Here is our op-ed on the Medicaid Redesign Team that ran in today’s Albany Times Union. Comments most welcome!
By Nisha Agarwal and Shena Elrington
Gov. Andrew Cuomo‘s Medicaid Redesign Team was handpicked by him and elected by no one. Though touted as a collection of health care “experts,” the majority of the team’s members have strong ties to special interests in the health care industry.
Not surprisingly, its proposals for cuts reflect the vested interests of its members.
Proposal 67 calls for the closing or downsizing of safety net hospitals that provide health care services in medically under-served areas. We need more health services in these communities, not less, particularly since these communities have been ravaged by hospital closures in recent years.
Central Brooklyn, with its extremely low-income and 90 percent black and Latino population, has lost two hospitals, OB-GYN and prenatal services at two other local hospitals, 13 outpatient clinics, a federally funded health center and at least two women, infants and children program centers that provide nutrition education and assistance in recent years, despite having some of the worst health outcomes in the city.
The infant mortality rate in the Brownsville section of central Brooklyn is nearly five times that of Manhattan’s Upper East Side.
Do we really need more hospitals in areas like central Brooklyn to close?
When safety net hospitals close, people are forced to travel farther to see care at the few institutions that remain open — usually elite private academic teaching centers. These are the very same institutions to which many of the Medicaid team’s members have strong connections, raising questions about the appropriateness of using the regulatory process to funnel business to special-interest groups.
What is more, proposals that would actually support safety net institutions and use public dollars in an accountable and transparent way never made it into the final Medicaid reform package.
Proposal 66, for example, would have recalibrated charity care and Medicaid dollars so that the distribution of that funding would be based on the actual Medicaid and uninsured losses. Hospitals in New York now receive “indigent care” funding regardless of the volume of care they actually provide to Medicaid and uninsured patients. So, hospitals that provide very little care to low-income New Yorkers often get more money from the indigent care pool than they deserve, while safety net institutions, which provide a lot of care to Medicaid and uninsured patients, do not get their fair share.
Recalibrating the way this funding is distributed would not only make sense and bolster the financial stability of critical safety net institutions. It also is required under federal health reform and was very favorably ranked through the Medicaid Redesign Team’s own scoring process. Yet, the proposal never made it into the team’s final recommendations.
New York is in the midst of an epic budget crisis. Medicaid is seen as the linchpin to solving that crisis. But its redesign should not be done in such a way as to threaten the very institutions that serve as a safety net for our state’s most vulnerable residents. The erosion of our health care safety net threatens the stability of the system for all of us.