the whole story. The New York State Department of Health recently issued a report on health care services in Queens, which notes that Southeast Queens has the lowest ratio of doctors to population in the entire borough. There are 48 full-time equivalent (FTE) primary care doctors per 100,000 population in Southeast Queens compared to 132 FTE’s per 100,000 in the Flushing/Clearview area. This report also indicates that there are 75 primary care clinics in Queens, but of the 75 clinics listed only 40 could be confirmed as primary care clinics available to members of the community at large. Several of the clinics are for special populations only (e.g. children, women), and of the remaining 40 primary care clinics, only 22 are located in Southern Queens.
Pointing out geographic and resource disparities like this isn’t just a complaint about who-gets-what; it is a matter of life and death for many. As the American Prospect piece notes:
Even when people of color are covered [by insurance], their access to quality care is diminished heavily by ongoing segregation and poverty; in nonwhite neighborhoods, it’s simply harder to find a primary provider than it is in white neighborhoods. The facilities that exist are often of lower quality and lack the resources institutions located in primarily white areas have. What this means is that even when minorities are covered by health insurance, they’re less likely to have quality care and less able to afford the associated out-of-pocket expenses — and the results are staggering. Children born to black women are more than twice as likely to die within their first year of life as are children born to white women. This disparity is unaffected by income or education level.
So, what can be done? Well, many things, but in Southeast Queens the most immediate action is being taken by a community coalition we work with called Southeast Queens United in Support of Health Care (SQUISH). When the State Department of Health published its report, it also announced that $30 million would be available in grants to develop health care services in the borough. SQUISH is reaching out to elected officials, community residents, local health care providers and the media to raise awareness about the need for some of that funding to be directed toward Southeast Queens. For a list of SQUISH’s asks, check out their talking points. Because green shouldn’t always follow white, and where you live shouldn’t be one of the primary determinants for how soon you die.
Yesterday afternoon, 3,000 New York City residents gathered to show their support for federal health reform and, in particular, the need for a public option. Here are some of the images we were able to capture from the day.
Raucous right-wing outbursts against health reform have been garnering a lot of attention lately, including within community organizing fora such as comm-org, whose editor recently asked: “Are right wing groups really building grass roots organizations and engaging in strategic actions? Or is this just right-wing-media-generated frenzy without any real organizing going on?” According to one thoughtful response:
“People misunderstand Alinsky’s tactics and what community organizing is about. It is NOT about being disruptive; it is about helping poor people and disenfranchised people find their voice and carve out their own platform for expression. It IS about helping people empower themselves; bringing the oppressed together to stop oppressing each other and to identify the real oppressors; and taking collective action to make a positive difference.”
Indeed, community organizing is not about hate — not about the kind of unrighteous indignation that prompted one anti-health reform protester in New Hampshire to bellow: “We don’t need illegals. Send ‘em all back. Send ‘em back with a bullet in the head the second time.” And hate there is in abundance at these town hall meetings, carefully crafted hate designed to shore up political fear and laziness. It is notable, for instance, that even the inclusion of legal immigrants in health care reform is considered too hot to touch by most federal legislators, though there are plenty of reasons to believe that doing so will only help everyone.
Those of us in New York may be tempted to hear-no-evil and see-no-evil when it comes to the place of immigrants in health care reform because legal immigrants, at least, are eligible for public health insurance and other benefits under our state law, so the decisions regarding immigrant inclusion made at the federal level may have little practical relevance for folks living here. (This is due to a lawsuit that was filed by several public interest legal organizations in New York City in the late-1990s, which resulted in the state’s highest court declaring that “care for the needy is not a matter of legislative grace; it is a constitutional mandate.”) But the kind of hate-mongering that has infected the public conversation on health policy is an affront to the low-income communities of color and immigrant communities that we represent, and to the kind of authentic and inclusive grassroots organizing for health justice that we embrace. We have a responsibility to offer an alternative frame to the debates, one centered on concepts of fairness, commitment, common sense and public welfare. (Click here for a set of resources from our friends at the National Immigration Law Center.) And we have the duty to inform others–our friends, family and neighbors–that true community organizing is not what they are seeing and reading about in these town hall meetings . Real organizing is about solidarity and social justice, not about divisiveness and disruption. Real organizing is what we can all do in response to the angry few.