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.

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Filed under health disparities, legislation, news, people of color, Uncategorized

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