Budget Cuts Bleed in Black and Brown

For the last year and a half, every American paper, news broadcast and radio station has been talking about “budget cuts,” the “financial crisis” and the “recession.” Americans are constantly inundated with these reports, often to the point of over saturation and desensitization. Just this week, for example, we learned about $775 million in cuts to New York State’s health budget. It’s easy in this flurry of information to lose track of what some this financial neglect will mean to New York residents, the actual people who utilize government-supported services simply so they can survive and function in this society. But, of course, budget cuts bleed through real people, and the impact is never race neutral.

Take, for example, the Health and Hospital Corporation (HHC), the public hospital system in New York City, which faces a devastating $1 billion shortfall this year between its costs and expected revenue.  HHC is the quintessential safety net provider: committed to delivering high-quality health care to low-income communities of color and immigrants, when many private hospitals devise subtle and not-so-subtle strategies to drive these patients away.  Last year, HHC had an astonishing 5 million outpatient visits.  That is over half of all New York City clinic visits and 66% of New York City’s overall uninsured patient clinic visits.

Not only did HHC serve a disproportionately large share of uninsured New Yorkers, but it did so in a high-quality and cost efficient manner. For instance, HHC has been groundbreaking in their methods for treating heart disease and diabetes, two of the most common diseases among people with low-incomes. They have also integrated their Electronic Medical Records system to prevent duplication and mistakes in treatment, all the while spending significantly less in administrative costs than New York’s private hospitals.

Meanwhile, many of New York City’s private hospitals funnel low-income patients of color into segregated and inferior care settings, or they refuse to treat them at all until advocates like us campaign for them to be more inclusive.

Given this context, which health care providers seem more worth of government support when times get tough?  We believe the answer is clear: state dollars should bolster providers who are open and accessible to all, and should not shore up institutions that chose to discriminate.  Unfortunately, the decisionmakers up in Albany don’t seem to agree.

One of the more shocking aspects of health care funding in New York State is that the over $1 billion in government charity care funding is not distributed based on whether hospitals actually provide any care for the uninsured.  Instead, New York uses an archaic accounting methodology in which many private hospitals that do not provide a lot of charity care nevertheless get an unfair share of the state’s charity care dollars.  (For more on this troubling reality, please read this helpful report by the Commission on the Public’s Health System (CPHS), a sister advocacy organization.)  The recently enacted health budget does nothing to change this dynamic and, what is more, it actually creates a new supplemental pool of money–$235 million—for private hospitals without asking enough from these hospitals in terms of providing care for low-income patients.  Who loses out in this elaborate shell game?  Public hospitals and the low-income communities of color and immigrants who rely on them. 

As we grapple with the financial crisis, the value of HHC hospitals and clinics cannot be underestimated or ignored. If it is, New Yorkers face devastating repercussions by way of overcrowded emergency rooms, increased hospital costs, and even fewer services for the already neglected immigrant and uninsured population. HHC services are valuable and effective—they are services the State might claim it cannot afford to prioritize but ones the people certainly cannot afford to lose.

In Victory for Low-Income New Yorkers, NYU Child Study Center Opens Door to Medicaid Patients

Below is a press release we just issued, announcing a major campaign victory!

FOR IMMEDIATE RELEASE

After advocacy groups’ campaign on behalf of parents of kids with special needs, NYU designates providers who will accept Medicaid and,Child Health Plus

New York, NY, June 1, 2010 – New York Lawyers for the Public Interest (NYLPI), a civil rights law firm whose practice includes health justice and disability rights, along with co-counsel, Cleary Gottlieb Steen & Hamilton LLP and LatinoJustice/PRLDEF, announced today that they successfully campaigned for the Child Study Center of the New York University Medical Center to designate certain doctors who will accept Medicaid and other health insurance. Previously, NYU’s Child Study Center had a cash-only policy for patients, which meant that they did not accept any insurance at all.

As part of the advocacy campaign, which included threats of litigation, a group of parents represented by NYLPI and co-counsel met with NYU leadership and explained how the cash only policy impacted them and the thousands of other families who were unable to access the Center’s state-of-the-art evaluations and medical services for children with disabilities. These services are in extremely short supply across New York City, and without access to the facility at NYU’s Child Study Center, many low-income and minority children were unable to obtain the medical attention they needed.

“NYU has taken a step in the right direction towards eradicating a few of the many institutional barriers keeping low-income New Yorkers from accessing quality health care,” said Nisha Agarwal, director of NYLPI’s Health Justice program. “We still have a long way to go to ensure that all children, regardless of their financial circumstance or background, have equal access to high-quality mental and behavioral health services, but this is one step forward.”

As a result of NYLPI’s action, the Child Study Center has announced that it will designate certain providers who will begin accepting fee-for-service Medicaid and Child Health Plus. Before this change, children and their parents who could not afford to pay cash for evaluations and medical services often went without necessary and recommended medical treatment for serious illnesses.

According to Lorraine Ali, “No mother wants to be told she can’t provide her child with the medical attention he needs. Now I can finally get my son to a doctor who can treat him. It’s the best news we’ve gotten in a long time.”

Although NYU’s Child Study Center has agreed to take the important step of accepting fee-for-service Medicaid and Child Health Plus, it does not have plans to accept any Medicaid managed care plans.  “There continues to be an acute shortage of evaluative and medical services for children with psychiatric disabilities in New York City,” said Kelly McAnnany, director of the Opportunity & Access Program at NYLPI.  “We will continue to work with providers and with state agencies to open the doors to quality health care and educational opportunity for low-income children with disabilities.”